Agenda 06/24/2025 Item #16D6 (Resolution for Continued Participation in Local Provider Participation Fund for Directed Payment and Graduate Medical Education Programs (1.74% Inpatient, 2.81% Outpatient Revenue Assessments))6/24/2025
Item # 16.D.6
ID# 2025-2030
Executive Summary
Recommendation to approve a Resolution to authorize continued participation in the Local Provider Participation Fund
for the Directed Payment Program and Graduate Medical Education Program, which will be solely funded by
assessments on Collier County hospital-owned property or property used as a hospital in an amount of 1.74% of net
inpatient revenue and 2.81% of net outpatient revenue.
OBJECTIVE: To enact a resolution in support of area hospitals that provide health services to the low-income citizens
of Collier County and provide training to medical professionals to advance Collier County’s strategic objective of
supporting access to health, wellness, and human services.
CONSIDERATIONS: The County has been a long-standing participant in the Florida Agency’s for Health Care
Administration (AHCA) Intergovernmental Transfer Program (IGT). A hospital focused program was established by the
Florida Legislature in FY21. To participate, counties assess hospitals and place funds into a Local Provider Participation
Fund (LPPF). Collier’s LPPF funds both the Directed Payment Program (DPP) and the Graduate Medical Education
Program (GME).
Nationwide, and especially in Florida, hospitals continue to struggle with the shortfall in Medicaid reimbursement rates.
Hospitals in Collier County provide millions of dollars of care to county residents who qualify for Medicaid annually.
As a direct result of continued revenue shortfalls created by the Medicaid reimbursement rates, during the FY21 Florida
Legislative session, Governor DeSantis, with the full support of the House and Senate, approved the establishment of the
DPP. This program is available to hospitals providing inpatient and outpatient services to Medicaid-managed care
enrollees. It is the intent of the DPP to offset hospitals’ Medicaid shortfalls and improve the quality of care provided to
the Florida Medicaid population.
On June 22, 2021, the Board adopted Ordinance 2021-23, enabling the County to levy a uniform non-ad valorem special
assessment, which is fairly and reasonably apportioned among the hospitals’ property interests within the County’s
jurisdictional limits, for the purpose of establishing and maintaining a system of funding for IGTs to support the non-
federal share of Medicaid payments. As a result, through the DPP, Collier allows its hospitals access to a pool of dollars
dedicated to one primary aim: increasing the rate of reimbursement for inpatient and outpatient Medicaid services while
improving quality. The result has been an increase in reimbursement up from 60 cents to about 80 cents per dollar of
cost.
On May 22, 2025, the United States House of Representatives adopted a budget bill, officially known as the “One Big
Beautiful Bill Act.” This bill includes several proposals that affect how states administer their Medicaid programs. Two
components have an immediate effect for Florida’s hospitals: a cap on the pool size for Florida’s DPP and a ‘freeze’ on
provider tax rates.
The One Big Beautiful Bill Act stops states from pursuing a pool size at average commercial rate if they have not
already done so by the Beautiful Bill’s adoption. As a result, Florida faces an ultimatum: either seek approval for the
higher pool size now or lose the option forever. Florida accepted the invitation. The state is now asking the federal
Centers for Medicare & Medicaid Services (CMS) for approval for a pool size that would allow Florida’s hospitals up to
about 80% of what commercial insurers would pay for the services that they render to patients on Medicaid. The state is
requiring hospitals to use their local assessments to put up the additional state-share dollars needed to bring in the new
federal match.
If the One Big Beautiful Bill Act is passed as is, the bill would freeze provider tax/assessment rates where they are at the
time of its adoption. Current federal law and regulations allow states to tax or assess up to 6% of the hospital net patient
revenues (as measured statewide, not jurisdiction by jurisdiction) to make up the state share of Medicaid funding. Given
the One Big Beautiful Bill’s ultimatum on pool size, Florida is now pursuing a higher reimbursement program. Florida
is calling on hospitals to fund the state share need. Absent any action, if the Beautiful Bill is adopted, Florida’s hospitals
would be forever locked in at the 3.5% rate. Florida’s hospitals would lose the opportunity to use their own dollars to
unlock available federal match for higher Medicaid reimbursement. To prevent this possibility, hospitals across Florida
are asking their local governments to step in and set a rate now that will forever preserve Florida’s ability to use hospital
dollars to unlock federal match. The goal is for all new rates to together approach the 6% statewide provider
tax/assessment target.
As such, hospitals are asking each local government in Florida to adopt a hospital assessment rate in June or early July
Page 2393 of 3580
6/24/2025
Item # 16.D.6
ID# 2025-2030
that places them where they need to be at the time of the freeze to maximize federal assistance. Adoption of this higher
rate ensures Florida’s hospitals will not lose their opportunity to benefit from available federal dollars. Staff has
addressed this with each hospital and they have stated they support higher assessments to draw down the federal match
as provided in federal regulations. The County will impose a non-ad valorem assessment upon real property owned or
used by the hospitals.
