Agenda 09/23/2025 Item #16D 8 (County Manager to sign the Low Income Pool Letter of Agreement with the Agency for Health Care Administration) Proposed Agenda Changes
Board of County Commissioners Meeting
September 23,2025
Move Item 17H to 9C: Recommendation to adopt an Ordinance repealing and replacing Ordinance No.
2004-06 to restructure the Domestic Animal Services Advisory Committee,provide for the creation,
purpose,powers and duties,provide for appointment and composition, terms of office, attendance and
removal from office, provide for officers, quorum, and rules of procedure. (Commissioners Saunders' &
McDaniel's Separate Requests)
Move Item 17I to 9D: Recommendation to adopt an Ordinance amending Ordinance 2013-33, as
amended,which established the Animal Control Ordinance. (Commissioners Saunders' &McDaniel's
Separate Requests)
Move Item 17K to 9E: Recommendation to adopt an Ordinance amending Ordinance 2013-55, which
established the Standards of Care for Animal-Related Businesses and Organizations, Breeders, and
Rodeos Ordinance. (Commissioners Saunders' &McDaniel's Separate Requests)
Continue Item 16A9 to October 14,2025,BCC Meeting: Recommendation to approve a Resolution superseding
Resolution No.2018-106, amending the Collier County Domestic Animal Services(DAS)Fee Policy,as it relates
to the authority of the Director of Domestic Animal Services and reflecting the operating costs associated with
animal-related businesses and breeders,with an effective date of October 1,2025. (Staff's Request)
Move Item 16D8 to 11F: Recommendation to approve and authorize the County Manager to sign the Low
Income Pool Letter of Agreement with the Agency for Health Care Administration, in the amount not to
exceed$2,371,401,to participate in the Medicaid Central Receiving Facility Low Income Pool Program,
generating $3,171,846.24 in federal matching funds for the benefit of David Lawrence Mental Health
Center, to sign the Provider Questionnaire to assist in meeting the state required match obligation, and
authorize necessary Budget Amendments to the Fiscal Year 2026 budget in the amount$594,235.91.
(Commissioner Hall's Request)
Add-on item 15B1:NIM Handout discussion(Staff's Request)
Notes:
• Item 5B is a PACE Legislative Update by PACE Industries.
• A typo was recognized in the table uploaded to item 16K1 and was corrected the day after it was initially
published.
TIME CERTAIN ITEMS:
Item 11D to be heard at 10:00 AM: Tourism Marketing FY26 Request up to$5M from Reserves for Enhanced
Promotion to remain competitive.
Item 11E to be heard at 11:00 AM: Marco Island Beach Berm Restoration of the Tigertail/Sand Dollar Island
spit reimbursement of$647,873 from TDT Funds.
9/23/2025 12:51 PM
9/23/2025
Item # 16.D.8
ID# 2025-2942
Executive Summary
Recommendation to approve and authorize the County Manager to sign the Low Income Pool Letter of Agreement with
the Agency for Health Care Administration, in the amount not to exceed $2,371,401, to participate in the Medicaid
Central Receiving Facility Low Income Pool Program, generating $3,171,846.24 in federal matching funds for the
benefit of David Lawrence Mental Health Center, to sign the Provider Questionnaire to assist in meeting the state
required match obligation, and authorize necessary Budget Amendments to the Fiscal Year 2026 budget in the amount
$594,235.91. (Fiscal Impact $2,371,401. General Fund 0001)
OBJECTIVE: To provide mental health and substance abuse services to the citizens of Collier County consistent with
Section 394.76(9)(a) and (b), Florida Statutes, while advancing the County’s strategic objective of promoting access to
health, wellness, and human services.
CONSIDERATIONS: The Agency for Health Care Administration (AHCA) is a State entity that provides Medicaid
funding in Florida and operates the Medicaid Low Income Pool (LIP) Program. The LIP Program leverages local funds
to obtain federal matching dollars. The County's participation in the LIP Program is outlined in the attached LIP Letter
of Agreement between Collier County and AHCA.
In recognition of the growing inpatient behavioral healthcare needs of Collier County residents, David Lawrence Center
(DLC) mobilized an expansion as an interim step towards the development of a Central Receiving Facility (CRF). The
development of the CRF allows DLC to participate in the LIP program through AHCA. DLC desires and is qualified to
administer the Central Receiving Facility LIP Program with AHCA using Collier County and Collier County Sheriff’s
Office (CCSO) ad valorem tax dollars.
