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Backup Documents 09/23/2014 Item #16D18 Y ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO . THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE1 6 d routing slip and original documents are to be forwarded to the County Attorney is ibal Print on pink paper. Attach to original document. The complete g p 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 Coun Attorney Office. Route to Addressee(s) (List in routing order) Office Initials Date � 1. Jennifer A. Belpedio, Assistant County County Attorney Office �`?�j‘\ Attorney 2. BCC Office Board of County b/� / 1-Z3`` Commissioners �l 5/ `� vk 3. Minutes and Records Clerk of Court's Office 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 Esther Mae ,\ vv- * Phone Number 252-8223 Contact/ Department Agenda Date Item was 09/23/2014 Agenda Item Number 155 \ to P'1"?,/ Approved by the BCC Type of Document 1) Agreement(Agency Health Care Number of Original 1) 4 originals Attached Administration) Documents Attached 2) Agreement(Collier Health 2) 4 originals Services,Inc.) Please see attached document for routing copies PO number or account n/a 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? EM 2. Does the document need to be sent to another agency for additional signatures? If yes, EM provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. V 3. Original document has been signed/initialed for legal sufficiency. (All documents to be EM 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 EM V 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 EM 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 EM signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip EM 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 on9 X3ind all changes made during the EM e' meeting have been incorporated in the attache document. The County Attorney's/7; 1 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 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 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 8 Item ID: 12987 AHCA: Please supply four originals of the Agreement between Collier County and the State of FL, Agency for Health Care Administration. These will need to be sent to the address below for signatures: Nicole Linn AHCA Medicaid Program Finance (MPF) 2727 Mahan Drive Mail Stop 23 Tallahassee, FL 32308 Phone: (850) 412-4287 **Please request that AHCA send three originals back to Collier County. CHS: Please supply 4 originals of the Agreement between Collier County and Collier Health Services, Inc. to be held by the Clerk's office until the three original signed Agreements from the State of FL, Agency for Health Care Administration are returned. The Clerk's office then will need to send one of these State signed originals affixed with the provided label marked "Attachment A" along with an original of the Collier County BOCC signed Collier Health Services, Inc.'s Agreement to the address for CHS as provided below. Collier Health Services, Inc. ATTN: Tami Raznoff 1454 Madison Ave. Immokalee, FL 34142 Phone: (239) 658-3137 (Tami Raznoff) Then after retaining the Clerk's one original Agreement please send the remaining original Agreements from the State of FL, Agency for Health Care Administration, from Collier Health Services, Inc. to the address for HHVS below: Housing, Human and Veteran Services ATTN: Esther Mae 3339 Tamiami Trail East, Ste 211 Naples, FL 34112 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 , County of Collier 16 D 18 CLERK OF THE CIRCUIT COURT Dwight E. Brock COLLIER COLN1,1;Y COLOR FFFOL SE Clerk of Courts Clerk of Courts 3315 FA\iIAmi FRL E STE IO2 - P.O. BOX 413044 Accountant NAPLES. FLORIDA , NAPLES, FLORIDA auditor 34112-5324 34101-3044 Custodian of Count} Funds September 24, 2014 Nicole Linn AHCA Medicaid Program Finance (MPF) 2727 Mahan Drive Mail Stop 23 Tallahassee, FL 32308 Ms. Linn, I have enclosed four (4) original Letter of Agreement to be signed by Stacey Lampkin. The Board of County Commissioners of Collier County approved this item at their September 23, 2014 BCC Regular Meeting. If you could return three (3) signed originals back to me, I would appreciate it. Any questions please contact me at 239-252-8411. Thank you, • Teresa Cannon, Deputy Clerk Phone- (239) 252-2646 Fax- (239) 252-2755 16018 MEMORANDUM Date: April 9, 2014 To: Esther Mae, Accountant Housing, Human and Veteran Services Department From: Teresa Cannon, Deputy Clerk Minutes & Records Department Re: An Agreement between