The proposed resolution will enable the County to levy a uniform non-ad valorem special assessment in compliance
with 42 C.F.R. 433.68(d). The assessment shall be fairly and reasonably apportioned among each of the hospital’s
properties within the County limits. Annually, the Board sets the assessment in amounts that in the aggregate will
generate sufficient revenue to fund the non-federal share of Medicaid payments associated with Local Services to be
funded by the assessment. The assessment shall constitute a lien upon the assessed properties. Revenue generated by the
proposed assessment shall be held in a separate account called the Local Provider Participation Fund (LPPF) and will be
used only to: (1) provide the Florida Agency for Health Care Administration the non-federal share for Medicaid
payments to be made directly or indirectly in support of hospitals serving Medicaid beneficiaries and (2) reimburse the
County for administrative costs associated with the implementation of the assessment authorized by the Ordinance, as
further specified in the resolution.
At the recommendation of the hospitals, the Local Provider Participation Fund Special assessment for FY 2025 will be
1.74% of net patient revenue and 2.81% of net outpatient revenue from participating hospitals. This, plus any
carryforward balance from prior LPPF special assessments, less $150,000 in administrative expenses, will be submitted
to AHCA. Budget Amendments will be presented to the Board in September along with the DPP and GME Letters of
Agreement between Collier County and AHCA permitting an IGT.
If at the end of the Fiscal Year, additional amounts remain in the LPPF, the Board is authorized to roll funds over to or
make a refund to assessed properties in proportion to amounts paid during the Fiscal Year.
Pursuant to section 197.3631, Florida Statutes, the alternative method of collection shall not require the tax collector or
property appraiser to perform those services as provided for in sections 197.3632 and 197.3635, Florida Statutes. If this
item is approved, the Tax Collector and Property Appraiser have no responsibilities under the alternative assessment
process that is proposed. Both offices have expressed that they have no objection to the County’s participation in the
program.
Advances Collier County’s strategic objective of supporting access to health, wellness, and human services.
FISCAL IMPACT: There is no fiscal impact at this time. Funding for LPPF is housed in the Local Provider
Participation Fund (1130); Cost Center 155941. A budget amendment will be prepared and submitted in September
with the DPP and GME Letters of Agreement between Collier County and AHCA.
GROWTH MANAGEMENT IMPACT: There is no Growth Management impact.
LEGAL CONSIDERATIONS: This item is approved as to form and legality and requires a majority vote for Board
action. -JAK
RECOMMENDATIONS: To approve a Resolution to authorize continued participation in the Local Provider
Participation Fund for the Directed Payment Program and Graduate Medical Education Program, which will be solely
funded by assessments on Collier County hospital-owned property or property used as a hospital in an amount of 1.74%
of net inpatient revenue and 2.81% of net outpatient revenue.
Page 2394 of 3580
6/24/2025
Item # 16.D.6
ID# 2025-2030
PREPARED BY: Carolyn Noble
ATTACHMENTS:
1. ordinance 2021-23
2. LPPF Resolution - Special Assessment CAO appvd 6.18.25
Page 2395 of 3580
ORDINANCE NO.2021- 9 3
AN ORDINANCE OF THE BOARD OF COUNTY COMMISSIONERS OF
COLLIER COUNTY,FLORIDA,TO BE CODIFIED IN CHAPTER 114 AS
ARTICLE VI OF THE COLLIER COUNTY CODE OF LAWS AND
ORDINANCES AUTHORIZING THE CREATION OF THE COLLIER
COUNTY LOCAL PROVIDER PARTICIPATION FUND ("FUND")
UNDER THE AUTHORITY OF SECTION 1(F), ARTICLE VIII OF THE
CONSTITUTION OF THE STATE OF FLORIDA SPECIFYING THE
METHOD OF SETTING AND COMPUTING ANNUAL NON-AD
VALOREM SPECIAL ASSESSMENTS TO BE DEPOSITED INTO THE
FUND AND SPECIFYING AUTHORIZED USES FOR THE FUND;
PROVIDING FOR CONFLICT AND SEVERABILITY; PROVIDING FOR
INCLUSION IN THE CODE OF LAWS AND ORDINANCES; AND
PROVIDING FOR AN EFFECTIVE DATE OF JULY 1, 2021 UNLESS
THE ENABLING LEGISLATION IS NOT APPROVED BY THE
GOVERNOR OF THE STATE OF FLORIDA.