The County’s General Fund and LIP allocations in the Fiscal Year 2026 (FY 26) budget are proposed and aim to assist
in meeting the state mandated required match obligation. The current DLC state required match obligation is
$2,313,044.78. The anticipated FY 26 budget has allocated $1,777,165.09, along with funding from the CCSO in the
amount of $594,235.91. CCSO has agreed to utilize these funds in support of the LIP program to augment the County
funds to yield a greater federal match. DLC will utilize the County and CCSO funds under the LIP Program to provide
additional mental healthcare services for low-income individuals in Collier County through its central receiving facility.
These funds are part of a tri-party agreement between DLC, CCSO, and the County to be brought to the Board of
County Commissioners (Board) in late October. CCSO will be invoiced by the County once an invoice is received from
AHCA to facilitate the payment to AHCA via an intergovernmental transfer (IGT).
The allocation of County and LIP matching funds is as follows:
Collier
County
General
Fund LIP
IGT
Federal Matching
Funds Provided to
DAVID
LAWRENCE
CENTER as
Program
Administrator
CCSO
Funds
Total Funds
Benefiting
Low-Income
Persons
$1,719,499.44 $2,295,209 $0.00 $4,014,708.44 Prior FY25
$1,777,165.09 $3,171,846.24 $594,235.91 $5,543,247.24 Proposed Action
$1,777,165.09 $3,171,846.24 FY26 Tentative Budget
If approved, the County will provide all of its General Fund allocation and that of CCSO to AHCA in support of the LIP
Page 2410 of 3896
9/23/2025
Item # 16.D.8
ID# 2025-2942
program. By the Board allowing the entire general fund allocation and the CCSO funds to be submitted to AHCA this
will remove any authority the County and CCSO has with respect to these dollars. However, staff will prepare a
memorandum of understanding for both the County and CCSO to ensure the services supported through the LIP
agreement are to support those residents in Collier County. Through the remittance of these funds, the County will meet
all the required state match obligation. Should CCSO not provide payment to the County the LIP LOA contribution will
be reduced accordingly.
It is important to note that the County has historically supported the entire required match obligation without local
support from other agencies or municipalities. In prior years, the County has often overmatched in support of DLC.
As shown in the table below is a five-year summary of funding to support the David Lawrence Center
TABLE #2
Advances the County’s strategic objective of promoting access to health, wellness, and human services.
FISCAL IMPACT: Funding in the amount of $1,777,165.09 is available within the FY26 Community & Human
Services (CHS), Community Mental Health & LIP Support Fund 0001, Cost Center 156010 for the County’s
contribution to the State of Florida Agency for Healthcare Administration. A FY26 Budget Amendment of $594,235.91
is needed to accept the CCSO’s contribution towards this payment.
GROWTH MANAGEMENT IMPACT: There is no Growth Management impact associated with this action.
LEGAL CONSIDERATIONS: This item has been approved as to form and legality and requires a majority vote for
Board approval. – CLD
RECOMMENDATIONS: To approve and authorize the County Manager to sign the Low Income Pool Letter of
Agreement with the Agency for Health Care Administration, in the amount not to exceed $2,371,401, to participate in
the Medicaid Central Receiving Facility Low Income Pool Program, generating $3,171,846.24 in federal matching funds
for the benefit of David Lawrence Mental Health Center, to sign the Provider Questionnaire to assist in meeting the state
required match obligation, and authorize necessary Budget Amendments to the Fiscal Year 2026 budget in the amount
$594,235.91. (Fiscal Impact $2,371,401. General Fund 0001)
PREPARED BY: Carolyn Noble, Grant Coordinator Community and Human Services
ATTACHMENTS:
1. LIP Letter of Agreement CAO Stamped
Page 2411 of 3896
9/23/2025
Item # 16.D.8
ID# 2025-2942
2. DLC CCSO LIP BA 9.2025c
3. LIP DLC IGT Provider Questionnaire 9.16.25 CAO Stamped
Page 2412 of 3896
Low lncome Pool Letter of Agreement
THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the _
day of _2025, by and between Collier County (the "lGT Provider") on behalf of
David Lawrence Behavioral Health 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
"Charity care" or "uncompensated charity care" means that portion of hospital charges reported
to the Agency for which there is no compensation, other than restricted or unrestricted revenues
provided to a hospital by local governments or tax districts, regardless ofthe method of
payment. Uncompensated care includes charity care for the uninsured but does not include
uncompensated care for insured individuals, bad debt, or Medicaid and Children's Health
lnsurance Program (CHIP) shortfall. The state and providers that are participating in the Low
lncome Pool (LlP) will provide assurance that LIP claims include only costs associated with
uncompensated care that is furnished through a charity care program and that adheres to the
principles of the Healthcare Financial Management Association (HFMA) operated by the
provider.
