Backup Documents 11/15/2016 Item #16E 6 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SIIP�
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 0 LT 6
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2.
3. County Attorney Office County Attorney Office SRT 11,YS-16
4. BCC Office Board of County 1:54
Commissioners y4/ k l k1--1\\b
5. 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 Artie Bay Contact Information 239-252-37 6
Contact/ Department
Agenda Date Item was November 15,2016 Agenda Item Number 16E6
Approved by the BCC
Type of Document An Amendment to Agreement 12-5874 for EMS Number of Original Two
Attached Billing to add consulting services for the purpose Documents Attached
of enrollment in the Florida EMS Public
Emergency Medical Transports Medicaid
program
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 sign re STAMP OK N/A
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 SRT b�
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 SRT
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 SRT
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 SRT
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip SRT
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 11/15/16 and all changes made during SRT
the meeting have been incorporated in the attached document. The County
Attorney's Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the
qi-DM
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
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MEMORANDUM
Date: November 21, 2016
To: Artie Bay, Supervisor
Emergency Medical Services Department
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Amending Agreement #12-5874
Attached for your records is an original copy of the amendment document referenced
above, (Item #16E6) approved by the Board of County Commissioners on Tuesday,
November 15, 2016.
The second original will be held in the Minutes and Records Department for the
Board's Official Record.
If you need further information, please feel free to contact me at 252-8406.
Thank you.
Attachment
1
AMENDMENT No.2 TO AGREEMENT 12-5874 1 6 E 6
FOR EMS BILLING
THIS AMENDMENT No. 2 (the "Amendment") is made and entered into this 8th day of November, 2016 (the
"Effective Date") by and between Collier County, Florida, a political subdivision of the State of Florida ("County") and
Advanced Data Processing,Inc.,a subsidiary of Intermedix Corporation,a Delaware corporation("Contractor").
WHEREAS, County and Contractor entered into an Agreement for EMS Billing, effective November 13, 2012
(the"Agreement")as amended;and
WHEREAS, County has requested and Contractor agrees to provide consulting services to County to enroll in the
Florida EMS PEMT (Public Emergency Medical Transports) Medicaid program, and provide ongoing consulting/costing
services for both the Florida CPE (Certified Public Expenditures) PEMT and the proposed IGT (Intergovernmental
Transfer) PEMT, which includes Medicaid managed care transports revenue programs (the "Consulting Services") for a
period running coterminous with that currently provided in the Agreement.
NOW THEREFORE, County and Contractor agree to amend the Agreement to include the following:
1. New Schedule A-1 (Description of Consulting Services and Revenue Recognition Process Related to the
EMS PEMT Medicaid Program,the Florida CPE PEMT Program and the IGT PEMT Program)and new Schedule A-2
(CPE Program for EMS and Medicaid Managed Care Supplemental Payment Program Service Fees)attached herewith are
hereby added to the Agreement.
1. Capitalized terms not otherwise defined in this Amendment shall have the meanings ascribed to such terms in the
Agreement. All other terms and conditions of the Agreement are hereby ratified and shall remain in full force and effect
except to the extent this Amendment expressly modifies or is inconsistent with the terms and conditions of the Agreement,
in which case the terms of this Amendment shall be controlling.
IN WITNESS OF, the parties have executed this Amendment to the above-referenced Agreement effective as of
the Effective Date.
ATTEST: •• / Coun Board of County Commissioners,Collier County,Florida
Dwight,.Broct jerk nf'tsourts 10.4...
By .:• �..,� ',� e-, r By:
Date. -••i :rdr"1lb'" onna Fiala,Chair
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D 1uty Coun Attorney
Contractor:Advanced Data Processing,Inc.,
a Subsidiary of Intermedix Corporation,a Delaware
'' Corporation
A , // . By: igic:2,//:&,1449
First Witness I �' V � c vU
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Name:
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t Recd AMENDMENT TO AGREEMENT 12-5874 OP
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Schedule A-1 16E6
Description of Consulting Services and Revenue Recognition Process Related to the
EMS PEMT Medicaid Program,the Florida CPE PEMT Program and the IGT PEMT Program
• Term of Consulting Services: To run conterminous with the period currently provided in the Agreement.
