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Backup Documents 06/24/2025 Item #16D 6 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 D 6 TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 2.25.24 BCC MTG 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 Attomey Office. Route to Addressee(s) (List in routing order) Office Initials Date 1. Carolyn Noble Community and Human CN 6.18.25 Services 2. County Attorney Office— County Attorney Office 5Atits4 3. BCC Office Board of County Commissioners 'f 3S fl /5/ 4. Minutes and Records Clerk of Court's Office / 1 LY PRIMARY CONTACT INFORMATION 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 Carolyn Noble Phone Number 239-450-5186 Contact/ Department Agenda Date Item was 6.24.25 BCC Meeting Agenda Item Number 16.D.6 Approved by the BCC Type of Document RESOLUTION(3 COPIESi, 2 Number of Original 3 DOCUMENTS Attached 'Z'o U — istJ Documents Attached PO number or account number if document is to be recorded 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 STAMP OK CN 2. Does the document need to be sent to another agency for additional signatures? If yes, N/A 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 Yes 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 N/A 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 N/A document or the final negotiated contract date whichever is applicable. 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's YES signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip N/A 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 above date and all changes made during N/A is not the meeting have been incorporated in the attached document. The County .�( 44 an option for Attorney's Office has reviewed the changes,if applicable. JJ this line. 9. Initials of attorney verifying that the attached document is the version approved by the i N/A is not BCC,all changes directed by the BCC have been made,and the document is ready for the sit p j an option for Chairman's signature. ( this line. 16D6 RESOLUTION NO. # 2025- 1 23 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 THE PURPOSE OF BENEFITING ASSESSED PROPERTIES THROUGH ENHANCED MEDICAID PAYMENTS FOR LOCAL SERVICES; FINDING AND DETERMINING THAT CERTAIN REAL PROPERTY IS SPECIALLY BENEFITED BY TILE 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 1)14:LEGATIONS 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 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; and WHEREAS, Hospitals in Collier County (the "County") support a non-ad valorem special assessment upon certain real property interests held by the Hospitals to help finance the non- federal share of the State's Medicaid program; and WHEREAS, the only real properties interests that will be subject to the non-ad valorem assessments authorized herein are those belonging to the hospitals; and WHEREAS, the County recognizes that one or more of the Hospitals within the County's boundaries may be located upon real property leased from governmental entities and that such I{ospitals 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 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; and 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- 1 6 D 6 described additional funding provided to said Hospitals; and WHEREAS, the County has determined that a logical relationship exists 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 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 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 growth 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 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 at a uniform 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 uniform 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 system 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. COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA, that: Section 1. Definitions. As used in this Resolution, the following capitalized terms, not otherwise defined herein or in the Ordinance, shall have the meanings below, unless the 1 6 D 6i 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. 6D6 Ordinance means the Collier County Local Provider Participation Fund Ordinance codified in Chapter 126 of the Collier County Code of Ordinances. Tax Collector means the Collier County Tax Collector. Section 2. Authority. Pursuant to Article VIII,Section 1(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. Special Assessment. 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 by 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. Assessment Scope, Basis, and Use. Funds generated from the Assessment shall be used only to: 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. If, at the end of the Fiscal Year, additional amounts remain in the local provider participation fund, 1 6 D 6 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 will be derived from data contained in cost reports and/or in the Florida Hospital Uniform 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 Hospital. The bill or accompanying explanatory material shall include: (1) 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 discharge any obligation for payment of the Assessment imposed by the Board under the 1 6 D 6 Ordinance and this resolution. Section 7. Public Hearing. 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 Roll. Section 8. 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. Section 9. Severabilitys If any clause,section, or provision of this resolution 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 invalid portion thereof had not been incorporated herein. Section 10. Effective Date.This Resolution shall become effective upon adoption by a majority vote of the Board of County Commissioners. This Resolution adopted bythe Board thisday tiN ---- This Zy of wie_. 2025, after motion, second and majority vote favoring same. ATTEST: AS TO COUNTY: CRYSTAL`K. KINZEL, CLERK BOARD OF COUNTY rha ;a• 1 COMMISSIONERSCOLLIER r� ; "4 f ! w � COUNTY, FLORIDA ;,, k' . U'- ',yip , Deputy Clerk ��y ira ,,,,i4 By I /fir Dated: B `j2f 25 Burt L. Saunders, Chairperson (SEAL) Attest as to Minna* �' i i signature only. Date: 4/25 _ Approval / . 1 and legality: -444kiI►._ Jeffrey 41 a ow, ,ty Attorney