"Low Income Pool (LlP)" means providing government support for safety-net providers for the
costs of uncompensated charity care for low-income individuals who are uninsured.
Uncompensated care includes charity care for the uninsured but does not include
uncompensated care for insured individuals, "bad debt," or Medicaid and CHIP shortfall.
"Medicaid" means the medical assistance program authorized by Title XIX of the Social Security
Act,42 U.S.C. SS 1396 et seq., and regulations thereunder, as administered in Florida by the
Agency.
A. GENERAL PROVISIONS
1. PerSenateBill 2500, theGeneral Appropriations Act of State Fiscal Year 2025-
2026, passed by the 2025 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 $2,37'1,401 .
a. The IGT Provider and the Agency have agreed that these IGT funds will only be
used to increase the provision of health services for the charity care of the IGT
Provider and the State of Florida at large.
b. The increased provision of charity care health services will be accomplished
through the following Medicaid programs:
CAO
"lntergovernmental Transfers (lGTs)" means transfers of funds from a non-Medicaid
governmental entity (e.9., counties, hospital taxing diskicts, providers operated by state or local
government) to the Medicaid agency. lGTs must be compliant with 42 CFR Part 433 Subpart B.
i. LIP payments to hospitals, federally qualified health centers, Medical
School Physician Practices, community behavioral health providers, and
Collier County_David Lawrence Behavioral Health_LlP LOA SFY 2025-26
Page 2413 of 3896
rural health centers pursuant to the approved Centers for Medicare &
l\/edicaid Services Special Terms and Conditions.
2. The IGT Provider will return the signed LOA to the Agency no later than October 1,
2025.
3. The IGT Provider will pay IGT funds to the Agency in an amount not to exceed the total
of $2,371,401.
Per Florida Statute 409.908, annual payments for the months of July 2025 through
June 2026 are due to the Agency no later than October 31, 2025, unless an
alternalive 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.
c. Audits and Records
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.
The IGT Provider agrees to ensure that these records shall be sub.iect at
all reasonable trmes to inspection, revrew, or audit by state personnel and
other personnel duly authorized by the Agency, as well as by federal
personnel.
The IGT Provider agrees to comply with public record laws as outlined in
section 1 19.0701, Florida Statutes.
d. Retention of Records
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.
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.
a
Collier County_David Lawrence Behavroral Health_LlP LOA SFY 2025-26 CAO
Page 2414 of 3896
The rights of access in this section must not be limited to the required
retention period but shall last as long as the records are retained.
e. 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.
f. Assignment and Subcontracts
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
conditlons 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
redirect any portion of these aforementioned charity care 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 the 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 fundjng shall first be used to fund the Medicaid program (including LIP or DSH) and
used secondarily for other purposes."
8. This LOA covers the period of July 1 , 2025, through June 30, 2026, and shall
be terminated September 30, 2026, which includes the state's certified foMard
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.
Co I er County_David Lawrence Behav oral Health_LlP LOA SFY 2025-26 CAO
Page 2415 of 3896
LIP Local lntergovernmental Transfers (lGTs)
Program / Amount State Fiscal Year 2025-2026
Estimated lGTs
$2,371,401.00
Total Funding Not to Exceed $2,371,401.00
WITNESSETH:
lN WITNESS WHEREOF, the parties have caused this (4) page Letter of Agreement
to be executed by their undersigned officials as duly authorized.