RECITALS:
WHEREAS, the hospitals in Collier County's jurisdiction (the "Hospitals") annually
provide millions of dollars of uncompensated care to persons who qualify for Medicaid because
Medicaid,on average, covers only 60%of the costs of the health care services actually provided
by Hospitals to Medicaid eligible persons, leaving hospitals with significant uncompensated
costs("Medicaid shortfall");and
WHEREAS, the State of Florida(the"State")has received federal authority to establish
the Statewide Medicaid Managed Care hospital directed payment program (the"DPP") to offset
hospitals' Medicaid shortfall and improve quality of care provided to Florida's Medicaid
population;and
WHEREAS,impacted Hospitals have asked Collier County (the"County")to impose an
assessment upon certain real property owned by the Hospitals to help finance the non-federal
share of the State's Medicaid program; and
WHEREAS, the only properties to be assessed in these localities are the real property
sites of such Hospitals;and
WHEREAS, the County recognizes that one or more Hospitals within the County's
boundaries may be located upon real property leased from governmental entities and that such
Hospitals may be assessed because courts do not make distinctions on the application of special
assessments based on "property interests" but rather on the distinction of the classifications of
real property being assessed;and
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Page 2396 of 3580
WHEREAS, the funding raised by the County assessment will, through
intergovernmental transfers ("IGTs") provided consistent with federal guidelines, support
additional funding for Medicaid payments to Hospitals to address the Medicaid shortfall;and
WHEREAS, the County acknowledges that the Hospital properties assessed will benefit
directly and especially from the assessment as a result of the above-described additional funding
provided to said Hospitals;and
WHEREAS, the County has determined that a logical relationship exists between the
Medicaid services provided by the Hospitals,which will be supported by the assessment,and the
special and particular benefit to the real property of the Hospitals;and
WHEREAS, the County has an interest in promoting access to health care for its low-
income and under-insured residents;and
WHEREAS, leveraging additional federal support through the above-described IGTs to
fund payments to the Hospitals for health care services provided to Medicaid eligible persons
directly and specifically benefits the Hospitals' properties and supports their continued ability to
provide those services;and
WHEREAS, imposing an assessment limited to Hospital properties to help fund the
provision of Medicaid services and the achievement of certain quality standards by the Hospitals
to residents of the County is a valid public purpose that benefits the health, safety,and welfare of
the citizens of the County;and
WHEREAS, the assessment ensures the financial stability and viability of the Hospitals
providing Medicaid services;and
WHEREAS, the Hospitals are important contributors to the overall County's economy,
and the financial benefit to these Hospitals directly and specifically supports their mission, as
well as their ability to grow, expand, and maintain their facilities in concert with the population
growth in the jurisdiction of the County; and
WHEREAS,the County finds the assessment will enhance the Hospitals' ability to grow,
expand, maintain, improve and increase the value of their properties and facilities under all
present circumstances and those of the foreseeable future;and
WHEREAS, the County is proposing a properly apportioned assessment by which all
Hospitals will be assessed a uniform amount that is compliant with 42 C.F.R. §433.68(d);and
WHEREAS, the adoption of this Ordinance will enable the County to levy a uniform
non-ad valorem special assessment, which is fairly and reasonably apportioned among the
Hospitals' properties within the County's jurisdictional limits,to establish and maintain a system
of funding for IGTs to support the non-federal share of Medicaid payments that will directly and
specially benefit Hospital properties.
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WHEREAS, for the first year of the assessment the County finds that the alternative
method, as specified in § 197.3631, Fla. Stat., for the assessment and collection of the non-ad
valorem special assessment is appropriate but in future tax years may elect to use the uniform
method if approved by the Board.
NOW, THEREFORE, BE IT ORDAINED BY THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY,FLORIDA,that:
SECTION 1. Chapter 126 of the Collier County Code of Laws and Ordinances, is hereby
amended,by adding a new Article VI as follows:
Sec. 126-211. -Title
This Article VI shall be known and may be cited as the "Collier County Local Provider
Participation Fund Ordinance."
Sec. 126-212.-Authority.
Pursuant to Article VIII, Section 1(0 of the Constitution of the State of Florida and Florida
Statutes 125, the Board is hereby authorized to impose a special assessment against private for-
profit and not-for-profit hospitals located within the County to fund the non-federal share of
Medicaid payments associated with Local Services.
Sec. 126-213.-Purpose.
The non-ad valorem special assessment authorized by this Article shall be imposed, levied,
collected,and enforced against Assessed Properties located within the County.Proceeds from the
Assessment shall be used to benefit Assessed Properties through enhanced Medicaid payments
for Local Services. When imposed, the Assessment shall constitute a lien upon the Assessed
Properties equal in rank and dignity with the liens of all state,county,district,or municipal taxes
and other non-ad valorem assessments. Failure to pay may cause foreclosure proceedings, which
could result in loss of title, to commence. The Assessment shall be computed and assessed only
in the manner provided in this Ordinance.
Sec. 126-214. -Alternative Method.
This Ordinance shall be deemed to provide an additional and alternative method, as specified in
197.3631, Fla. Stat., for the assessment and collection of the non-ad valorem special
assessment described herein. The Ordinance shall be regarded as supplemental and additional to
powers conferred by other laws and shall not be regarded as in derogation of any powers now
existing or which may exist hereafter.This Ordinance,being necessary for the health,safety,and
welfare of the inhabitants of the County, shall be liberally construed to effect the purposes
hereof.
Sec. 126-215. -Definitions.
