Agenda 03/11/2014 Item #16D83/11/2014 16.D.8.
EXECUTIVE SUMMARY
Recommendation to approve an agreement in the amount of $250,000 with the Agency for Health
Care Administration (AHCA) and an agreement with Naples Community Hospital, Inc. (NCH) to
participate in the Medicaid Low Income Pool Program, generating $21,250 in Federal matching
funds that will provide additional health services for the citizens of Collier County.
OBJECTIVE: To provide additional health services for low - income citizens of Collier County.
CONSIDERATIONS: The Agency for Health Care Administration (AHCA) is a State entity that
provides Medicaid services in Florida and operates the Medicaid Low Income Pool (LIP) program. The
LIP program takes local funds and leverages them to obtain Federal matching dollars. Collier County
has participated in the LIP Program for many years. Housing, Human and Veterans Services (HHVS)
was recently informed of an additional opportunity to participate in the LIP program.
Naples Community Hospital (NCH) desires and is qualified to administer the LIP program with AHCA
using County tax dollars. By participating in this program, NCH will receive $21,250.in matching Federal
funds that will be utilized to increase the provision of health services for the Medicaid, uninsured, and
underinsured people in Collier County. The allocation of County and matching funds is shown in the table
below:
The proposed agreements are consistent with prior Board- approved LIP arrangements.
Physicians Regional Healthcare System was also invited to participate, but has declined at this
time.
FISCAL IMPACT: Funds in the amount of $250,000 are budgeted in the HHVS Client Assistance
budget in the General Fund (001). These funds will be sent to AHCA, then used to pay for medical care
for income - qualified HHVS clients, while also being leveraged to garner an additional $21,250 paid
directly to NCH.
LEGAL CONSIDERATIONS: NCH agreements include the most current insurance and
indemnification provisions for County intergovernmental agreements. NCH is also required to
make payments to specific health care programs and services irrespective of whether it receives
funds from AHCA. Accordingly, this item is approved for form and legality and requires a
majority vote for Board approval. — JAB
GROWTH MANAGEMENT IMPACT: None.
RECOMMENDATION: The Board of County Commissioners approves and authorizes the Chairman to
sign the agreement with the Agency for Health Care Administration and the agreement with Naples
Community Hospital.
/0'1 Prepared By: Esther Mae, Accountant, Housing, Human, and Veterans Services
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Collier County Budgeted
Matching Funds Provided to
Total Funds Benefitting
Funds for Medical
NCH as Program Administrator
Low- Income Persons
Assistance
Total
$250,000
$21,250
$271,250
The proposed agreements are consistent with prior Board- approved LIP arrangements.
Physicians Regional Healthcare System was also invited to participate, but has declined at this
time.
FISCAL IMPACT: Funds in the amount of $250,000 are budgeted in the HHVS Client Assistance
budget in the General Fund (001). These funds will be sent to AHCA, then used to pay for medical care
for income - qualified HHVS clients, while also being leveraged to garner an additional $21,250 paid
directly to NCH.
LEGAL CONSIDERATIONS: NCH agreements include the most current insurance and
indemnification provisions for County intergovernmental agreements. NCH is also required to
make payments to specific health care programs and services irrespective of whether it receives
funds from AHCA. Accordingly, this item is approved for form and legality and requires a
majority vote for Board approval. — JAB
GROWTH MANAGEMENT IMPACT: None.
RECOMMENDATION: The Board of County Commissioners approves and authorizes the Chairman to
sign the agreement with the Agency for Health Care Administration and the agreement with Naples
Community Hospital.
/0'1 Prepared By: Esther Mae, Accountant, Housing, Human, and Veterans Services
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3/11/2014 16.D.8.
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.16.D.16.D.8.
Item Summary: Recommendation to approve an agreement in the amount of $250,000
with the Agency for Health Care Administration (AHCA) and an agreement with Naples
Community Hospital, Inc. (NCH) to participate in the Medicaid Low Income Pool Program,
generating $21,250 in Federal matching funds that will provide additional health services for
the citizens of Collier County.
