Backup Documents 10/09/2012 Item #16D 3ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1603
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
evrention oftee C..hairman's aiQnature_ draw a line through routing lines #1 through #4_ complete the checklist. and forward to Ian Mitchell (line #5).
Route to Addressee(s)
Office
Initials
Date
List in routin order
appropriate.
(Initial)
Applicable)
1. Kimberley Grant,
Interim Director of Housing, Human, and
KG
10/9/12
Approved by the BCC
Veteran's Services
f
2. Jennifer White, Asst. County Attorney
County Attorney
JBW
10/9/12
3. Ian Mitchell, Executive Manager BCC
Board of County Commissioners
Documents Attached
f G
Z
4. Minutes and Records
Clerk of Court's Office
'v
M
�,t fq I �Z
t
Chairman and Clerk to the Board and possibly State Officials.
0
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
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
16.13.3
Approved by the BCC
signed by the Chairman, with the exception of most letters, must be reviewed and signed
f
Type of Document
One of each agreement approved by the
Number of Original
2
Attached
I Board
Documents Attached
11NQTR1ICT1(1NS Rr 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
f
by the Office of the County Attorney. This includes signature pages from ordinances,
4,
(� V
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 fl
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
g
document or the final negotiated contract date whichever is applicable.
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
should be provided to Ian Mitchell in the BCC office within 24 hours of BCC approval.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time firame 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
<:A
meeting have been incorporated in the attached docume t. The County Attorney's
,
Office has reviewed the changes, if applicable. D rJA4 h
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
1603
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:
County IGT Matching Total **
Commitment Funds*
Total $225,759 $308,329 $534,081
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.
16 D3
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
1603
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
16D3
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
1603
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
9. Indemnity. The Center 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 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.
16D3
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.
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.
4
16D3
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
,/' ,
Approved as to form and
legal sufficiency
Assistant County Attorney
Collier County
Nr
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
By: lua G_t1r'4
Fred W. Coyle, Chairma
Date: October 09, 2012__
COLLIER HEALTH SERVICES
See next page for
original signature
By:
Sandra E. Steele, CFO
Date
5
1603
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
ByIt
u
Approved as to form and
legal sufficiency
Assis ant County Attorney
Collier County
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
By:
Fred W. Coyle, Chairmagl
Date: October 09, 2012
COLLIER HEALTH SERVICES
F I I F-A ad F�W� � �J O/A I
__!Iii MM10=-
•
Date �' J
5
16D3
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
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
r.•. _ �__e____._e_ _:�_�___ J_ —__... I:_,. A— ......L — ....�:....1:...... ill :L.......L +�� ......, «lore rl.o..ho,.4l;�t a.A f r. M to ran Mitnhell (line Hil
Route to Addressee(s)
List in routing order)
Office
Initials
Date
1. Kimberley Grant,
Interim Director of Housing, Human, and
Veteran's Services
KG
10/17/12
2. Jennifer White, Asst. County Attorney
County Attorney
JBW
10/17/12
3. Ian Mitchell, Executive Manager BCC
Board of County Commissioners
10 I M 117-
4. Minutes and Records
Clerk of Court's Office
7M
to p r(Z
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
hem.
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
16.13.3
Approved by the BCC
signed by the Chairman, with the exception of most letters, must be reviewed and signed
Type of Document
One of each agreement approved by the
Number of Original
2
Attached
Board
Documents Attached
ti.T� "WTd"IVW/AATV R l 1EXVA-1 1l 1CT
�3 ►M R See. o� a -w%oC% U3 ,,,,\ d VI Kt �3o _V0
+0 W�tl�l4rr ���f� ��r ,ANClA 5%gY10.-Jc�•
�J
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
by the Office of the County Attorney. This includes signature pages from ordinances,
0\1
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/ f}
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
a-
document or the final negotiated contract date whichever is applicable.
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
should be provided to Ian Mitchell in the BCC office within 24 hours of BCC approval.
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
Office has reviewed the changes, if applicable.
�3 ►M R See. o� a -w%oC% U3 ,,,,\ d VI Kt �3o _V0
+0 W�tl�l4rr ���f� ��r ,ANClA 5%gY10.-Jc�•
�J
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
16D3
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 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.
County 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.
1603
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
16D3
WhiteJennifer
From:
WhiteJennifer
Sent:
Tuesday, October 16, 2012 8:34 AM
To:
'Bill.Perry@ahca.myflorida.com'
Cc:
'MorganTrish'; MarkuBendisa; GrantKimberley
Subject:
FW: Minor LIP for AHCA signature
Bill,
Please hold off on routing the PDF. Our Clerk's Office will send you two originals of the Agreement with
AHCA. Please execute them and return one back to the Clerk. The Clerk's Office will provide you with an
envelope when they send the originals to you for you to send one original back.