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Page 2398 of 3580
When used in this Ordinance, the following terms shall have the meanings below, unless the
context clearly requires otherwise:
Annual Final Assessment Resolution means the resolution described in Sections 126-224
and 126-225 hereof, which shall be the final proceeding for the imposition of an Assessment,
establishing the rate for the non-ad valorem assessment for a specific Fiscal Year.
Assessed Property means an Institutional Health Care Provider holding a right of
possession and right of use of real property in the County through an ownership or leasehold
interest,thus making the property subject to the Assessment.
Assessment means a non-ad valorem special assessment imposed by the County on
Institutional Health Care Providers located in the County limits to fund the non-federal share of
Medicaid and Medicaid managed care payments directed to hospitals providing Local Services in
the County.
Assessment Coordinator means the person appointed by the County Manager or designee
to administer the Assessment imposed pursuant to this Article,or such person's designee.
Assessment Resolution means the resolution described in Section 126-219 hereof.
Board means the Board of County Commissioners of Collier County,Florida.
County means Collier County,Florida.
Fiscal Year means the period commencing on October 1 of each year and continuing
through the next succeeding September 30, or such other period as may be prescribed by law as
the fiscal year for the County.
Institutional Health Care Provider means a private for-profit or not-for-profit hospital
that provides inpatient hospital services.
Local Services means the provision of inpatient and outpatient hospital services to
Medicaid,indigent,and uninsured members of the Collier County community.
Non Ad Valorem Assessment Roll means the special assessment roll prepared by the
County.
Ordinance means the Collier County Local Provider Participation Fund Ordinance as it
may be codified in Chapter 114 as Article VI in the Collier County Code of Laws and
Ordinances.
Tax Collector means the Collier County Tax Collector.
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Sec. 126-216.-Interpretation.
Unless the context indicates otherwise, the terms "hereof," "hereby," "herein," "hereto,"
hereunder"and similar terms refer to this Article.The term"hereafter"means after and the term
heretofore"means before the effective date of the Ordinance.
Sec. 126-217. -Assessment.
Pursuant to § 125.01, Fla. Stat., the Board is hereby authorized to create a non-ad valorem
special assessment that shall be imposed, levied, collected, and enforced against Assessed
Property to fund the non-federal share of Medicaid payments benefitting Assessed Properties
providing Local Services in the County. Funds generated as a result of the Assessment shall be
held in a separate account called the local provider participation fund and shall be available to be
used only to: (1) provide to the Florida Agency for Health Care Administration the non-federal
share for Medicaid payments to be made directly or indirectly in support of hospitals serving
Medicaid beneficiaries and (2)reimburse the County for administrative costs associated with the
implementation of the Assessment authorized by this Ordinance, as further specified in the
Assessment Resolution.
The Assessment will be broad based, and the amount of the Assessment must be uniformly
imposed on each Assessed Property. The Assessment may not hold harmless any Institutional
Health Care Provider, as required under 42 U.S.C. § 1396b(w). As set forth in Section 126-213,
the Assessment shall constitute a lien upon the Assessed Properties equal in rank and dignity
with the liens of all state, county, district, or municipal taxes and other non-ad valorem
assessments. In addition to other remedies available at law or equity, the enforcement of the
aforesaid Assessment shall be at the same time and in like manner as ad valorem taxes and
subject to all ad valorem tax enforcement procedures afforded to the official annual real property
tax notice.
Creation and implementation of the Assessment will not result in any additional pecuniary
obligation on the County, Board,or County residents. The Assessment shall be imposed, levied,
collected, and enforced against only Assessed Properties, and the Assessment Resolution shall
provide that the County's administrative costs shall be reimbursed from the collected amounts.
The County's administrative costs shall not exceed$150,000.
Any reasonable expenses the County incurs to collect delinquent assessments, including any
attorney's fees incurred as a result of contracting with an attorney to represent the county in
seeking and enforcing the collection of delinquent assessments, are not subject to the limitation
on administrative costs.
Sec. 126-218.-Computation of Assessment.
The annual Assessment shall be specified for each Assessed Property. The Board shall set the
Assessment in amounts that in the aggregate will generate sufficient revenue to fund the non-
federal share of Medicaid payments associated with Local Services to be funded by the
Assessment.
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The amount of the Assessment required of each Assessed Property may not exceed an amount
that,when added to the amount of other required assessments, equals an amount of revenue that
exceeds the maximum percent of the aggregate net patient revenue of all Assessed Hospitals in
the County permitted by 42 C.F.R. §433.68(f)(3)(i)(A).Assessments for each Assessed Property
will be derived from data contained in the Florida Hospital Uniform Reporting System, as
available from the Florida Agency for Health Care Administration.
Sec. 126-219. -Assessment Resolution.
The Assessment Resolution shall describe: (a)the Medicaid payments proposed for funding from
proceeds of the Assessment; (b) the benefits to the Assessment Properties associated with the
Assessment; (c) the methodology for computing the assessed amounts; and (d) the method of
collection,including how and when the Assessment must paid.