Collier County and Collier Health Services, Inc. and FQHCs $11 Million Alternative LIP Letter of Agreement Attached for your records are fully executed original copies of both of the agreements referenced above, approved by the Board of County Commissioners (Item #16D18) on Tuesday, September 23, 2014. Our office has held original copies for the Board's Official Record and sent Collier Health Services an original. If you have any questions, please call me at 252-8411. Thank you. Attachments County of Collier 161318 CLERK OF THE CIRCIT COURT COLLIER COUNTY,'COUR1UOUSE 3315 TAMIAMI TRL E STE 102 Dwight E. Brock-G1erk of Circuit Court P.O. BOX 413044 NAPLES, FL 34112-5324 NAPLES,FL 34101-3044 Clerk of Courts • Comptroller • Auditor ustodian of County Funds October 9, 2014 Collier Health Services, Inc. 1454 Madison Ave Immokalee, FL 34142 Attn: Tami Raznoff Ms. Raznoff, Enclosed is your originals of the agreement between Collier County and Collier Health Services, Inc. approved at the September 23, 2014 Board of County Commissioners Meeting and signed by the State. Any questions, please contact me. Thank you, C.CAJAALV Teresa Cannon, Senior Deputy Clerk Phone- (239) 252-2646 Fax- (239) 252-2755 Website- www.CollierClerk.com Email- CollierClerkqcollierclerk.com 16018 AGREEMENT THIS AGREEMENT is made and entered on the �3rdday of 2014, by and between Collier County, Florida, a political subdivision of the State of F orida, hereinafter Y Y referred to as "the County" and Collier Health Services, Inc., a Florida not for profit incorporated under the laws of the State of Florida, and a Federal Health Qualified Center hereinafter referred to as "Center". RECITALS: WHEREAS, Section 125.01(1)(e), Florida Statutes, authorizes the County to provide health welfare programs for the residents of Collier County to the extent not inconsistent with general or special law. WHEREAS, the establishment and maintenance of such programs are in the common interest of the people of Collier County. WHEREAS, The County desires the Center to become a community health partner to assist in providing payments for health prevention programs, and mental health services to residents of the County. WHEREAS, The Center desires to be a community health partner and is willing to voluntarily provide payments for such services, subject to the terms and conditions hereinafter set forth. NOW THEREFORE, in consideration of the covenants herein contained, the parties hereby agree as follows: ARTICLE I SERVICES TO BE PERFORMED 1. The Center shall provide documentation and monthly reports to the County related to payment for the delivery of hospital services, designated primary health care services, specialty health care services and other health care services. 2. The Center and/or its sub-contractor shall provide timely responses to contract requirements. Responses to inquiries from the Public Services Division or designee regarding any aspect of payment of services being provided shall be as indicated below. a. Emergency room, secondary and tertiary care for those patients determined eligible by the County Human Services Department. b. Secondary and tertiary services shall be provided upon the referring physician or designated physician's order. The referral order shall distinguish between a referral for specific therapeutic services and a diagnostic workup. 3. Nothing in this contract shall be construed to limit access for a patient to any service provided by a Health Services provider that is medically necessary and approved by the County. ARTICLE II PAYMENTS 1 CA 160 8 The County shall make intergovernmental transfers, on behalf of Collier Health Services in connection with the LIP program to the State of Florida, hereinafter referred to as "State", in accordance with the Letter of Agreement between the County and the Agency for Health Care Administration. 1. The county will remit to the State an amount not to exceed a grand total of$107,283. The County will transfer payments to the State in the following manner: a. The first quarterly payment of$26,820 for the months of July, August, and September is due upon notification by the State. b. Each successive payment of$26,821 is due no later than, November 30, 2014, March 31, 2015 and May 25, 2015. c. The State will bill the County each quarter payments are due. 2. The following document is hereby incorporated by reference as Attachment A to this Agreement. a. Low Income Pool Agreement (LIP) with State of Florida AHCA reflecting the anticipated annual distributions for State Fiscal Year 2014-2015 (Attachment A). ARTICLE III CLAIMS VALUATION AND CLAIMS PROCESSING 1. As the claims processing entity, the Center will provide quarterly financial reports to the County in such detail as required by the County. 