Backup Documents 09/24/2024 Item #16F 7 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 F 7
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2.
3. County Attorney Office County Attorney Office 64 /1</'4. BCC Office Board of County ` �
Commissioners 6.1 tfds 1)01 y
5. Minutes and Records Clerk of Court's Office Qa
PRIMARY CONTACT INFORMATION 7 ( 7
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees
above,may need to contact staff for additional or missing information.
Name of Primary Staff Cherie DuBock/EMS Phone Number 239-252-3756
Contact/ Department
Agenda Date Item was 9/24/2024 Agenda Item Number 16.F.7
Approved by the BCC
Type of Document State of FL LOA and n Resoluti A Number of Original 2
Attached a O 4" 1 i 4 Documents Attached
PO number or account
number if document is � q
to be recorded P1ecse C r c ( 1'W ft P
C her, e . dv bact< p to Ili trco ) #%(f I . , o V
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? CD
2. Does the document need to be sent to another agency for additional signatures? If yes, CD
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the
document or the foal negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's CD
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 5(2`I and all changes made _
during the meeting have been incorporated in the attached document. The County
Attorney's Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the
BCC,all changes directed by the BCC have been made, and the document is ready for the 1
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
16F7
RESOLUTION NO. 2024-17 6
RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF
COLLIER COUNTY, FLORIDA,TO AUTHORIZE COLLIER COUNTY
EMS TO PARTICIPATE IN INTERGOVERNMENTAL TRANSFERS
WITH THE STATE OF FLORIDA AGENCY FOR HEALTH CARE
ADMINISTRATION AND THE SUPPLEMENTAL PAYMENT
PROGRAM FOR MEDICAID MANAGED CARE PATIENTS;
AUTHORIZING THE CHAIRMAN TO EXECUTE ALL REQUIRED
AGREEMENTS OR DOCUMENTS TO PARTICIPATE IN
INTERGOVERNMENTAL TRANSFERS AND THE SUPPLEMNTAL
PAYMENT PROGRAM FOR MEDICAID MANAGED CARE
PATIENTS SUBJECT TO BOARD RATIFICATION.
WHEREAS, Collier County provides emergency ambulance transportation services
throughout Collier County; and
WHEREAS, the State of Florida has created a supplemental payment program for
Medicaid managed care patients who are transported to the hospital by public emergency
medical transportation providers and has appropriated an additional $54 million for this
program; and
WHEREAS, Collier County EMS transports more than 1,500 Medicaid managed care
patients annually to hospitals and receives approximately $163 per patient for this service; and
WHEREAS, by participating in the supplemental payment program for Medicaid
managed care patients, Collier County EMS can substantially increase its Medicaid managed
care patient transport revenue and provide better services to the community,
NOW THEREFORE, IT IS RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA, that:
1. Authorizes Collier County EMS to participate in intergovernmental transfers
with the State of Florida Agency Health Care Administration and the supplemental payment
program for Medicaid managed care patients.
2. Authorizes the Collier County Chairman to execute any and all agreements or
documents necessary for Collier County EMS to participate in intergovernmental transfers or
the Medicaid managed care supplemental payment program subject to ratification by this Board.
GPO
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This Resolution adopted2 on this
t day of September 2024, after
motion, second and majority vote.
ATTEST;"A ". � `4^ BOARD OF COUNTY COMMISSIONERS
CRYS1AL ZI L, Clerk of the OF COLLIER COUNTY, FLORIDA
Circuit' o ptroller
�®�// :'�i►:.� By:
A " airma, ` Chri all, Chairman
. atUtO only
Approv s to form and legality:
Sal . Ashk N
sistant County Attorney v
0�\`51
Gp,O
16F7
Public Emergency Medical Transportation Letter of Agreement
THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the 2`l'31
day of Sept 2024, by and between Collier County (the "IGT Provider") on behalf of Collier
County EMS, and the State of Florida, Agency for Health Care Administration (the
"Agency"), for good and valuable consideration, the receipt and sufficiency of which is
acknowledged.
DEFINITIONS
"Intergovernmental Transfers (IGTs)" means transfers of funds from a non-Medicaid
governmental entity (e.g., counties, hospital taxing districts, providers operated by state or local
government) to the Medicaid agency. IGTs must be compliant with 42 CFR Part 433 Subpart B.
"Medicaid" means the medical assistance program authorized by Title XIX of the Social Security
Act, 42 US.C. §§ 1396 et seq., and regulations thereunder, as administered in Florida by the
Agency.
"Public Emergency Medical Transportation (PEMT)," pursuant to the General Appropriation Act,
Laws of Florida 2024-231 is the program that provides supplemental payments for eligible Public
Emergency Medical Transportation (PEMT) entities that meet specified requirements and provide
emergency medical transportation services to Medicaid beneficiaries.