Sec. 126-220.-Non-Ad Valorem Assessment Roll.
The Assessment Coordinator shall prepare, or direct the preparation of, the Non-Ad Valorem
Assessment Roll,which shall contain the following:
a) The names of the Assessed Properties;and
b) The Assessment rate and amount of the Assessment to be imposed against each
Assessed Property based on the Assessment Resolution.
The Non-Ad Valorem Assessment Roll shall be retained by the Assessment Coordinator and
shall be open to public inspection. The foregoing shall not be construed to require that the
Assessment Roll be in printed form if the amount of the Assessment for each Assessed Property
can be determined by use of a computer terminal available to the public.
Sec. 126-221. -Notice by Publication.
Upon completion of the Non-Ad Valorem Assessment Roll, the Assessment Coordinator shall
publish once in a newspaper of general circulation within the County a notice stating that theBoard, at a regular, adjourned, or special meeting on a certain day and hour, not earlier than 20
calendar days from such publication, will hear objections of all interested persons to approve the
aforementioned Non-Ad Valorem Assessment Roll. Such notice shall include:
a) The Assessment rate;
b) The procedure for objecting to the Assessment rate;
c) The method by which the Assessment will be collected;and
d) A statement that the Non-Ad Valorem Special Assessment Roll is available for
inspection at the Office of the Assessment Coordinator.
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Sec. 126-222.-Notice by Mail.
In addition to the published notice required by Section 126-221, but only for the first fiscal year
in which an Assessment is imposed by the Board against Assessed Properties, the Assessment
Coordinator shall provide notice of the proposed Assessment by first class mail to the Assessed
Properties. Such notice shall include:
a) The purpose of the Assessment;
b) The Assessment rate to be levied against each Assessed Property;
c) The unit of measurement applied to determine the Assessment;
d) The total revenue to be collected by the County from the Assessment;
e) A statement that failure to pay the Assessment will cause a tax certificate to be issued
against the property or foreclosure proceedings,either of which may result in a loss of
title to the property;
f) A statement that all affected and/or interested parties have a right to appear at the
hearing and to file written objections with the Board within 20 days of the notice;and
g) The date,time,and place of the hearing.
Notice shall be mailed at least 20 calendar days prior to the hearing to each Assessed Property at
such address as is shown on the Assessment Roll. Notice shall be deemed mailed upon delivery
thereof to the possession of the United States Postal Service. The Assessment Coordinator may
provide proof of such notice by affidavit. Failure of the Assessed Property to receive such notice,
because of mistake or inadvertence, shall not affect the validity of the Assessment Roll or release
or discharge any obligation for payment of the Assessment imposed by the Board pursuant to
this Article.
Sec. 126-223. -Adoption of Assessment Resolution and Non-Ad Valorem Assessment Roll.
At the time named in the notice, the Board shall receive and consider any written objections of
interested persons. All objections to the Assessment Resolution and Non-Ad Valorem
Assessment Roll shall be made in writing and filed with the Assessment Coordinator at or before
the time or adjourned time of such hearing. At the date and time named in the notice,the Board
may adopt the Assessment Resolution and Non-Ad Valorem Assessment Roll which shall:
a) Set the rate of the Assessment to be imposed;
b) Approve the Non-Ad Valorem Assessment Roll,with such amendments as it deems just
and right;and
c) Affirm the method of collection.
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Sec. 126-224.-Annual Final Assessment Resolution.
The Board may revise the Non-Ad Valorem Assessment Roll during the Fiscal Year to modify
the Assessment rate. However, the Board must adopt an Annual Final Assessment Resolution
during the Fiscal Year to memorialize the final rate applicable for the Fiscal Year.
Sec. 126-225.-Effect of Annual Final Assessment Resolution.
The adoption of the Annual Final Assessment Resolution shall be the final adjudication of the
issues presented(including,but not limited to, the method of apportionment and Assessment, the
Assessment rate, the initial rate of Assessment, the Non-Ad Valorem Assessment Roll, and the
levy and lien of the Assessments), unless proper steps shall be initiated in a court of competent
jurisdiction to secure relief within 20 days from the date of Board action on the Annual Final
Assessment Resolution. The Non-Ad Valorem Assessment Roll shall be delivered to the Tax
Collector or such other official as the Board by resolution shall designate.
Sec. 126-226. -Method of Collection.
The amount of the assessment is to be collected pursuant to the Alternative Method, as specified
in the Assessment Resolution.
Sec. 126-227.-Refunds.
If, at the end of the Fiscal Year, additional amounts remain in the local provider participation
fund, the Board is hereby authorized to make refund to Assessed Properties in proportion to
amounts paid in during the Fiscal Year for all or a portion of the unutilized local provider
participation fund.
Sec. 126-228.-Responsibility for Enforcement,
The County and its agent, if any, shall maintain the duty to enforce the prompt collection of the
Assessment by the means provided herein. The duties related to collection of assessments may
be enforced at the suit of any holder of obligations in a court of competent jurisdiction by
mandamus or other appropriate proceedings or actions.