2. Prompt payment of invoices as presented to the Center should be made within 30 business days of receipt from the County. 3. Copies of all checks issued are to be sent to the County for record keeping. ARTICLE IV TERMS OF AGREEMENT AND TERMINATION 1. The term of this Agreement shall be October 1, 2014 through September 30, 2015 with no renewal. 2. Either party may terminate this Agreement thirty (30) calendar days after receipt by the other party of written notice of intent to terminate. In the event of termination, the County shall pay for services rendered, prorated to the date of termination. 3. Upon breach of this Agreement, the aggrieved party may, by written notice of breach to the breaching party, terminate the whole or any part of this Agreement. Termination shall be upon no less than twenty-four (24) hours notice, in writing, delivered by certified mail, telegram or in person. Waiver by either party of breach of any provisions of this Agreement shall not be deemed to be a waiver of any other or subsequent breach and shall not be construed to be a modification of the terms of this Agreement. 2 bJ 16018 6 4. It is further agreed that in the event general funds to finance all or part of this Agreement do not become available, the obligations of each party hereunder may be terminated upon no less than twenty-four (24) hours notice in writing to the other party. Said notice shall be delivered by certified mail, telegram or in person. The County shall be the final authority as to the availability of funds and as to how any available funds will be allocated among its various service providers. ARTICLE V ASSIGNMENT The Center and/or its sub-contractor shall not assign or transfer this Agreement, or any interest, right or duty herein, without the prior written consent of the County, which consent shall not be unreasonably withheld by the County. Without obtaining prior consent by the County, the Center shall be allowed to assign or transfer this Agreement or any of the Center's obligations hereunder to affiliates or wholly owned subsidiaries of the Center. This Agreement shall run to the County and its successors. ARTICLE VI SUBCONTRACTING The parties agree that the Center shall be permitted to execute subcontracts for the purchase by the Center of such services, articles, supplies, and equipment, which is both necessary and incidental to the performance of the work, required under this Agreement. However, the Center expressly understands that it shall assume the primary responsibility for performing the services outlined in Article I of this Agreement. ARTICLE VIII INSURANCE, SAFETY AND INDEMNIFICATION 1. Indemnity. To the maximum extent permitted by Florida law, the Center and/or its sub- contractor shall indemnify and hold harmless the County against any claims, damages, losses, and expenses, including reasonable attorneys' fees and costs, arising out of or resulting from the Center's failure to pay for services or performance under this Agreement. This indemnification obligation shall not be construed to negate, abridge or reduce any other rights or remedies which otherwise may be available to an indemnified party or person described in this paragraph. Center shall jointly and severally indemnify and hold harmless Collier County for all claims, demands, actions, suits, losses, costs, charges, expenses, damages and liabilities whatsoever which the County may pay, sustain, suffer or incur by reason of or in connection with this agreement including payment of all legal costs, including but not limited to, attorney's fees paid by the County. 