Backup Documents 10/09/2012 Item #16D 2ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 D 2
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. Original documents should be hand delivered to the Board Office. The completed routing slip and original
documents are to be forwarded to the Board Office only after the Board has taken action on the item.)
ROUTING SLIP
Complete routing lines #I through #4 as appropriate for additional signatures, dates, and/or information needed. If the document is already complete with the
exception of the Chairman's simature. draw a line through routine lines #I through #4, complete the checklist, and forward to Ian Mitchell (line #5).
Route to Addressee(s)
(List in routing order
Office
Initials
Date
1. Kimberley Grant,
Interim Director of Housing, Human, and
Veteran's Services
KG
10/9/12
2. Jennifer White, Asst. County Attorney
County Attorney
JBW
10/9/12
3. Ian Mitchell, Executive Manager BCC
Board of County Commissioners
l
01 ,
t
4. Minutes and Records
ClT of Court's OfficeM
Number of Original
4
V
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending BCC approval. 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, including Ian Mitchell needs to contact staff for additional or missing
information. All original documents needing the BCC Chairman's signature are to be delivered to the BCC office only after the BCC has acted to approve the
Grp..,
Name of Primary Staff
Bendisa Marku
Phone Number
239- 252 -2689
Contact
appropriate.
(Initial)
Applicable)
Agenda Date Item was
10/9/12
Agenda Item Number
16.D.2
Approved by the BCC
signed by the Chairman, with the exception of most letters, must be reviewed and signed
l
01 ,
Type of Document
One of each agreement approved by the
Number of Original
4
Attached
I Board
I Documents Attached
INSTRUCTIONS & CHECKLIST
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
08- MGR - 00132/33
Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is
Yes
N/A (Not
appropriate.
(Initial)
Applicable)
1.
Original document has been signed/initialed for legal sufficiency. (All documents to be
signed by the Chairman, with the exception of most letters, must be reviewed and signed
l
01 ,
by the Office of the County Attorney. This includes signature pages from ordinances,
W
resolutions, etc. signed by the County Attorney's Office and signature pages from
contracts, agreements, etc. that have been fully executed by all parties except the BCC
Chairman and Clerk to the Board and possibly State Officials.
2.
All handwritten strike - through and revisions have been initialed by the County Attorney's
N (A
Office and all other parties except the BCC Chairman and the Clerk to the Board
3.
The Chairman's signature line date has been entered as the date of BCC approval of the
p
document or the fmal negotiated contract date whichever is applicable.
d
4.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
signature and initials are required.
5.
In most cases (some contracts are an exception), the original document and this routing slip
_ r
should be provided to Ian Mitchell in the BCC office within 24 hours of BCC approval.
a 8
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!
6.
The document was approved by the BCC on 10/9/12 and all changes made during the
)
meeting have been incorporated in the attached document. The County Attorney's
aQJ
Office has reviewed the changes, if applicable. top a n Yn
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
08- MGR - 00132/33
16D2
MEMORANDUM
Date: October 26, 2012
To: Jennifer B. White, Assistant County Attorney
County Attorney's Office
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Letter of Agreement with the Agency for Health Care
Administration and agreements with Physicians Regional
Medical Center and Naples Community Hospital to allow
participation in the alternative intergovernmental transfer
programs (IGT)
Attached for your records are copies of the documents referenced above, (Item #16D2)
approved by the Board of County Commissioners on October 9, 2012.
The Minutes and Record's Department will hold the original agreements in the
Official Records of the Board.
If you have any questions, please contact me at 252 -8406.
Thank you.
Attachment
16D2
EXECUTIVE SUMMARY
Recommendation to approve four agreements to allow participation in alternative
intergovernmental transfer programs (IGT): Two between the County and Agency for Health Care
Administration (AHCA), and one each between the County and Physicians Regional Medical
Center and Naples Community Hospital. The County's total financial commitment is $2,097,484
which is currently budgeted.
OBJECTIVE: To partner with Physicians Regional Medical Center and Naples Community Hospital
(collectively "the Hospitals ") to enhance the quality of care and the health of low income persons.
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 use these funds to obtain Federal matching
dollars.
In recent years, the State Legislature has reduced Medicaid reimbursement rates to providers by a
substantial margin. This is significant not only in and of itself, but the Federal match is dependent on the
state funding. The State Legislature has created the Buyback and Self- Exemption matching fund
programs, which the Legislature has approved. These programs allow communities to leverage existing
dollars spent for health services to offset the reductions in the state funding, and thereby obtaining a
federal match. The combination of Federal matching funds for the Buyback and Self- Exemption
programs will provide funding to offset some of the Hospital Medicaid rate cuts so that the Hospitals can
continue to serve our community's uninsured and underinsured patients.