COLLIER COUNTY STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION
SIGNED
BY:
NAME:
TITLE:
DATE:
SIG NEO
BY:
NAME:
TITLE:
Stephanie Scanlon
Chief of Medicaid Program
Finance
DATE:
Collier County_David Lawrence Behavioral Health_LlP LOA SFY 2025-26
CAO
Page 2416 of 3896
lntergovernmental Transfers Questionnaire
IGT Provider Name:
Health Care Provider Name
IGT Amount:
State Fiscal Year Ending:
Collier County
David Lawrence Behavioral Health
$2,371,401.00
6t30t2026
1. What type of governmental entity is your organization considered? (county, city, hospital taxing district,
or other)
County
lf other,
2. Does your organization have a relationship with the provider for which you contribute lGTs as named in
the preamble of the enclosed Letter of Agreement (LOA)?
Yes
lf yes, please describe your relationship, including services provided to/by the provider to/by the
organization and any other financial transactions between the provider and the organization.
e County provides IGT to David Lawrence Behavioral Health. They are also a subrecipient
of our grant programs providing healthcare services to citizens of Collier County
3. Please describe the source of the IGT funding for your organization, including whether the source is
from a tax, a provider donation, or other funds. Provide the amount of funding from each source.
Source Amount
General Fun Ad Valorem Tax $1,777j65
Collier County Sheriff Office $594,236
$
lf other SC
a. Verify whether the funds are public funds as defined by 42 CFR S 433.51, and exclude any federal
funds.
Yes
in
Yes
tf
4. Does your organization have taxing authority?
CAO
no. olease exola
Page 2417 of 3896
5. lf the source of IGT funding is from taxes, please answer the following questions:
a. ls the tax a state or district tax?
lf other
b. What entities are taxed?
Property Owners in Collier County
c. What is the tax structure .e.tax of revenue ASSESSME
d. What is the amount or of the tax?
e. Does at least 85% of the burden of the tax revenue fall on health care providers as defined in 42
CFR 5433.55? (Provide the total tax revenue and the health care provider tax burden) lf so, please
answer the following questions:
Amount
i) ls the tax broad based? A broad based tax can be defined as a tax that is imposed on at least
all health care items or services in the class or providers of such items or services furnished by
all non-Federal, non-public providers in the State, and is imposed unlformly, pursuant to 42
cFR S 433.68.
No
lfn
Valorem/Property Tax
07 per $1000 value
Total Tax Burden $
Healthcare Provider Tax Burden $
CAO
Countv
Page 2418 of 3896
ii) ls the tax uniform across all entities being taxed? Based on 42 CFR S 433.68, a health care-
related tax will be considered to be imposed uniformly even if it excludes Medicaid or Medicare
payments (in whole or in part), or both; or in the case of health care-related tax based on
revenue or receipts with respect to a class of items or services, if it excludes either Medicaid or
Medicare revenue with respect to a class of items or services, or both. The exclusion of
Medicaid revenue must be applied uniformly to all providers being taxed.
No
lf no ain
iii) ls the tax generally redistributive and a waiver of the broad-based or uniform tax requirement
was granted in accordance with 42 CFR $a33.68(e)?
No
lfn ease
iv) Does the tax program comply with the hold harmless provisions included in 42 CFR $
433.68(0?
lfn lease in
v) Does every tax paying entity receive a supplemental payment equal to or exceeding its tax cost?
tf lease in
6. Please answer the following regarding provider funds recelved from the healthcare entity and/or other
health care entities.
a. Are provider voluntary payments or in-kind services received by the organization as defined in 42
cFR S 433.52?
No
b. How much of the organization's revenue is received from provider-related donations (Provide the
total revenue and the provider-related donation amounts)?
Amount
Total Revenue $
Provider Related Donations $
c. Do individual provider donations exceed $5,000 per year or $50,000 per year for a health care
organizational entity?
No
CAO
Page 2419 of 3896
lf yes, please list the provider and payment amount.
Provider Name F Source Amount
d. Does any portion of the provider donation constitute as a "bona fide donation" pursuant to 42 CFR
S 433.54? 42 CFR S 433.54 requires donations will not be returned to the individual provider, the
provider class, or related entity under a hold harmless provision.
No
e. ls there an agreement between the IGT provider and the health care entity? lf so, please specify
whether the agreement is written and provide the details.
7. Were funds utilized for the IGT specifically appropriated by the organization's board?
lf yes, provide the board minutes and date of the appropriation.
Amy Patterson certify that the statements and information contained
in this submittal are true, accurate, and complete.
Signature of Officer or Administrator
Title
Date
$
$
$
CAO
Page 2420 of 3896