2. Insurance Required: During the term of this agreement the Center shall procure and maintain liability insurance coverage. The liability insurance coverage shall be in amounts not less than $1,000,000 per person and $2,000,000 per incident of occurrence 3 Ud 16018 for personal injury, death, and property damage or any other claims for damages caused by or resulting from the activities under this Agreement. Such policies of insurance shall name the County as an additional insured. The Center shall purchase all policies of insurance from a financially responsible insurer duly authorized to do business in the State of Florida. The Center shall be financially responsible for any loss due to failure to obtain adequate insurance coverage and the failure to maintain such policies or certificate in the amounts set forth herein shall constitute a breach of this agreement. ARTICLE VIII BILLING PROCEDURES The Center has standard, acceptable billing procedures that the Center will utilize in the performance of its obligations under this Agreement. The County shall direct the Center to make payments pursuant to this Agreement once the County has verified the validity of the invoices to be paid by the Center. The Center will not pay any invoices prior to the County's approval. The Center will provide copies of checks for payments as they are remitted. The Center shall also provide quarterly reports showing invoices paid and pending payments. The Center shall make payments on a voluntary basis in the amount of$107,283 to specific healthcare programs and services that are pre-approved by the County for payment. The Center shall use reasonable efforts to pay invoices approved by the County within thirty (30) days of receipt of County approved invoices. Payments shall be made in accordance with this Agreement irrespective of whether the Center has received funds from AHCA. If the amount invoiced to the Center does not result in the amount of$107,283, the Center will hold the funds for the County for the difference and voluntarily make those payments to providers elected by the County until all funds are exhausted. ARTICLE IX RECORDS 1. The Center and/or its sub-contractor shall keep orderly and complete records of its accounts and operations related to the services provided under this Agreement for the entire term of the Agreement plus three (3) years. The Center and/or its sub-contractor shall keep open these records to inspection by County personnel at reasonable hours during the entire term of this Agreement. If any litigation, claim or audit is commenced prior to the expiration of the three (3) year period and extends beyond this period the records must remain available until any litigation, claim or audits have been resolved. Any person duly authorized by the County shall have full access to and the right to examine any of said records during said period. Access to PHI shall be in compliance with federal laws and HIPAA. ARTICLE X CIVIL RIGHTS 4 ®`) 16018 1. There will be no discrimination against any employee or person served on account of race, color, sex, age, religion, ancestry, national origin, handicap or marital status in the performance of the Agreement. 2. It is expressly understood that, upon receipt of evidence of such discrimination, the County shall have the right to terminate this Agreement for breach of agreement. 3. The Center and/or its sub-contractor shall comply with Title VI of the Civil Rights Act of 1964 (42 USC 2000d) in regard to persons served. 4. The Center and/or its sub-contractor shall comply with Title VII of the Civil Rights Act of 1964 (42 USC 2000c) in regard to employees or applicants for employment. 5. The Center and/or its sub-contractor shall comply with Section 504 of the Rehabilitation Act of 1973 in regard to employees or applicants for employment and clients served. ARTICLE XI OTHER CONDITIONS 1. Any alterations, variations, modifications or waivers of provisions of this Agreement shall only be valid when they have been reduced to writing, duly signed and attached to the original of this Agreement. The parties agree to renegotiate the Agreement if revision of any applicable laws or regulations makes changes in the Agreement necessary. 2. This Agreement contains all the terms and conditions agreed upon by the parties. All items incorporated by reference are as though physically attached. No other agreements, oral or otherwise, regarding the subject matter of this Agreement, shall be deemed to exist or to bind any of the parties hereto. 3. The Center and/or its sub-contractor shall obtain and possess throughout the term of this Agreement all licenses and permits applicable to its operations under federal, state, and local laws, and shall comply with all fire, health and other applicable regulatory codes. 4. The Center and/or its sub-contractor agrees to comply with all applicable requirements and guidelines prescribed by the County for recipients of funds. The Center and/or its sub-contractor agree to safeguard the privacy of information pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA). 