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Agenda 10/09/2012 Item #16D 310/9/2012 Item 16.D.3. EXECUTIVE SUMMARY Recommendation to approve an agreement in the amount of $225,759 with the Agency for Health Care Administration and an agreement with Collier Health Services (CHS) to participate in the Medicaid Low Income Pool Program. Participation in this program will generate $308,329 in Federal matching funds that will provide additional health services for the citizens of Collier County.. OBJECTIVE: To provide additional health services for the citizens of Collier County. CONSIDERATIONS: AHCA is a State entity that provides Medicaid services in Florida and operates the Medicaid Low Income Pool (LIP) program. The LIP program (per the attached agreement) takes local funds and uses these funds to obtain Federal matching dollars as follows: The allocation of County and matching funds is shown in the table below: Partners Countv IGT Commitment Matching Funds* Total ** Total $225,759 $308,329 $534,088 Partners Funds to Partners from Collier Health Services General Operating Funds Various Health Services Providers $225,759 *Match based on most recent formulas ** Per the program, the entire amount of Medicaid funding is provided to CHS Collier Health Services (CHS) desires to be a Community Health partner and is willing to voluntarily provide payment of $225,759 for health related services for the County's low income residents. CHS is a Federal Qualified Health Center and has qualified to participate in the Low Income Pool program with the AHCA. By participating in this program, it will allow CHS to receive $308,329 in additional Federal funds that will be utilized for additional healthcare services for low income individuals in Collier County. FISCAL IMPACT: The County will remit $225,759 to the State. These funds have already been budgeted in the Housing, Human and Veteran Services, Fiscal Year 13 General Fund Client Assistance budget. Participation in the LIP program will provide a total of $308,329 in matching funds that will be utilized for health related services for low income individuals in Collier County. LEGAL CONSIDERATIONS: This item is legally sufficient for Board action and requires a majority vote. — JBW GROWTH MANAGEMENT IMPACT: There is no growth management impact associated with this executive summary. Packet Page -863- 10/9/2012 Item 16.D.3. RECOMMENDATION: The Board of County Commissioners approve and authorize the Chairman to sign the agreement with Collier Health Services and the agreement with Agency for Health Care Administration. Prepared By: Kimberley Grant, Interim Director of Housing, Human, and Veterans Services Packet Page -864- COLLIER COUNTY Board of County Commissioners Item Number: 16.D.3. 10/9/2012 Item 16.D.3. Item Summary: Recommendation to approve an agreement in the amount of $225,759 with the Agency for Health Care Administration and an agreement with Collier Health Services (CHS) to participate in the Medicaid Low Income Pool Program. Participation in this program will generate $308,329 in Federal matching funds that will provide additional health services for the citizens of Collier County.. Meeting Date: 10/9/2012 Prepared By Name: Bendisa Marku Title: Operations Analyst,Wastewater 9/24/2012 7:02:56 PM Submitted by Title: Operations Analyst,Wastewater Name: Bendisa Marku 9/24/2012 7:02:57 PM Approved By Name: GrantKimberley Title: Interim Director, HHVS Date: 9/27/2012 4:13:42 PM Name: AlonsoHailey Title: Operations Analyst, Public Service Division Date: 10/1/2012 10:03:02 AM Name: AckermanMaria Title: Senior Accountant, Grants Date: 10/1/2012 10:19:33 AM Name: CarnellSteve Title: Director - Purchasing /General Services,Purchasing Packet Page -865- Date: 10/2/2012 1:39:27 PM 10/9/2012 Item 16.D.3. Name: WhiteJennifer Title: Assistant County Attomey,County Attorney Date: 10/2/2012 2:15:25 PM Name: KlatzkowJeff Title: County Attorney Date: 10/2/2012 3:20:17 PM Name: StanleyTherese Title: Management /Budget Analyst, Senior,Office of Management & Budget Date: 10/2/2012 3:43:35 PM Name: PryorCheryl Title: Management/ Budget Analyst, Senior,Office of Management & Budget Date: 10/2/2012 5:23:46 PM Name: IsacksonMark Title: Director -Corp Financial and Mgmt Svs,CMO Date: 10/3/2012 8:28:08 AM Packet Page -866- 10/9/2012 Item 16.D.3. AGREEMENT THIS AGREEMENT is made and entered on the day of October 2012, by and between Collier County, Florida, a political subdivision of the State of Florida, hereinafter 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 quarterly 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 including, but not limited to, the following services: a. Health prevention programs and health service providers. b. 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. c. Emergency room, secondary and tertiary care for those patients determined eligible by the County Human Services Department. d. 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. e. Nothing in this contract shall be construed to limit access for a patient to any service provided by the Center that is medically necessary and approved by the County. ARTICLE 11 1 Packet Page -867- 10/9/2012 Item 16.D.3. PAYMENTS 1. The County shall make intergovernmental transfers, on behalf of Collier Health Services 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: The County will transfer payments to the State in the following manner: a) The first quarterly payment of $56,442 for the months of July, August, and September is due upon notification by the State. b) Each successive payment of $56,439 is due no later than. November 30, 2012, March 31, 2013 and June 15, 2013. 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 1. Low Income Pool Agreement (LIP) with State of Florida AHCA (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. ARTICLE IV TERMS OF AGREEMENT AND TERMINATION 1. The term of this Agreement shall be October 1, 2012 through September 30, 2013 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. 