Sec. 126-229, -Correction of Errors and Omissions.
No act of error or omission on the part of the Comptroller, Property Appraiser, Tax Collector,
Assessment Coordinator, Board, or their deputies or employees shall operate to release or
discharge any obligation for payment of the Assessment imposed by the Board under the
provision of this Chapter.
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SECTION 2. APPLICABILITY.
It is hereby intended that this Ordinance shall constitute a uniform Iaw applicable in all
unincorporated areas of Collier County, Florida, and to all incorporated areas of Collier County
where there is no existing conflict of law or municipal ordinance.
SECTION 3. SEVERABILITY.
In the event this Ordinance conflicts with any other Ordinance of Collier County or other
applicable law, deemed a separate, distinct and independent provision and such holding shall
not affect the validity of the remaining portion.
SECTION 4. RESOLUTION OF CONFLICT OF LAWS.
In all instances where Florida law, as evidenced by the Florida Administrative Code, Florida
Statutes, applicable case law, or otherwise mandates standards or requirements that are stricter
than the provisions of this Ordinance, or where a matter is addressed by Florida law that is not
addressed by this Ordinance, then said law shall govern. In situations where this Ordinance
addresses a matter in a manner that is stricter than that of Florida law, the provisions of this
Ordinance shall control.
SECTION 5. INCLUSION IN THE COLLIER COUNTY CODE.
The provisions of this Ordinance shall be included and incorporated in the Collier County Code,
as an addition or amendment thereto, and shall be appropriately renumbered to conform to the
uniform numbering system of the Collier County Code, once established. The word "ordinance"
may be changed to "section," "article," or other appropriate word or phrase necessary to
accomplish such intentions.
SECTION 6. FILING OF ORDINANCE.
In accordance with the provisions of§ 125.66,Fla. Stat.,a certified copy of this Ordinance shall
be filed with the Florida Department of State.
SECTION 7. EFFECTIVE DATE.
This Ordinance shall become effective July 1, 2021 unless the enabling legislation is not
approved by the Governor of the State of Florida.
PASSED AND 13ULY ADOPTED by the Board of County Commissioners of Collier County,
Florida,this aorday of J u,ne, ,2021.
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Page 2404 of 3580
ATTEST: BOARD OF COUNTY COMMISSIONERS
CRYSTAL K KINZEL,CLERK COLLIER O Y, FLORIDA
By—:)(By:
DEPUT PENNY TAYL ,CHAIRP SON
Attest as to Chaim an's •••.
signature only.
Approved as to form
and legality:
e i r A.Bel edio 1Jna p 5PAssistantCountyAtto
I i
This ordinance flied with t1'xs:
Secr tort' of State's
day of
and acknowledgement of that
filing received ihis day
By Deouty C erk,
Page 10 of 10
0G
Page 2405 of 3580
r .
FLORIDA DEPARTMENT Of STATE
RON DESANTIS LAUREL M. LEE
Governor Secretary of State
July 1, 2021
Ms. Martha Vergara, BMR & VAB Senior Deputy Clerk
Office of the Clerk of the Circuit Court
Comptroller of Collier County
3329 Tamiami Trail E, Suite#401
Naples, Florida 34112
Dear Ms. Vergara:
Pursuant to the provisions of Section 125.66, Florida Statutes, this will acknowledge receipt of your
electronic copy of Collier County Ordinance No. 2021- 23, which was filed in this office on July 1, 2021.
Sincerely,
Anya Grosenbaugh
Program Administrator
AG/lb
R. A. Gray Building • 500 South Bronough Street • Tallahassee, Florida 32399-0250
Telephone: (850) 245-6270
Page 2406 of 3580
RESOLUTION NO. # 2025-
AN ASSESSMENT RESOLUTION OF THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA,
AUTHORIZING AND ADOPTING A NON-AD VALOREM
SPECIAL ASSESSMENT WITHIN THE COUNTY LIMITS FOR
THF. PURPOSE OF BENEFITING ASSESSED PROPERTIES
THROUGH ENHANCED MEDICAID PAYMENTS FOR LOCAL
SERVICES; FINDING AND DETERMINING THAT CERTAIN
REAL PROPERTY IS SPECIALLY BENEFITED BY THE
ASSESSMENT; COLLECTING THE ASSESSMENT AGAINST THE
REAL PROPERTY; ESTABLISHING A PUBLIC HEARING TO
CONSIDER IMPOSITION OF THE PROPOSED ASSESSMENT AND
THE METHOD OF ITS COLLECTION; AUTHORIZING AND
DIRECTING THE PUBLICATION OF NOTICES IN CONNECTION
THEREWITH; PROVIDING FOR CERTAIN OTHER
AUTHORIZATIONS AND DELEGATIONS OF AUTHORITY AS
NECESSARY; AND PROVIDING AN EFFECTIVE DATE.