5 Oy 16018 IN WITNESS WHEREOF, the parties have executed this Agreement on the dates indicated below. ATTEST: BOARD OF COUNTY COMMISSIONERS DWIGHT E. BROCK, Clerk COLLIER COUNTY, FLORIDA B O_OLtut-kx_Cs-c----- I By: .` A__ , Deputy Clerk Tom Henning, Chai I an Attest as to Chairman's signature only. COLLIE' EALTH SERVICES, INC. Approved as to form and legality: By: A __Ir■ii. _ --------' G'kT"--"- Title: CEO Jennifer A. Belpedio Assistant County Attorney \‘ e Collier County 9 0A Date: q I IN 6 0 16018 SEP 2 5 2014- FQHCs $11 Million Alternative LIP Letter of Agreement THIS LETTER OF AGREEMENT (LOA) made and entered into in duplicate on the oot.. day of Sae 2014, by and between Collier County (the County) on behalf of Collier Health Services / Health Care Network of SW FL, and the State of Florida, through its Agency for Health Care Administration (the Agency), 1. Per House Bill 5001, the General Appropriations Act of State Fiscal Year 2014-2015, passed by the 2014 Florida Legislature, County and the Agency, agree that County will remit to the State an amount not to exceed a grand total of$107,283. a. The County and the Agency have agreed that these funds will only be used to increase the provision of health services for the Medicaid, uninsured, and underinsured people of the County and the State of Florida at large. b. The increased provision of Medicaid, uninsured, and underinsured funded health services will be accomplished through the following Medicaid programs: i. Medicaid LIP payments to hospitals in the approved appropriations categories. ii. Medicaid LIP payments to Federally Qualified Health Centers. iii. Medicaid LIP payments to County Health Departments iv. Medicaid LIP payments for the expansion of primary care services to low income, uninsured individuals. 2. The County will pay the State an amount not to exceed the grand total amount of $107,283. The County will transfer payments to the State in the following manner: a. The first quarterly payment of$26,820 for the months of July, August, and September is due upon notification by the Agency. b. Each successive payment of$26,821 is due as follows, November 30, 2014, March 31, 2015 and May 25, 2015. c. The State will bill the County when each quarterly payment is due. 3. Attached is the LIP schedule reflecting the anticipated annual distributions for State Fiscal Year 2014-2015. 4. The County and the State agree that the State will maintain necessary records and supporting documentation applicable to Medicaid, uninsured, and underinsured health services covered by this LOA. Further, the County and State agree that the County shall have access to these records and the supporting documentation by requesting the same from the State. Collier County_Collier Health Services/Health Care Network of SW FL_FQHCs$11 Million Alternative LIP LOA SFY 2014- 15 .16 D 1 8 5. The County and the State 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 County confirms that there are no pre-arranged agreements (contractual or otherwise) between the respective counties, taxing districts, and/or the providers to re- direct any portion of these aforementioned Medicaid supplemental payments in order to satisfy non-Medicaid, non-uninsured, and non-underinsured activities. 7. The County agrees the following provision shall be included in any agreements between the County and local providers where funding is provided for the Medicaid program. Funding provided in this agreement shall be prioritized so that designated funding shall first be used to fund the Medicaid program (including LIP) and used secondarily for other purposes. 8. This LOA covers the period of July 1, 2014 through June 30, 2015 and shall be terminated June 30, 2015. FQHCs $11 Million Alternative LIP Local Intergovernmental Transfers (IGTs) State Fiscal Year 2014-2015 Total Funding $107,283 Collier County_Collier Health Services/Health Care Network of SW FL_FQHCs$11 Million Alternative LIP LOA SFY 2014- 15 a`� 16018 WITNESSETH: IN WITNESS WHEREOF the parties have duly executed this LOA on the day and year above first written. Collier County State of Florida 411111 c.. \' GC_ IV . ill/.►1...l,C- — Si nature acey La pin Assistant Deputy Secretary for Medicaid Finance, Agency for Health Care Administration Tom Henning Name RECEIVED Chairman SEP 2 5 2014 Title MEDICAID PROGRAM FINANCE ATTE,'T° Approved as to form and legality DW c E. 6rlocJ , CI ork hiot Assistant County mey Attest as to ClTairman s �3NI 4- signature,only Collier County_Collier Health Services/Health Care Network of SW FL_FQHCs$11 Million Alternative LIP LOA SFY 2014- 15 C—)