Agenda 09/14/2010 Item #16D 4
Agenda Item f'-Jo. 1604
September 14, 2010
Page 1 of 7
EXECUTIVE SUMMARY
Recommendation that the Board of County Commissioners approve and authorize the
Chairman to sign an agreement with the Agency for Health Care Administration in the
amount of $2,488,228 to participate in the Medicaid Low Income Pool Program for services
provided on behalf of the Housing, Human and Veteran Services Department in order to
generate an additional $449,227 in Federal matching funds.
OBJECTIVE: That the Board of County Commissioners approve and authorize the Chairman
to sign an agreement with the Agency for Health Care Administration (AHCA) to participate in
the Medicaid Low Income Pool (UP) program.
CONSIDERATIONS: The Agency for Health Care Administration (ARCA) is the State entity
that provides Medicaid services in Florida and operates the Hospital Low Income Pool (UP)
program. This program takes local funds and through an agreement between local government
and ARCA uses these funds to obtain Federal matching dollars.
These dollars are returned to the community through an inpatient hospital in the form of special
medicaid payments in order to provide enhanced services to low-income individuals.
Physician's Regional Medical Center will continue to participate in this program to receive these
special Medicaid payments and serve as the Third Party Administrator for Collier County. The
Board of County Commissioners approved an agreement with Physicians Regional Medical
Center on November 11, 2009 outlining the costs associated with the administration of this
agreement. The agreement with AHCA is for $2,488,228 of existing funds within the Housing,
Human and Veteran Services Department, Health Department and Mental Health FY 2010-11
budgets.
Collier County will also receive $75,993 in additional funding based on a funding formula that
ARCA utilizes that takes into consideration the level of Medicaid and Charity Care Physicans
Regional Medical Center provides to the community. The allocation of County and ARCA
matching funds is shown in the table below:
Program County LIP ARC A Total Additional Total
Commitment Match at Commitment ARCA Allocation
15% Allocation
Collier County $1,063,000 $159,450 $1,222,450 0 $1,222,450
Health
Department
David Lawrence $ 899,300 $134,895 $1,034,195 0 $1,034,195
Center
Social Services $525,928 $78,889 $604,817 $75,993 680,810
Total $2,488,228 $373,234 $2,861,462 $75,993 $2,937,455
FISCAL IMPACT: Participation in the Low Income Payment Program will provide a total of
$449,227 in additional revenue for healthcare resources to Collier County.
Agenda Item No. 1604
September 14, 2010
Page 2 of 7
GROWTH MANAGEMENT IMP ACT: There is no growth management impact associated
with this executive summary.
LEGAL CONSIDERATIONS: This item has been reviewed by the County Attorney's Office
and is legally sufficient for Board action. - JBW
RECOMMENDA TION: Staff recommends that the Board of County Commissioners approve
and authorize the Chairman to sign the agreement with the Agency on Health Care
Administration.
Prepared by: Terri Daniels, Accounting Supervisor
Housing, Human and Veteran Services
Aaenda Item No. 1604
~September 14, 2010
Page 3 of 7
COLLIER COUNTY
BOARD OF COUNTY COMMISSIONERS
Item Number:
Item Summary:
16D4
Meeting Date:
Recommendation to approve and authorize the Chairman to sign an agreement with the Agency
for Health Care Administration in the amount of $2,488,228 budgeted in FY2011 to participate in
the Medicaid Low Income Pool Program for services provided on behalf of the Housing, Human
and Veteran Services Department in order to generate an additional $449,227 in Federal
matching funds.
9/14/201090000 AM
Prepared By
Terri A. Daniels
Supervisor - Accounting
Date
Public Services Division
Human Services
8/26/2010 4:41 :49 PM
Approved By
Marcy Krumbine
Director - Housing & Human Services
Date
Public Services Division
Human Services
8/27/201010:30 AM
Approved By
Jennifer White
Assistant County Attorney
Date
County Attorney
County Attorney
8/27f2010 11:49 AM
A pproved By
Marla Ramsey
Administrator - Public Services
Date
Public Services Division
Public Services Division
8f30/2010 9:59 AM
Approved By
Kathy Carpenter
Executive Secretary
Date
Public Services
Public Services Admin.
8/30/201010:00 AM
Approved By
OMS Coordinator
Date
County Manager's Office
Office of Management & Budget
8130120103:49 PM
Approved By
Jeff Klatzkow
County Attorney
Date
8130120104:25 PM
Approved By
Sherry Pryor
Management! Budget Anaiyst, Senior
Date
Office of Management &
Budget
Offi::e 07 Management & Budget
8131/201011:10 AM
Approved By
Leo E. Ochs. Jr.
County Manager
Date
County Managers Office
County Managers Office
912/20105:31 PM
" r- jI
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~September 14, 2010
Page 4 of 7
Letter of Agreement
THIS LETTER OF AGREEMENT made and entered into in duplicate on the 14th day
of Seotember 2010, 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 2010-2011,
passed by the 2010 Florida Legislature, County and the Agency, agree that County will remit
to the State an amount not to exceed a grand total of $2,488,228.
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 cap on 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.
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-September 14, 2010
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2. The County will pay the State an amount not to exceed the grand total amount of
$2.488,228. The County will transfer payments to the State in the following manner:
a) The first quarterly payment of $622,057 for the months of July, August,
and September is due upon notification by the Agency.
b) Each successive payment of $622,057 is due as follows, November 1,
2010, March 31, 2011 and June 15, 2011.
c) The State will bill the County each quarter payments are due.
3. The enhanced FMAP is in effect for the first six months of SFY 2010-11. Any payments
made by the Agency on or after January 1, 2011, will not be eligible for the enhanced
FMAP. Therefore, the County will be responsible for funding the State share required as a
result of the reduced FMAP. Iffunding is not adequate due to the FMAP change, the State
will reduce the rate to the level of funded by the County.
4. Timelines: This agreement must be signed and submitted to the Agency no later than May
31, 2011, to be effective for SFY 2011.
5. Attached are the DSH and LIP schedules reflecting the anticipated annual distributions for
State Fiscal Year 2010-2011.
6. 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.
7. 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.
8. The County confinns 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.
9. 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.
10. This Letter of Agreement covers the period of July 1, 2010 through June 3D, 2011.
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September 14, 2010
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t
WITNESSETH:
IN WITNESS WHEREOF the parties have duly executed this Letter of Agreement on the day
and year above first written.
ATTEST:
DWIGHT E. BROCK, Clerk
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
By:
By:
Fred W. Coyle, Chairman
Board of County Commissioners
Deputy Clerk
Date: September 14.2010
STATE OF FLORIDA:
Approved as to fonn and
legal sufficiency
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'.. '. istant County Attome~
. '. . -: . Collier County
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By:
Phil E. Williams
Assistant Deputy Secretary for Medicaid Finance
Agency for Health Care Administration
Date: September 14. 2010
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September 14. 2010
Page 7 of 7
Local Government Inter overnmental Transfers
Pro ram I Amount State Fiscal Year 2010-2011
DSH
LIP, Exem tions & SWI $2,488,228
Nursin Home SMP
Total Fundin $2,488,228
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