Last year the Board approved an item allowing Physicians Regional Medical Center to become the
County's sole community healthcare partner. The arrangement proposed by this item is identical except
Physicians Regional Medical Center and Naples Community Hospitals are recommended to participate.
Accordingly, the proposed arrangement allows the Hospitals to become community healthcare partners
and serve as third party administrators for Collier County. In addition the benefit realized by the
Hospitals, Collier's contribution of $2,097,484 will generate $419,497 for our partners noted below.
The allocation of County and matching funds is shown in the table below and has been agreed to by each
of the hospitals:
Partners
County IGT
AHCA
Total"
from Physicians Regional
Commitment
Matching Funds*
(50% to each
Social Services — HHVS Budget
(budgeted general
from Naples Community Hospital
Hospital from
$2,516,981
funds)
AHCA)
Total
$2,097,484
$2,864,626
$4,962,110
Partners
Funds to Partners From Hospital's General
Operating Funds
Collier County Health Department
$1,357,560
from Physicians Regional
David Lawrence Center
$1,025,040
from Naples Community Hospital
Social Services — HHVS Budget
$134,381
from Naples Community Hospital
Total
$2,516,981
,•II
*Matches based on most recent formulas and anticipated volumes of Medicaid patients
** Per the program, the entire amount of Medicaid funding is provided to the hospitals
The mechanics of this program are:
• Collier County utilizes already budgeted allowable general funds to be transferred to AHCA
• By participation in these programs, AHCA matches /leverages the funds allocated by Collier and
distributes them to the hospitals, for the purpose outlined above
• HHVS collects and validates invoices from DLC and the Health Department and for social
services and forwards them to the Hospitals; they, in turn, voluntarily pay the invoices from their
operating funds
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.
FISCAL IMPACT: The County will remit $2,097,484 to the State. These funds have been already
budgeted in the Fiscal Year 13 Collier County Public Health Department, David Lawrence Center, and
Housing, Human and Veteran Services Department budgets. Participation in the Buyback and Self -
Exemption IGT programs will provide a total of $2,516,981 ($2,864,626 Federal and $419,497 Partner
Hospitals) in matching funds that will provide healthcare services to Collier County low- income
individuals.
LEGAL CONSIDERATIONS: The two agreements with AHCA are standard form documents that are
required by AHCA. The Agreements cover the period of July 1, 2012 through June 30, 2013 which is the
State's Fiscal Year 2012 -2013. As such, the first quarterly payment made by the County in November
will cover the period from July, August, and September 2012. Last year, the same payment arrangement
was approved by the Board and the County made payment to the State. This item is legally sufficient and
requires a majority vote for Board action. - JBW
GROWTH MANAGEMENT IMPACT: There is no growth management impact associated with this
executive summary.
RECOMMENDATION: To approve and authorize the Chairman to sign four agreements to allow for
participation in the Alternative Intergovernmental Transfer programs.
Prepared by: Bendisa Marku, Accounting Supervisor, Housing, Human and Veteran Services
16D2
Letter of Agreement
THIS LETTER OF AGREEMENT made and entered into in duplicate on the C1 36 day of
Qc�t , 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
16D2
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
•1/
WITNESSETH:
IN WITNESS WHEREOF the parties have duly executed this Letter of Agreement on the day
and year above first written.
Collier County
x�
Signature
Fe, E- p coyL�
Name
C" ,&a % t2tinAQ
Title
ATTEST:.
DWIGHT E. BROM Clark
i;
State of Florida
See next page for
original signature
Phil E. Williams
Assistant Deputy Secretary for Medicaid Finance,
Agency for Health Care Administration
ApWws ! as to forma & legal Suffftclrncy
Asslst nt County attorney
P0NIFE2 C3,
SFY 2012 -13 Buyback LOA Page 3
16D2
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 Phir E. Williams
Assistant Deputy Secretary for Medicaid Finance,
Agency for Health Care Administration
FRE-D 0. cayt
Name
C- "'k +RMAQ
Title
ATTEST:. < ; " APPWsd as to form & legal Sufflclincy
DWIQI4T E. BROOK, Clerk
SY' Assist nt County Attorney -
l��i►itw"i«i�i:
\O
SFY 2012 -13 Buyback LOA Page 3
HM
Letter of Agreement
THIS LETTER OF AGREEMENT made and entered into in duplicate on the cl +4, 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, 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
SFY 2012 -13 Public Exemptions LOA Page 1
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
1602
WITNESSETH:
IN WITNESS WHEREOF the parties have duly executed this Letter of Agreement on the day
and year above first written.
