Agenda 10/23/2012 Item #16D12 10/23/2012 Item 16.D.12.
EXECUTIVE SUMMARY
Recommendation to authorize the Chairman to execute agreements between the County and the
Agency for Health Care Administration (AHCA) for any additional eligible funding that may be
leveraged under the alternative intergovernmental transfer programs (IGT). Any funds so
identified are already budgeted in the FY 2013 approved budget and executed agreements will be
brought back to the Board for ratification.
OBJECTIVE: To further leverage budgeted funds to augment the IGT arrangement with Physicians
Regional Medical Center and Naples Community Hospital (collectively "the Hospitals") to enhance the
quality of care provided to,and the health of,underinsured and uninsured citizens.
CONSIDERATIONS: The Agency for Health Care Administration (AHCA) is the State entity that
provides Medicaid services in Florida and operates the IGT programs. Through agreements between local
government and AHCA, these programs take local funds and uses these funds to obtain Federal matching
dollars. At the October 9, 2012 meeting, item 16D2, approval was granted to enter into agreements for
this upcoming year. Also,in that executive summary,the following was noted:
"Since two hospitals are now participating, greater participation in the AHCA programs may be
warranted considering the benefit such participation brings to these hospitals and the community. This
would require locating additional existing County budgeted funds already designated to fund allowable
health services, and including them in the AHCA programs. Should we be able to identify any such funds
that could also be reasonably managed under such an arrangement, staff will bring back agreements with
AHCA for greater amounts at a future board meeting."
Staff has been reviewing options for additional leverage, but final decisions/recommendations are not
fully developed as of the writing of this executive summary. One potential option being explored is to
leverage the additional $300,000 of funding to be awarded to the David Lawrence Center in support of
Baker Act services which was directed by the Board during the final budget hearing. There may be other
opportunities such as general fund appropriations already existing in the Human Services budget allocated
to persons with incomes at or below the poverty level, and other health related arrangements already in
the budget. Staff is committed to locating any reasonably available funding and working with the
Hospitals and their consultants to create the most advantageous outcome for all parties.
Expanding beyond the historical avenues for identification of funds to leverage in these arrangements
takes careful consideration, communication and evaluation of all impacts. There is advantage to all
parties to seek additional funds, as the Hospitals can receive the Federal match, and the County's partners
can receive a leverage increase/match from the Hospitals on the funding allocated by the County.
To illustrate why this is worth pursuing, the approved agreements from 10/23/12 provided for a County
leverage of just over $2 Million which, in turn, provided a total match of over $2.8 Million. So, if, for
example, staff can locate an additional $300,000 of appropriate expenditures within the existing FY13
budget, then the approximate match (AHCA would perform final match calculations) for that would be
another $300,000+ coming back into our community to cover services to these underinsured and un-
insured citizens that the Hospitals are required to treat.
We have a very short window of opportunity to complete this analysis in order to meet the AHCA
statutory deadline of 10/31/12 for execution of agreements for this program year. As of the agenda
deadline,the proposed revised agreements with ACHA have not been finalized. Copies of the previously
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10/23/2012 Item 16.D.12.
approved agreements with ACHA are provided as backup to this agenda item. Staff is requesting the
Board to authorize the Chairman to sign the revised agreements in order to submit them to ACHA. The
only change from the previously approved agreements will be the increased allocation amount. Finalized
agreements will be provided to the Hospitals for their review and acceptance prior to requesting the
Chairman's signature. A copy of the newly executed agreements will be provided to the Board at the
November 13 meeting for ratification.
FISCAL IMPACT: There is no net change to the Fiscal Year 2013 adopted budget as a result of these
potential actions.
LEGAL CONSIDERATIONS: If this item is approved, AHCA's standard form agreements will be
used and almost identical to the agreements with AHCA that were approved by the Board at the October
9, 2012 meeting,Agenda Item 16D2. The notable difference will be the dollar amounts. The two AHCA
Agreements are back-up to this item. -JBW
GROWTH MANAGEMENT IMPACT: There is no growth management impact associated with this
executive summary.
RECOMMENDATION: Authorize the Chairman to execute revised agreements with AHCA as
outlined in the Executive Summary (the only revision proposed is to reflect increased funding amounts).
Executed agreements will be brought back to the Board for ratification after the fact at the meeting of
November 13, 2012.
Prepared by: Bendisa Marku,Accounting Supervisor, Housing,Human and Veteran Services
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10/23/2012 Item 16.D.12.
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.D.12.
Item Summary: Recommendation to authorize the Chairman to execute agreements
between the County and Agency for Health Care Administration (AHCA)for any additional
eligible funding that may be leveraged under the alternative intergovernmental transfer
programs (IGT). Any funds so identified are already budgeted in the FY2013 approved budget
and executed agreements will be brought back to the Board for ratification.
Meeting Date: 10/23/2012
Prepared By
Name: HutchinsonBarbetta
Title: Executive Secretary,Office of Management&Budget
10/17/2012 8:30:17 AM
Submitted by
Title: Executive Secretary,Office of Management&Budget
Name: HutchinsonBarbetta
10/17/2012 8:30:19 AM
Approved By
Name: AlonsoHailey
Title: Operations Analyst,Public Service Division
Date: 10/17/2012 8:37:02 AM
Name: GrantKimberley
Title: Interim Director,HHVS
Date: 10/17/2012 8:54:49 AM
Name: CarnellSteve
Title: Director-Purchasing/General Services,Purchasing
Date: 10/17/2012 9:04:18 AM
Name: WhiteJennifer
Title: Assistant County Attorney,County Attorney
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10/23/2012 Item 16.0.12.