WHEREAS, hospitals in Collier County's jurisdiction (the "Hospitals") annually provide
millions of dollars of uncompensated care to uninsured persons and those who qualify for Medicaid
hecause Medicaid, on average, covers only 60% of the costs of the health care services actuallv
provided by Hospitals to Medicaid-eligible persons. leaving hospitals with significant
uncomrcnsated costs; and
WHEREAS, Hospitals in Collier County (the "County") support a non-ad valorcm specia!
assessment upon certain real property interests held by the Hospitals to help finance the non-
tederal share of the State's Medicaid program; and
WHEREAS, the only real properties interests that will be subject to the non-ad valorcm
assessments authorized herein are those belonging to the Hospitals; and
WHEREAS, the County recognizes that one or more or the Hospitals within the County's
boundaries may be located upon real proper1y leased from governmental entities and that such
I lospitals may be assessed because courts do not make distinctions on the application of special
assessments based on "property interests" but rather on the distinction of the classifications ofreal
property being assessed; and
WHEREAS, the funding raised by the County assessment will, through intergovernmental
transfers ("lGTsr,) provided consistent with federal guidelines, support additional funding for
Medicaid payments to Hospitals; and
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WHEREAS, the County acknowledges that the Hospital properties assessed will have
increased income potential directly and especially from the assessment as a result of the above-
descri bed additional funding provided to said Hospitals: and
WHEREAS, the County has detennincd that a logical relationship t:xists between the
services provided by the Hospitals, which will be supported by the assessment, and the special and
particular benefit to the real property of the Hospitals; and
WHEREAS, the County has an interest in promoting access to health care for its low-
income and uninsured residents; and
WHEREAS, imposing an assessment limited to Hospital properties to help fund the
provision of these services and the achievement of certain quality standards by the I Iospitals to
residents of the County is a valid pub] ic purpose that benefits the health. safety, and we) fare of the
citizens of the County; and
WHEREAS, the assessment ensures the financial stability and viability of the Hospitals
providing such services; and
WHEREAS, the Hospitals are important contributors to the County's economy, and the
financial benefit to these Hospitals directly and specifically supports their mission, as well as their
ability to grow, expand, and maintain their facilities in concert with the population gro,.,vth in the
jurisdiction of the County; and
WHEREAS, the Board finds the assessment will enhance the Hospitals' ability to grow,
expand, maintain. improve, and increase the value of their Collier County propc11ics and facilities
under all present circumstances and those of the foreseeable future; and
WHEREAS, the County is proposing a properly apportioned assessment by which all
Hospitals will be assessed at a unifonn rate that is compliant with 42 C.F.R. § 433.68(d); and
WHEREAS, on June 22, 2021, the Board of County Commissioners adopted Ordinance
2021-23. enabling the County to levy a unifonn non-ad valorem special assessment, which is fairly
and reasonably apportioned among the Hospitals' property interests within the County's
jurisdictional limits, to establish and maintain a s:ystem of funding for IGTs to support the non-
federal share of Medicaid payments, thus directly and specially benefitting Hospital properties.
NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COU NTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA, that:
Section I. Definitions. As used in this Resolution, the following capitalized terms,
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not otherwise defined herein or in the Ordinance. shall have the meanings below, unless the
context otherwise requires.
Assessed Property means the real property in the County to which an Institutional Health Care
Provider holds a right of possession and right of use through an ownership or leasehold interest, thus
making the property subject to the Assessment.
Assessment means a non-ad valorem special assessment imposed by the County on Assessed
Property to fund the non-federal share of Medicaid and Medicaid managed care payments that
will benefit hospitals providing Local Services in the County.
Assessment Coordinator means the person appointed to administer the Assessment imposed
pursuant to this Article, or such person's designee.
Board means the Board of County Commissioners of Collier County, Florida.
Comptroller means the Collier County Comptroller, ex officio Clerk to the Board, or other such
person as may be duly authorized to act on such person's behalf.
County means Collier County, Florida.
Fiscal Year means the period commencing on October 1 of each year and continuing through
the next succeeding September 30, or such other period as may be prescribed by law as the fiscal
year for the County.
Institutional Health Care Provider means a private for-profit or not-for-profit hospital that
provides inpatient hospital services.
local Services means the provision of health care services to Medicaid, indigent, and uninsured
members of the Collier County community.
Non-Ad Valorem Assessment Roll means the special assessment roll prepared by the County .
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Ordinance means the Collier County Local Provider Participation Fund Ordinance codified m
Chapter 126 of the Collier County Code of Ordinances.
Tux Collector means the Collier County Tax Collector.
Section 2. Authority. Pursuant to Article VIIL Section !(f) of the Constitution of the State
of Florida, Chapter 125 of the Florida Statutes, and the Collier County Local Provider Participation
fund Ordinance, the Board is hereby authorized to impose a special assessment against private for-
profit and not-for-profit hospitals located within the County to fund the non-federal share of
Medicaid payments associated with Local Services.