I copied our Deputy Clerk, Trish Morgan on this communication. The Board's agenda item is 10.9.12, Item
16D3.
Thank you,
Jewr y B. W ki4v
Assistant County Attorney
Collier County, Florida
Office: 239 - 252 -5709
From: Perry, Bill fmailto : Bill. Per[y(&ahca.myflorida.com]
Sent: Tuesday, October 16, 2012 7:54 AM
To: WhiteJennifer; Behenna, Lecia
Cc: GrantKimberley; MarkuBendisa
Subject: RE: Minor LIP for AHCA signature
Good Morning Jennifer,
If at all possible we too will also need an original signature. I will route the copy that you sent for execution and will mail
two day Fed -Ex an original to you.
Thank you,
Bill
William D. Perry III.
Medical /Health Care Program Analyst
Medicaid Program Finance - DSH /LIP
2727 Mahan Dr MS #23
Tallahassee, FL 32308 -5407
850.412 -4131 Work#
850.922 -0461 Fax#
L
Privacy Statement: This e-mail may include confidential and /or proprietary information, and may be used only by the person or entity to which it is addressed. If the
reader of this e-mail is not the intended recipient or his or her authorized agent, the reader is hereby notified that any dissemination, distribution or copying of this
e -mail is prohibited. If you have received this in error, please reply to the sender and delete it immediately.
1
16U3
From: WhiteJennifer fmailto: JenniferWhite(abcolliergov.net]
Sent: Monday, October 15, 2012 4:38 PM
To: Perry, Bill; Behenna, Lecia
Cc: GrantKimberley; MarkuBendisa
Subject: FW: Minor LIP for AHCA signature
Bill and Lecia,
Attached below is a Letter of Agreement signed by the Board Chairman. Please return the agreement to us
with Mr. Williams' signature for our records. If possible, we would like his original signature and can provide
you with our address if you need it.
Thank you,
J eft4n f e.�- 13. W kUe,
Assistant County Attorney
Collier County, Florida
Office: 239 - 252 -5709
Under Florida Law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send
electronic mail to this entity. Instead, contact this office by telephone or in writing.
Letter of Agreement
THIS LETTER OF AGREEMENT made and entered into in duplicate on the Cr 4 k day of
Q k 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 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.
LIP Letter of Agreement for SPY 2612 -13
16D3
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, 2013.
LIP Letter of Agreement for SFY 2012 -13
1603
WITNESSETH:
IN WITNESS WHEREOF the parties have duly executed this Letter of Agreement on the day
and year above first written.
Collier County
� .
Signature
Name
CHAtQ &,I,,(
Title
ATTI: ` n' .y
IDW
State of Florida
Phil E. Williams
Assistant Deputy Secretary for Medicaid Finance,
Agency for Health Care Administration
App -, O Od as to tornj & lid 8ldllohnc`:
Clerk �
, ' iQ R_ As tant County Attorney
:17i-aN IFE9-
LIP Letter of Agreement for SFY 2012 -13
16D3
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
X
CLERK OF THE
Dwight E. Brock COLLIER COUNTY
Clerk of Courts 3301 TAMIAMI
P.O. BOX 4
NAPLES, FLORIDA
November 1, 2012
Phil E. Williams, Asst. Deputy Secretary
c/o William D. Perry III, Program Analyst
Medicaid Program Finance
2727 Mahan Drive MS #23
Tallahassee, FL 32308 -5407
Hier 16 D3
IT COURT
IR OUSE Clerk of Courts
L E ST
4 Accountant
101 -3 44 Auditor
Custodian of County Funds
Re: Letter(s) of Agreement between Collier County and the State of Florida
Mr. Perry,
Attached for signature are two original Letter(s) of Agreement between
Collier County and the State of Florida, through AHCA, regarding provisions
for Medicaid program funding approved by the Collier County Board of County
Commissioners on October 9, 2012.
After the agreement (s) have been signed, please return one original to our office,
Board Minutes and Records that serves as Clerk to the Board, for the official record.
Upon return executed copies will be furnished to all parties involved.
I have included a pre- addressed envelope for easier processing.
If you have any questions, I can be reached at 239 - 252 -8406.
Thank you.
DWIGHT E. BROCK, CLERK
Ann Jenn '0''
Deputy Cle
Attachments
Phone (239) 252 -2646 Fax (239) 252 -2755
Website: www.collierelerk.com Email: collierclerk@collierclerk.com
M l�
N N O
T•^ O
Lt
►.w � � � N
o-v �
.= U
3i�NF-
W
a
a
V�u�
aw o
• i y � C R <
wWO�o�
ofj-
C)
wu
Avw
z
a
a
O
U
,A,
16D3