4. 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. 5. 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. 2 Packet Page -868- 10/9/2012 Item 16.D.3. 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. The Center and /or its sub - contractor shall indemnify the County against any claims, damages, fosses, and expenses, including reasonable attorneys' fees and costs, arising out of, resulting from the Center's failure to pay for services as directed by the County. The County shall indemnify the Center against any claims, damages, losses, and expenses, including reasonable attorneys' fees and costs, arising out of, resulting from or in any way connected with the performance of the County's responsibilities under this Agreement including the County's review of all invoices to insure that no violations of state of federal laws, rules or regulations occurs in payments made pursuant to this Agreement. Collier County's indemnification is subject to the limits of § 768.28, sovereign immunity. 2. Insurance Required. The Center maintains insurance that fully satisfies the insurance requirements of the County. ARTICLE IIIV 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 shall make payments to specific healthcare programs and services, such as the health programs at the Collier County Health Department 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 County approval. Packet Page -869- 10/9/2012 Item 16.D.3. For the healthcare services provided by the Center, the Center shall be reimbursed at the federally approved Medicare rates. The County shall be responsible for verifying invoices for such services prior to reimbursement to the Center. The Center has the right to bill the balance to the patient for any difference between the Medicare rate and the amount the Center is paid pursuant to the County's authorization. ARTICLE IX RECORDS 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 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. 1 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. 4 Packet Page -870- 10/9/2012 Item 16.D.3. 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. 5. 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). IN WITHNESS WHEREOF, the parties have executed this Agreement on the dates indicated below. ATTEST: DWIGHT E. BROCK, Clerk M Deputy Clerk Approved as to form and legal sufficiency BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY, FLORIDA in Fred W. Coyle, Chairman Date: October 09, 2012 COLLIER HEALTH SERVICES By: Sandra E. Steele, CFO Assistant County Attorney Collier County Date Packet Page -871- 10/9/2012 Item 16.D.3. Letter of Agreement THIS LETTER OF AGREEMENT made and entered into in duplicate on the day of 2012, by and between Collier County (the County), 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 2012 -2013, passed by the 2012 Florida Legislature, County and the Agency, agree that County will remit to the State an amount not to exceed a grand total of $225,759. 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 inpatient and outpatient reimbursement ceilings for teaching, specialty and community hospital education program hospitals. iii. The removal of inpatient and 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 inpatient and outpatient reimbursement ceilings for hospitals whose Medicaid days, as a percentage of total hospital days, exceed 7.3 percent, and are trauma centers. v. Increase the annual capon outpatient services for adults from $500 to $1,500. vi. Medicaid Low Income Pool (LIP) payments to rural hospitals, trauma centers, specialty pediatric hospitals, primary care services and other Medicaid participating safety -net hospitals. vii. Medicaid LIP payments to hospitals in the approved appropriations categories. viii. Medicaid LIP payments to Federally Qualified Health Centers. ix. Medicaid LIP payments to Provider Access Systems (PAS) for Medicaid and the uninsured in rural areas. x. Medicaid LIP payments for the expansion of primary care services to low income, uninsured individuals. LIP Letter of Agreement for SFY 2012 -13 Packet Page -872- 10/9/2012 Item 16.D.3. 2. The County will pay the State an amount not to exceed the grand total amount of $225,759. The County will transfer payments to the State in the following manner: a. The first quarterly payment of $56,442 for the months of July, August, and September is due upon notification by the Agency. b. Each successive payment of $56,439 is due as follows, November 30, 2012, March 31, 2013 and June 15, 2013. c. The State will bill the County each quarter payments are due. 3. Timelines: This agreement must be signed and submitted to the Agency no later than October 9, 2012, to be effective for SFY 2012 -2013, 4. Attached are the DSH and LIP schedules reflecting the anticipated annual distributions for State Fiscal Year 2012 -2013. 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. 8. 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 2011 -12 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 2012 -13) LOAs. 10. This Letter of Agreement covers the period of July 1, 2012 through June 30, 2013 and shall be terminated June 30, 2011 LIP Letter of Agreement for SFY 2012 -13 Packet Page -873- 10/9/2012 Item 16.D.3. WITNESSETH: IN WITNESS WHEREOF the parties have duly executed this Letter of Agreement on the day and year above first written. Collier County State of Florida Signature Phil E. Williams Assistant Deputy Secretary for Medicaid Finance, Agency for Health Care Administration Name Title LIP Letter of Agreement for SFY 2012 -13 Packet Page -874- Local Government Inter overnmental Transfers Program / Amount State Fiscal Year 2012 -2013 DSH LIP, Exemptions & SWi 225,759 Nursing Home SMP Total Funding $225,759 LIP Letter of Agreement for SFY 2012 -13 Packet Page -875- 10/9/2012 Item 16.D.3.