• Drafting application materials and responding to requests for additional information necessary for the provider to
gain approval to participate in the Ambulance Supplemental Payment Programs.
• Preparing a fiscal impact study and presenting results to department/state stakeholders to demonstrate benefits of a
Continuing Public Expenditure("CPE")Program,Medicaid Managed Care supplemental payment,and uninsured
CPE(if applicable)program to the provider.
• Identifying eligible costs and developing appropriate cost allocation methodologies to report only allowable costs
for providing emergency medical services to Medicaid and,as applicable,uninsured populations.
• Preparing the annual Medicaid cost report for EMS on behalf of provider.
• Conducting analysis of the provider's financial and billing data in order to prepare and submit annual cost reports,
the mechanism for providers to receive additional revenue under Ambulance Supplemental Payment Programs.
• Providing comprehensive desk review support, including but not limited to conducting reviews of all cost
settlement files, performing detailed analysis of billing reports generated by Medicaid agencies to ensure that all
allowable charges and payments are encompassed in the calculation of the final settlement, and drafting letters
and providing supporting documentation to meet Medicaid requirements and expedite settlement.
• Performing relevant analysis to determine a viable Medicaid managed care supplemental payment methodology.
• Executing Medicaid managed care supplemental payment calculations in adherence with the approved
methodology.
• Determining enhanced supplemental payments realized by provider,as necessary.
• Conducting comparative analysis to identify significant trends in billing and financial data.
• Providing charge master review to ensure that the provider is optimizing charges to drive revenue generation.
• Meeting with the Florida Agency for Health Care Administration (ARCA) and Client to further develop the
supplemental payments program for both Medicaid managed care and uninsured patient transports.
• Respond to, and represent Client on any AHCA or CMS audit, review or communication regarding any PEMT
cost report prepared by Intermedix and delivered to AHCA on behalf of the Client.
AMENDMENT TO AGREEMENT 12-5874
PAGE 2 °VD
1 6 E6
Schedule A-2
CPE PROGRAM FOR EMS AND MEDICAID MANAGED
CARE SUPPLEMENTAL PAYMENT PROGRAM SERVICE FEES
All revenue realized by the Client from the Certified Public Expenditure (CPE)Program for Emergency Medical Services
and Medicaid Managed Care Supplemental Payment Program shall be paid in full directly to Client. Revenue realized as a
result of the Certified Public Expenditures (CPE) for Emergency Medical Services (EMS) shall be determined by the
Medicaid cost settlement determined through the Medicaid cost report.
Intermedix will not receive any compensation until the CPE for Emergency Medical Services settlement or Medicaid
Managed Care Supplemental Payment revenues are received by the Client. Intermedix will invoice and receive revenue
upon the receipt of revenue received by Client for either initiative, meaning revenue does not have to be generated for both
the CPE for Emergency Medical Services and the Medicaid Managed Care Supplemental Payment program,rather revenue
simply needs to be generated for either initiative to allow Intermedix to generate invoices. Intermedix will invoice Client
based on the final CPE for Emergency Medical Services settlement or Medicaid Managed Care Supplemental payments
within thirty(30)days of receipt of funds by the Client.
The contingency fee to be paid associated with the respective successful implementation, generation and recovery of
incremental Medicaid revenues as a result of the CPE for Emergency Medical Services and Medicaid Managed Care
Supplemental Payment programs is established as fifteen percent(15%) of Client revenues collected from the State under
those programs. Client will remit payment to Intermedix upon receipt of a proper invoice and in compliance with Chapter
218 Fla. Stats.,otherwise known as the"Local Government Prompt Payment Act."
AMENDMENT TO AGREEMENT 12-5874
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