A. GENERAL PROVISIONS
1. Per House Bill 5001, the General Appropriations Act of State Fiscal Year 2024-2025,
passed by the 2024 Florida Legislature, the IGT Provider and the Agency agree that the
IGT Provider will remit IGT funds to the Agency in an amount not to exceed the total of
$800,219.65.The IGT Provider and the Agency have agreed that these IGT funds will only
be used for the PEMT program.
2. The IGT Provider will return the signed LOA to the Agency.
3. The IGT Provider will pay IGT funds to the Agency in an amount not to exceed the total
of$800,219.65. The IGT Provider will transfer payments to the Agency in the following
manner:
a. Per Florida Statute 409.908, annual payments for the months of July 2024
through June 2025 are due to the Agency no later than October 31, 2024, unless
an alternative plan is specifically approved by the agency.
b. The Agency will bill the IGT Provider when payment is due.
4. The IGT Provider and the Agency agree that the Agency will maintain necessary records
and supporting documentation applicable to health services covered by this LOA in
accordance with public records laws and established retention schedules.
a. AUDITS AND RECORDS
Collier County_Collier County EMS_PEM LOA_SFY 2024-25
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i. The IGT Provider agrees to maintain books, records, and documents (including
electronic storage media) pertinent to performance under this LOA in accordance
with generally accepted accounting procedures and practices, which sufficiently
and properly reflect all revenues and expenditures of funds provided.
ii. The IGT Provider agrees to assure that these records shall be subject at all
reasonable times to inspection, review, or audit by state personnel and other
personnel duly authorized by the Agency, as well as by federal personnel.
iii. The IGT Provider agrees to comply with public record laws as outlined in section
119.0701, Florida Statutes.
b. RETENTION OF RECORDS
i. The IGT Provider agrees to retain all financial records, supporting documents,
statistical records, and any other documents (including electronic storage media)
pertinent to performance under this LOA for a period of six (6) years after
termination of this LOA, or if an audit has been initiated and audit findings have not
been resolved at the end of six (6) years, the records shall be retained until
resolution of the audit findings.
ii. Persons duly authorized by the Agency and federal auditors shall have full access
to and the right to examine any of said records and documents.
iii. The rights of access in this section must not be limited to the required retention
period but shal last as long as the records are retained.
c. MONITORING
i. The IGT Provider agrees to permit persons duly authorized by the Agency to inspect
any records, papers, and documents of the IGT Provider which are relevant to this
LOA.
d. ASSIGNMENT AND SUBCONTRACTS
i. The IGT Provider agrees to neither assign the responsibility of this LOA to another
party nor subcontract for any of the work contemplated under this LOA without prior
written approval of the Agency. No such approval by the Agency of any assignment
or subcontract shall be deemed in any event or in any manner to provide for the
incurrence of any obligation of the Agency in addition to the total dollar amount
agreed upon in this LOA. All such assignments or subcontracts shall be subject to
the conditions of this LOA and to any conditions of approval that the Agency shall
deem necessary.
5. This LOA may only be amended upon written agreement signed by both parties.
The IGT Provider and the Agency agree that any modifications to this LOA shall be in the
same form, namely the exchange of signed copies of a revised LOA.
6. The IGT Provider confirms that there are no pre-arranged agreements (contractual or
otherwise) between the respective counties, taxing districts, and/or the providers to re-
Collier County_Collier County EMS_PEM LOA_SFY 2024-25
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I6F7
direct any portion of these aforementioned supplemental payments in order to satisfy non-
Medicaid, non-uninsured, and non-underinsured activities.
7. The IGT Provider agrees the following provision shall be included in any agreements
between IGT Provider and local providers where IGT funding is provided pursuant to this
LOA. Funding provided in this agreement shall be prioritized so that designated IGT
funding shall first be used to fund the Medicaid program and used secondarily for other
purposes.
8. This LOA covers the period of July 1, 2024, through June 30, 2025, and shall be
terminated September 30, 2025, which includes the state's certified forward period.
9. This LOA may be executed in multiple counterparts, each of which shall constitute an
original, and each of which shall be fully binding on any party signing at least one
counterpart.
PEMT Local Intergovernmental Transfers
Program I Amount State Fiscal Year 2024-2025
Estimated IGTs $800,219.65
Total Funding Not to Exceed $800,219.65
IN WITNESS WHEREOF, the parties have caused this page Letter of Agreement to be
executed by their undersigned officials as duly authorized.
COLLIER COUNTY STATE OF FLORIDA,AGENCY FOR
HEALTH CARE ADMINISTRATION
SIGNEDOva(64 SIGNED
BY: BY:
NAME: Tom Wallace
Chris Hall, Chairman
TITLE: Deputy Secretary for Health Care
Finance and Data
DATE: 47/2Y/24/ DATE:
Approved as to form • legality
Assistant Co tto
1._4er d ci kk
.'Attest as.to,Ghairman's
Collier County_Collier County EMS_PEM LOA_SFY 2024-25 sirgnfure only
(CAO