Backup Documents 10/23/2012 Item #16D12ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 16012
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 signature_ draw a line through routing lines #1 thmnah #4 mmnlete. the rherklict and fnr and to ran Mitrhell (line liQl
Route to Addressee(s)
List in routing order
Office
Initials
Date
1. Kimberley Grant,
Interim Director of Housing, Human, and
Veteran's Services
KG
10/25/12
2. Jennifer White, Asst. County Attorney
County Attorney
JBW
10/25/12
3. Kristi Bartlett, Executive Aid to the BCC
Board of County Commissioners
4. Minutes and Records
Clerk of Court's Office
4(\
ro(2J6(tz
Attached
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
item.)
Name of Primary Staff
Bendisa Marku
Phone Number
239- 252 -2689
Contact
appropriate
Initial
Applicable)
Agenda Date Item was
10/23/12
Agenda Item Number
16.D.12
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 provided by AHCA
Number of Original
2
Attached
I
I Documents Attached
INSTRUCTIONS & CHECKLIST
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip W WS 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,
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
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
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 10/23/12 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.
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip W WS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
08- MGR -00132/33
16012
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 16132, 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
16D12
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
16 012;
OFFICE OF THE CO UNTY A TTORNE Y
INTEROFFICE MEMORANDUM
TO: Board Minutes and Records
FROM: Jennifer B. White, Assistant County Attorney '��
DATE: October 25, 2012
RE: October 23, 2012, Agenda Item 16 D. 12
Please send the two Letters of Agreement that are signed or stamped by the Board Chairman to
William Perry and request that one be executed by Phil E. Williams, Assistant Deputy Secretary
for Medicaid Finance, and returned to your office for County records.
Mr. Perry's contact information is:
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#
Bill.Perry@ahca.myflorida.com
Thank you for your assistance.
ibos�
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
Re: Amendment to Agreement between Collier County and the State of Florida
Mr. Perry,
Attached for signature are two original Amendments to the 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 23, 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 -8411.
Thank you.
DWIGHT E. BROCK, CLERK
Teresa Cannon,
Deputy Clerk
Attachments
iboi2
Letter of Agreement
THIS LETTER OF AGREEMENT made and entered into in duplicate on the 23rd day of October,
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 $1,453,770.
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
$1,453,770. The County will transfer payments to the State in the following manner:
a. The first quarterly payment of $363,444, for the months of July, August, and
September, is due upon notification by the Agency.
b. Each successive payment of $363,442 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 26, 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
16D12
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
16D12
WITNESSETH:
IN WITNESS WHEREOF the parties have duly executed this Letter of Agreement on the day
and year above first written.
Collier County
Signature
FAP-D W. c0y1- E
Name
CA A A M-t
Title
ATTEST;
DW E. BROCK. Clerk
All"U t ' n to CM IrM a
State of Florida
Phil E. Williams
Assistant Deputy Secretary for Medicaid Finance,
Agency for Health Care Administration
Approved as to form & legal Suf'Ifcl*ncy
As stant County Attorney
-SF-NN JF6k e . WH 17e
SFY 2012 -13 Buyback LOA Page 3
16D12
Letter of Agreement
THIS LETTER OF AGREEMENT made and entered into in duplicate on the q t day of
.Q- -, 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
16D12
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
16D12
WITNESSETH:
IN WITNESS WHEREOF the parties have duty executed this Letter of Agreement on the day
and year above first written.
Collier County
Signature
Fe, E- O
Name
Title
ATTEST:.
DWIQWT E. BROCK, Clerk
gy; ...
ALM
°a
E�atw�'Md� -
t.
State of Florida
Phil E. Williams
Assistant Deputy Secretary for Medicaid Finance,
Agency for Health Care Administration
ApprMod as to form & lapel Sufftlency
Asslat nt County Attorney
T1 #0 NiFEtz t3. era '!�
SFY 2012 -13 Buyback LOA Page 3
16D12
Letter of Agreement
THIS LETTER OF AGREEMENT made and entered into in duplicate on the 9 +4% day of
0 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
SFY 2012 -13 Public Exemptions LOA Page I
16012
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
16012
WITNESSETH:
IN WITNESS WHEREOF the parties have duly executed this Letter of Agreement on the day
and year above first written.
Collier County
"-1U& W.
Signature
FP, ED -). cay t--,E
Name
C- V. a.�2 "PtJ
Title
s' ATTEST;-'
D1IVlpHT ;BRbCK. Clark
fr g*
State of Florida
Phil Williams
Assistant Deputy Secretary for Medicaid Finance,
Agency for Health Care Administration
AWWAd Its tO Wm & 109al Suffic;"EY
�. Assistant Countv Attorney
s� ry -:!� \ Fr-Q s • '--� , : '�-'
SFY 2012 -13 Public Exemptions LOA Page 3