Section 3. Specia l Assessme nt. The non-ad valorem special assessment discussed
herein shall be imposed, levied, collected, and enforced against Assessed Properties located within
the County. Proceeds from the Assessment shall be used to benefit Assessed Properties through
enhanced Medicaid payments from programs, including the hospital directed payment program and
graduate medical education program, that will benefit the Assessed Properties for Local Services.
When imposed, the Assessment shall constitute a lien upon the Assessed Properties owned by
Hospitals and/or a lien upon improvements on the Property made by Hospital leaseholders equal in
rank and dignity with the liens of all state, county, district, or municipal taxes and other non-ad
valorem assessments. Payments made hy Assessed Properties may not be passed along to patients
of the Assessed Property as a surcharge or as any other form of additional patient charge. Failure to
pay may cause foreclosure proceedings, which could result in loss of title. to commence.
Section 4.
shall be used only to:
A ssessme nt Scope, Basis, and Use. Funds generated from the Assessment
1. Provide to the Florida Agency for Health Care Administration the non-federal
share for Medicaid payments, including the hospital directed payment program
and graduate medical education program, to be made directly or indirectly in support
of hospitals serving Medicaid beneficiaries: and
2 . Reimburse the County for administrative costs associated with the implementation
of the Assessment authorized by the Ordinance.
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If, at the end of the Fiscal Year, additional amounts remain in the local provider participation fund,
the Board is hereby authorized either (a) to refund to Assessed Properties, in proportion to amounts
paid in during the Fiscal Year, all or a portion of the unutilized local provider participation fund,
or (b) to retain such amounts in the fund to transfer to the Agency in the next fiscal year for use
as the non-federal share of Medicaid hospital payments.
If, after the Assessment funds are transferred to the Agency, the Agency returns some or all of the
transferred funding to the County (including, but not limited to, a return of the non-federal share after
a disallowance of matching federal funds), the Board is hereby authorized to refund to Assessed
Properties, in proportion to amounts paid in during the Fiscal Year, the amount of such returned
funds.
Section 5. Computation of Assessment, The Assessment shall equal 1.74% of net
patient revenue for each Assessed Property specified in the attached Non-Ad Valorem Assessment
Roll. The amount of the Assessment required of each Assessed Property may not exceed an amount
that, when added to the amount of other hospital assessments levied by the state or local
government, exceeds the maximum percent of the aggregate net patient revenue of all Assessed
Hospitals in the County permitted by 42 C.F.R. § 433.68(f)(3)(i)(A). Assessments for each
Assessed Property vvill be derived from data contained in cost reports and/or in the Florida Hospital
Uniforrn Reporting System, as available from the Florida Agency for Health Care Administration.
Section 6. Timing and Method of Collection. The amount of the assessment is to be
collected pursuant to the Alternative Method outlined in § 197.3631, Fla. Stat.
The County shall provide Assessment bills by first class mail to the owner of each affected I lospital.
The bill or accompanying explanatory material shal I include: (I) a reference to this Resolution, (2)
the total amount of the hospital's Assessment for the appropriate period, (3) the location at which
payment will be accepted, ( 4) the date on which the Assessment is due, and ( 5) a statement that the
Assessment constitutes a lien against assessed property and/or improvements equal in rank and dignity with
the liens of all state, county, district or municipal taxes and other non-ad valorem assessments.
No act of error or omission on the part of the Comptroller. Property Appraiser, Tax Collector,
Assessment Coordinator, Board, or their deputies or employees shall operate to release or
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discharge any obligation for payment of the Assessment imposed by the Board under the
Ordinance and this resolution.
Section 7. Publi c Heari ng. Per the notice provided on June 3, 2025 , the Board has
heard and considered objections of all interested persons prior to rendering a decision on the
Assessment and attached Non-Ad Valorem Assessment Ro ll.
Section 8. Respon s ib ili ty for Enforcement. The Coun ty and its agent, if any, shall
maintain the duty to enforce the prompt collection of the Assessment by the means provided herein.
The duties related to collection of assessments may be enforced at the suit of any holder of
obligations in a court of competent jurisdiction by mandamu s or other approp1iate proceedings or
actions.
Section 9. Severability. If any clause, section, or provision of this re so lution is
declared unconstitutional or invalid for any reason or cause, the remaining portion hereof shall be in
full force and effect and shall be valid as if such in valid portion thereof had not been incorporated
herein.
Section JO. Effective Date. This Resolution shall become effective upon ad o ption by a majority
vote of the Board of County Commissioners.
This Re solution adopted by the Board this __ day of ______ 2025, aft er motion,
second and majority vote favoring same.
ATTEST:
CRYSTAL K. KINZEL, CLERK
, Deputy Clerk
and legality:
ty Attorney
AS TO COUNTY:
BOARD OF COUNTY
COMMISSIONERSCOLLIER
COUNTY, FLORIDA
By: -------------Bu rt L. Saunders, Chairperson
Date: -----------
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