Collier County
.--� W. ��k
Signature
FRED w
Name
Title
ATtESI d
DWIGH"' ' BROCK, Clerk
Y.
At
MOM" "lam
State of Florida
See next page for
original signature
Phil Williams
Assistant Deputy Secretary for Medicaid Finance,
Agency for Health Care Administration
AWWW as to fpm & leyei Su Mclsncy
ASSIStant County Attornay
\cam 13 \ %-2-_
SFY 2012 -13 Public Exemptions LOA Page 3
16D2
WITNESSETH:
IN WITNESS WHEREOF the parties have duly executed this Letter of Agreement on the day
and year above first written.
Collier County
�-�Ua U0, G-�J'4
Signature
F2�F-D w.
Name
C.,,, a. � 2 �-' P, rJ
Title
ATTEST: J
owleNT .� BRICK, Clark
Atli.Li
'84MWV MIA
State of Florida
Phil Williams
Assistant Deputy Secretary for Medicaid Finance,
Agency for Health Care Administration
A "to #arm & 1e9nl Sufftiiancy
Ass tstsnt County Attorney
S£..»\Fr-2 e. " � " �L*-
\ol3t\-Z,
SFY 2012 -13 Public Exemptions LOA Page 3
160?
AGREEMENT
THIS AGREEMENT is made and entered into on October 9, 2012 by and between Collier County, Florida,
a political subdivision of the State of Florida, hereinafter referred to as "the County" and Naples HMA,
LLC. d /b /a Physicians Regional Healthcare System, a Florida limited liability company, hereinafter
referred to as "the Hospital ".
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; and
WHEREAS, the establishment and maintenance of such programs are in the common interest of
the people of Collier County; and
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, where no existing state or federal resources are available; and
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 I
SERVICES TO BE PERFORMED
The Hospital shall provide documentation and quarterly reports to the County that support
Hospital's expenditures 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. Immunization program provided by the Collier County Health Department
b. AIDS Prevention Program provided by the Collier County Health Department
c. Tuberculosis Program provided by the Collier County Health Department
d. Communicable Disease Program provided by the Collier County Health Department
e. Child Health Program provided by the Collier County Health Department
f. Healthy Start Prenatal Program provided by the Foundation for Women's Health
g. School Health Program provided by the Collier County Health Department
h. Adult Health Program provided by the Collier County Health Department
i. Dental Program provided by the Collier County Health Department
j. Community Mental Health Services provided by the Collier County Health Department.
k. Other health related programs and services
ARTICLE If
PAYMENTS
The County shall make intergovernmental transfers, on behalf of the Hospital, in connection
with the State's Medicaid Programs -- specifically the buyback of the Medicaid inpatient and
outpatient trend adjustment and self funding of exemptions - to the State of Florida in
•�1
accordance with the Letter(s) of Agreement between the County and the Agency for Health Care
Administration.
2. There are no pre - arranged agreements (contractual or otherwise) between the County and the
Hospital to re- direct any portion of Medicaid supplemental payments in order to satisfy non -
Medicaid activities.
3. The following documents are hereby incorporated by reference as Attachments to this
Agreement
a. Buy -Back Letter of Agreement with State of Florida AHCA (Attachment A)
b. Self Funding Exemptions Letter of Agreement with State of Florida AHCA (Attachment B)
ARTICLE III
CLAIMS VALUATION AND CLAIMS PROCESSING
1. 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 October 1, 2012 through September 30, 2013.
2. Either party may terminate this Agreement thirty (30) calendar days after receipt by the other
party of written notice of intent to terminate.
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.
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.
16D2
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
1. Indemnity. The Hospital and /or its sub - contractor shall indemnify the County against any
claims, damages, losses, and expenses, including reasonable attorneys' fees and costs, arising
out of, resulting from the Hospital's failure to perform its obligations under this Agreement.
Subject to the limitations set forth in Section 768.28, Florida Statutes, the County shall
indemnify the Hospital 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.
2. 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 or 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
The Hospital has standard, acceptable billing procedures that the Hospital will utilize in the performance
of its obligations under this Agreement.
The County shall provide the Hospital with invoices 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 shall make payment, on a voluntary basis, to specific healthcare programs and services,
such as the Collier County Health Department 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.
ARTICLE IX
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
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 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 provision 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 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.