Meeting Date: 3/11/2014
Prepared By
Name: MaeEsther
Title: Accountant, Housing, Human & Veteran Services
2/27/2014 8:58:48 AM
r-� Approved By
Name: TownsendAmanda
Title: Director - Operations Support, Public Services Division
Date: 2/27/2014 5:06:32 PM
Name: AlonsoHailey
Title: Operations Analyst, Public Services Division
Date: 2/28/2014 11:47:38 AM
Name: Bendisa Marku
Title: Supervisor - Accounting, Housing, Human & Veteran Services
Date: 2/28/2014 3:57:36 PM
Name: CarnellSteve
Title: Administrator - Public Services, Public Services Division
Date: 3/2/2014 8:33:45 PM
Name: RobinsonErica
Title: Accountant, Senior, Grants Management Office
Date: 3/3/2014 8:32:24 AM
Name: BelpedioJennifer
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Title: Assistant County Attorney, CAO General Services
Date: 3/3/2014 10:26:47 AM
Name: StanleyTherese
Title: Management/Budget Analyst, Senior, Grants Management Office
Date: 3/3/2014 11:42:23 AM
Name: KlatzkowJeff
Title: County Attorney,
Date: 3/3/2014 11:46:50 AM
Name: FinnEd
Title: Management/Budget Analyst, Senior, Transportation Engineering & Construction Management
Date: 3/4/2014 9:18:13 AM
Name: OchsLeo
Title: County Manager, County Managers Office
Date: 3/4/2014 9:36:26 AM
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3/11/2014 16.D.8.
AGREEMENT
THIS AGREEMENT is made and entered on the day of , 2014, by and
between Collier County, Florida, a political subdivision of the State of Florida, hereinafter
referred to as "the County" and Naples Community Hospital, Inc., a Florida not for profit
corporation herein after referred to as "Hospital ".
RECITALS:
WHEREAS, Section 125.01(1xe), 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 Hospital 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 Hospital 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 .1
SERVICES TO BE PERFORMED
1. The Hospital 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.
spital 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.
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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
The County shall make Intergovernmental transfers, on behalf of Naples Hospital in connection
with the LIP program to the State of Florida in accordance with the Letter of Agreement between
the County and the Agency for Health Care Administration.
I. The county will remit to the State an amount not to exceed a grand total of $250,000.
The County will transfer payments to the State in the following manner:
a. The first quarterly payment of $62,500 for the months of July, August, and
September is due upon notification by the Agency.
b. Each successive payment of $62,500 is due by June 1, 2014.
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 (Attachment A).
ARTICLE III
CLAIMS VALUATION AND CLAIMS PROCESSING
I. As the claims processing entity, the Hospital will provide quarterly financial reports to the
County in such detail as required by the County.
ARTICLE IV
TERMS OF AGREEMENT AND TERMINATION
1. The term of this Agreement shall be March 11, 2014 through March 10, 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.
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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.
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 parity 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, 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 Hospital 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
Hospital shall be allowed to assign or transfer this Agreement or any of the Hospital's
obligations hereunder to affiliates or wholly owned subsidiaries of the Hospital. This Agreement
shall run to the County and its successors.
ARTICLE VI
SUBCONTRACTING
The parties agree that the Hospital shall be permitted to execute subcontracts for the purchase
by the Hospital 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 Hospital
expressly understands that it shall assume the primary responsibility for performing the services
outlined in Article I of this Agreement.
ARTICLE VII
INSURANCE, SAFETY AND INDEMNIFICATION
Indemnity. To the maximum extent permitted by Florida law, the Hospital and/or its sub-
contractor shall indemnify and hold harmless the County against any claims, damages,
losses, and expenses, including reasonable attomeys' fees and costs, arising out of or
resulting from the Hospital's failure to pay for services or performance under this
Agreement. This indemnification obligation shall not be construed to negate, abridge or
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reduce any other rights or remedies which otherwise may be available to an indemnified
party or person described in this paragraph.
2. Hospital 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, attomey's fees paid by the County.
3. Insurance Required: During the term of this agreement the Hospital 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
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 Hospital shall purchase all policies of
insurance from a financially responsible insurer duly authorized to do business in the
State of Florida. The Hospital 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 1001%,
The Hospital has standard, acceptable billing procedures that the Hospital will utilize in the
performance of its obligations under this Agreement.
The County shall direct the Hospital to make payments pursuant to this Agreement once the
County has verified the validity of the invoices to be paid by the Hospital. The Hospital will not
pay any invoices prior to the County's approval.
The Hospital will provide copies of checks for payments as they are remitted. The Hospital shall
also provide quarterly reports showing invoices paid and pending payments.
The Hospital shall make payments on a voluntary basis in the amount of $250,000 to specific
healthcare programs and services that are pre - approved by the County for payment. The
Hospital shall use reasonable efforts to pay invoices approved by the County within thirty (30)
days of County approval. Payments shall be made in accordance with this Agreement
irrespective of whether the Hospital has received funds from AHCA.
If the amount invoiced to the Hospital does not result in the amount of $250,000, the Hospital
will credit the County for the difference and voluntarily make those payments to providers
elected by the County in the following year.
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ARTICLE D(
RECORDS
The Hospital 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 Hospital 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 Ittigabon, 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
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 Hospital 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 Hospital 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 Hospital 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
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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 Hospital 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 Hospital and /or its sub - contractor agrees to comply with all applicable requirements
and guidelines prescribed by the County for recipients of funds.