Date: 10/17/2012 9:07:54 AM Amok
Name:KlatzkowJeff
Title: County Attorney
Date: 10/17/2012 11:09:46 AM
Name: StanleyTherese
Title: Management/Budget Analyst, Senior,Office of Manage
Date: 10/17/2012 11:13:44 AM
Name: PryorCheryl
Title: Management/Budget Analyst, Senior,Office of Manag
Date: 10/17/2012 1:29:05 PM
Name: IsacksonMark
Title: Director-Corp Financial and Mgmt Svs,CMO
Date: 10/17/2012 3:19:51 PM
Askt-
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10/23/2012 Item 16.D.12.
Letter of Agreement
THIS LETTER OF AGREEMENT made and entered into in duplicate on the day of
Q ct , 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, the County and the Agency agree that the
County will remit to the State an amount not to exceed a grand total of $967,854.
a. The County and the Agency have agreed that these funds will only be used to
increase the provision of Medicaid funded health services to the people of the
County and the State of Florida at large.
b. The increased provision of Medicaid funded health services will be accomplished
through the buyback of the Medicaid inpatient and outpatient trend adjustments
up to the actual Medicaid inpatient and outpatient cost but not to exceed the
amount specified in the Appropriations Act for public hospitals, including any
leased public hospital found to have sovereign immunity, teaching hospitals as
defined in section 408.07 (45) or 395.805, Florida Statutes, which have seventy
or more full-time equivalent resident physicians, designated trauma hospitals and
hospitals not previously included in the GAA.
2. The County will pay the State an amount not to exceed the grand total amount of
$967,854. The County will transfer payments to the State in the following manner:
a. The first quarterly payment of$241,965, for the months of July, August, and
September, is due upon notification by the Agency.
b. Each successive payment of$241,963 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. The County and the State agree that the State will maintain necessary records and
supporting documentation applicable to Medicaid 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.
5. 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.
6. The County confirms that there are no pre-arranged agreements (contractual or
otherwise) between the respective counties, taxing districts, and/or the hospitals to re-
direct any portion of these aforementioned Medicaid supplemental payments in order to
satisfy non-Medicaid activities.
SFY 2012-13 Buyback LOA Page 1
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10/23/2012 Item 16.D.12.
7. This Letter of Agreement is contingent upon the State Medicaid Hospital Reimbursement
Plan reflecting 2012-13 legislative appropriations being approved by the federal Centers
for Medicare and Medicaid Services.
8. 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.
9. This Letter of Agreement covers the period of July 1, 2012 through June 30, 2013 and
shall be terminated June 30, 2013.
SFY 2012-13 Buyback LOA Page 2
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1
10/23/2012 Item 16.D.12.
W1TNESSETH:
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
7 �1 .
•
Signature Phil E. Williams
Assistant Deputy Secretary for Medicaid Finance,
Agency for Health Care Administration
F R Lb kA- ' C" L E
Name
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Title
ATTEST:, -; Approved as to form & legal Sufficiency
DWIGHT E: BROOK, Clerk
t "()'\3 _SY A k' ` 9 n sssnt County Attorney
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SFY 2012-13 Buyback LOA Page 3
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10/23/2012 Item 16.D.12.
Letter of Agreement
THIS LETTER OF AGREEMENT made and entered into in duplicate on the c1 ` day of
()c , 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, the County and the Agency agree
that the County will remit to the State an amount not to exceed a grand total of
$1,129,630.
a. The County and the Agency have agreed that these funds will only be used
to increase the provision of Medicaid funded health services to the people
of the County and the State of Florida at large.
b. The increased provision of Medicaid funded health services will be
accomplished through the removal of inpatient and outpatient
reimbursement ceilings for public hospitals, or any leased public hospital
found to have sovereign immunity, hospitals with graduate medical
education positions that do not qualify for the elimination of the inpatient
and outpatient ceilings under any section of the General Appropriations Act
(GAA), that provide services to Medicaid recipients or hospitals not
previously included in the GAA.
2. The County will pay the State an amount not to exceed the grand total amount of
$1,129,630. The County will transfer payments to the State in the following
manner:
a. The first quarterly payment of$282,409, for the months of July, August, and
September, is due upon notification by the Agency.
•
b. Each successive payment of $282,407 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. The County and the State agree that the State will maintain necessary records and
supporting documentation applicable to Medicaid 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.
5. 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.
6. The County confirms that there are no pre-arranged agreements (contractual or
otherwise) between the respective counties, taxing districts, and/or the hospitals to
Ask
SFY 2012-13 Public Exemptions LOA Page 1
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10/23/2012 Item 16.0.12.
re-direct any portion of these aforementioned Medicaid supplemental payments in
order to satisfy non-Medicaid activities.
7. This Letter of Agreement is contingent upon the State Medicaid Hospital
Reimbursement Plan reflecting 2012-13 legislative appropriations being approved
by the federal Centers for Medicare and Medicaid Services.
8. 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.
9. This Letter of Agreement covers the period of July 1, 2012 through June 30, 2013
and shall be terminated June 30, 2013.
SFY 2012-13 Public Exemptions LOA Page 2
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10/23/2012 Item 16.D.12.
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 Williams
Assistant Deputy Secretary for Medicaid Finance,
Agency for Health Care Administration
"FRED i., c o t .
Name
cAaA� fZ ►�W�
Title
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";'ATTEST;W • Mood its to tom & legal Sufficiency
DWI BR?CK, Clerk
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41 C Assistant County Attorney
- '' Irolit�f 3-g ►.�ry ��Q ;
,sioestan sky*
SFY 2012-13 Public Exemptions LOA Page 3
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