16D2
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, CLERIC
Cb°t� E UTY ,,LERK
ir� lr�
Approval as to form and legal Sufficiency:
Jennifer B. White
Assistant County Attorney
ATTEST:
Date:
BOARD OF COUNTY COMMISSIONERS
OF COLLIER COUNTY, FLORIDA
By: }
FRED W. COYLE, CHAIRMAN
Naples HMA, LLC., d /b /a Physicians Regional Healthcare
System, a Florida limited liability company
By: s"
Title: �yb
See next page for
original signature
16D2
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
, DEPUTY CLERK
Approval as to form and legal Sufficiency:
Jennifer B. White
Assistant County Attorney
ATTEST:
By: 2f:;
Date:
BOARD OF COUNTY COMMISSIONERS
OF COLLIER COUNTY, FLORIDA
By:
FRED W. COYLE, CHAIRMAN
Naples HMA, LLC., d /b /a Physicians Regional Healthcare
System, a Florida limited liability company
By:
Title: (. F'0
A q c e e r-, e V% �- w �-� �,. � M'A O 5 ��'oZ ` �o oZ
16 D2
AGREEMENT
THIS AGREEMENT is made and entered into on October 9, 2012 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, hereinafter referred to as "the Hospital ".
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; and
WHEREAS, the establishment and maintenance of such programs are in the common interest of
the people of Collier County; and
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, where no existing state or federal resources are available; and
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 I
SERVICES TO BE PERFORMED
1. The Hospital shall provide documentation and quarterly reports to the County that support
Hospital's expenditures 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. Community Mental Health Services provided by the David Lawrence Center, Inc.
b. Other health related programs and services
ARTICLE II
PAYMENTS
The County shall make intergovernmental transfers, on behalf of the Hospital, in connection
with the State's Medicaid Programs — specifically the buyback of the Medicaid inpatient and
outpatient trend adjustment and self funding of exemptions - to the State of Florida in
accordance with the Letter(s) of Agreement between the County and the Agency for Health Care
Administration.
2. There are no pre - arranged agreements (contractual or otherwise) between the County and the
Hospital to re -direct any portion of Medicaid supplemental payments in order to satisfy non -
Medicaid activities.
3. The following documents are hereby incorporated by reference as Attachments to this
Agreement
16D2
a. Buy -Back Letter of Agreement with State of Florida AHCA (Attachment A)
b. Self Funding Exemptions Letter of Agreement with State of Florida AHCA (Attachment B)
ARTICLE III
CLAIMS VALUATION AND CLAIMS PROCESSING
1. 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 October 1, 2012 through September 30, 2013.
2. Either party may terminate this Agreement thirty (30) calendar days after receipt by the other
party of written notice of intent to terminate.
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.
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
•1
INSURANCE, SAFETY AND INDEMNIFICATION
1. Indemnity. The Hospital and /or its sub- contractor shall indemnify the County against any
claims, damages, losses, and expenses, including reasonable attorneys' fees and costs, arising
out of, resulting from the Hospital's failure to perform its obligations under this Agreement.
Subject to the limitations set forth in Section 768.28, Florida Statutes, the County shall
Indemnify the Hospital 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.
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 or 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
The Hospital has standard, acceptable billing procedures that the Hospital will utilize in the performance
of its obligations under this Agreement.
The County shall provide the Hospital with invoices 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 shall make payment, on a voluntary basis, to specific healthcare programs and services,
such as the Mental Health programs of the David Lawrence Center and other social service providers
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.
ARTICLE IX
RECORDS
1. 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)
•1
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 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.
S. 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 provision 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 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
"O'411"as to form and legal Sufficiency:
Jennifer B. White
Assistant County Attorney
ATTEST:
By: HM V1 I1 A t -Lsr�,,
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Date: Mb� 119-
BOARD OF COUNTY COMMISSIONERS
OF COLLIER COUNTY, FLORIDA
By:
FRED W. COYLE, CHAIRMAN
Naples Community Hospital, Inc.
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Title: C 4 44--
See next page for
original signature
ATTEST:
DWIGHT E. BROCK, CLERK
, DEPUTY CLERK
Approval as to form and legal Sufficiency:
Jennifer B. White
Assistant County Attorney
ATTEST:
By: &
Date: `- 6col4
16D?
BOARD OF COUNTY COMMISSIONERS
OF COLLIER COUNTY, FLORIDA
By:
FRED W. COYLE, CHAIRMAN
Naples Community Hospital, Inc.
CIBy: � L-), S >/
Title: S - C-0
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