5. The Hospital and /or its sub - contractor agree to safeguard the privacy of information
pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
IN WITNESS WHEREOF, the parties have executed this Agreement on the dates indicated
below.
ATTEST:
DWIGHT E. BROCK, Clerk
By:
, Deputy Clerk
Attest as to Chairman's signature only.
Approved as to form and legality:
Jennifer A. Belpedio
Assistant County Attorney Q�
Collier County 2
45
BOARD OF COUNTY COMMISSIONERS
COLLIER COUTNY, FLORIDA
By:
Tom Henning, Chairman
NAPLES CO UI PeA
INC.
By: fR1WVV J10
Titre: C(_0
Date: Z
L
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Letter of Agreement
THIS LETTER OF AGREEMENT made and entered into in duplicate on the day of
2014, by and between Collier County (the County), and the State of Florida, through its
Agency for Health Care Administration (the Agency),
1. Per Senate Bill 1500, the General Appropriations Act of State Fiscal Year 2013 -2014,
passed by the 2013 Florida Legislature, County and the Agency, agree that County will
remit to the State an amount not to exceed a grand total of $250,000.
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. The Disproportionate Share Hospital (DSH) program.
ii. The removal of outpatient reimbursement ceilings for teaching, specialty
and community hospital education program hospitals.
iii. The removal of outpatient reimbursement ceilings for hospitals whose
charity care and Medicaid days as a percentage of total adjusted hospital
days equals or exceeds 11 percent.
iv. The removal of outpatient reimbursement ceilings for hospitals whose
Medicaid days, as a percentage of total hospital days, exceed 7.3
percent, and are trauma centers.
v. Inpatient DRG add -ons for teaching, specialty, children's, public and
community hospital education program hospitals; hospitals whose charity
care and Medicaid days as a percentage of total adjusted hospital days
equals or exceeds 11 percent; or hospitals whose Medicaid days, as a
percentage of total hospital days, exceed 7.3 percent, and are trauma
centers.
vi. The annual cap increase on outpatient services for adults from $500 to
$1,500.
vii. Medicaid Low Income Pool (LIP) payments to rural hospitals, trauma
centers, specialty pediatric hospitals, primary care services and other
Medicaid participating safety -net hospitals.
viii. Medicaid LIP payments to hospitals in the approved appropriations
categories.
ix. Medicaid LIP payments to Federally Qualified Health Centers.
Collier County Naples Community Hospital—LIP LOA SFY 2013 -14
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x. Medicaid LIP payments to Provider Access Systems (PAS) for Medicaid
and the uninsured in rural areas.
xi. 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
$250,000. The County will transfer payments to the State in the following manner.
a. The first quarterly payment of $62,500 for the months of July, August, and
September is due upon notification by the Agency.
b. Each successive payment of $62,500 is due by June 1, 2014.
c. The State will bill the County each quarter payments are due.
3. Timelines: This agreement must be signed, submitted, and received to the Agency no
later than October 1, 2013, for self - funded exemptions, buybacks and DRG add -ons, to
be effective for SFY 2013 -2014.
s
4. Attached are the DSH and LIP schedules reflecting the anticipated annual distributions
for State Fiscal Year 2013 -2014.
5. 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 Letter of Agreement. 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.
6. The County and the State agree that any modifications to this Letter of Agreement shall
be in the same form, namely the exchange of signed copies of a revised Letter of
Agreement.
7. 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.
B. 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.
9. The Agency will reconcile the difference between the amount of the IGTs used by or on
behalf of individual hospitals' buybacks of their Medicaid inpatient and outpatient trend
adjustments or exemptions from reimbursement limitations for SFY 2012 -13 and an
estimate of the actual annualized benefit derived based on actual days and units of
service provided. Reconciliation amount may be incorporated into current year (SFY
2013 -14) LOAs.
Collier County_Naples Community Hospital_LIP LOA SFY 2013 -14
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r1 10. This Letter of Agreement covers the period of July 1, 2013 through June 30, 2014 and
shall be terminated June 30, 2014.
Collier County Naples Community Hospital_LIP LOA SFY 2013 -14
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3/11/2014 16.D.8.
WITNESSETH:
IN WITNESS WHEREOF the parties have duly executed this Letter of Agreement on the day
and year above first written.
Collier County
Signature
Tom NE1'j a%0lC'
Name
C-%A A i 12mA r�
Title
State of Florida
Stacey Lampkin
Assistant Deputy Secretary for Medicaid Finance,
Agency for Health Care Administration
ATTEST
DWIGHT E. BROCK, Gertc
By: Approved as to form and lid,
ant county
Collier County_Naples Community Hospital-LIP LOA SFY 2013 -14
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Collier County_Naples Community Hospital_LIP LOA SFY 2013 -14
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