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Agenda 12/15/2009 Item #16D 1 Agenda Item No. 16D1 December 15, 2009 Page 1 of 13 EXECUTIVE SUMMARY Recommendation to approve and authorize the Chairman to sign an agreement with Collier Health Services (CHS), and an agrcement with the Agency for Health Care Administration (AHCA) to participate in the Low Income Pool Program. Participation in this program will require the County to send $207,127 to AHCA, which will generate an additional $432,944 in Federal matching funds to bc paid directly to Collier Health Services. OBJECTIVE: That the Board of County Commissioners approve and authorize the Chairman to sign an agreement with Collier Health Services and the Agency for Health Care Administration to participate in the Low Income Pool (LIP) program for Federally Qualified Health Centers. CONSIDERATIONS: Collier Health Services (CHS), a Federally Qualified Health O:nter (FQHC), has qualified to participate in the Low Incomc Pool program with the Agency for Health Care Administration (AHCA). This program requires a local County match of $207,127 which will allow CHS to draw down $432,944 in additional Fedcral funds to be distributed by AHCA. Richard Akin, President and CEO of CHS, has requestcd that Collier County GovenmlenL. via - the Department of Housing and Human Scrvices, partncr with his organization by providing the matching funds for CHS's participation in this program. In return, CHS has agreed to pay $207,127 of the County's low income or medically needy expenses as determined by the statr of the Housing and Human Scrvices Department. CHS will utilize the additional LIP monies to expand their comprehensive Plimary health care services for Collier's most vulnerable population and medically needy at the Mike Davis Medical Center (formerly Horizons Primary Care Centcr) and other sites. The Housing and Human Services Department will use a portion of the funds Collier County Government is currently expending for medical scrvices as a local match f'Jr CHS. FISCAL IMPACT: The County will send $207,127 to the Agency f()r Health Care Administration. In addition to that amount, CHS will receive $432,944 from AHCA lor a total of $640,071 to be utilized for health related services. These funds have already been budgeted in the Housing and Human Services, Client Assistance Program FY I 0 Client Assistance budget. GROWTH MANAGEMENT IMPACT: There is no growth management impact associated with this executive summmy. LEGAL CONSIDERATIONS: The State requires that the County sign this Agreement with the Agency for Health Care Administration first. This item has been reviewed and approved by the County Attorney's Office. This item is legally sufticient for Board action.-CMG Agenda Item No. 1601 December 15, 2009 Pal)e 2 of 13 RECOMMENDA TION: Staff recommcnds that the Board of County Commissioners approve and authorize the Chainnan to sign the agreement with Collier Health Services and the agreement with the Agency for Health Care Administration and authorize the expenditure of $207,127 to be utilized as local match funds. Prepared by: Terri Daniels, Accounting Supervisor, Housing and Human Services Department Item Number: Item Summary: Meeting Date: Agenda Item No. 16D1 December 15, 2009 Page 3 of 13 COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS 1601 Recommendation to approve and authorize the Chairman to sign an agreement with Collier Health Services (CHSj, and an agreement with the Agency for Health Care Administration (AHCA) to participate in the Low Income Pool Program. Participation in this program will require the County to send $207,127 to AHCA, which will generate an additional $432,944 in Federal matching funds to be paid directly to Collier Health Services for medical services for the most medically needy in Collier County. Collier Health Services will receive a total distribution of $640,071 from the State. 12/15/20099:00:00 AM Prepared By Terri A. Daniels Public Services Division Supervisor ~ Accounting Date Human Services 11/25/20094:04:33 PM Approved By Kathy Carpenter PubliC Services Executive Secretary Date Public Services Admin. 12/4/200910:02 AM Approved By Marcy Krumbine Public Services Division Director - Housing & Human Services Date Human Services 12/4/200912:58 PM Approved By Colleen Greene County Attorney Assistant County Attorney Date County Attorney 12/4/20092:34 PM Approved By Marla Ramsey Public Services Division Administrator - Public Services Date Public Services Division 12/7/200911:59 AM Approved By Jeff Klatzkow County Attorney Date Approved By 12/7/20092:07 PM OMB Coordinator County Manager's Office Date Office of Management & Budget 12/7/20093:46 PM Approved By Sherry Pryor Office of Management & Budget Management! Budget Analyst, Senior Date Office of Management & Budget 12/8/20099:13 AM Approved By John A. Yonkosky Offtce of Management & Budget Aaenda Item No. 16D1 ~ December 15, 2009 Page 4 of 13 Director ~ Management and Budget Date Office of Management & Budget 1218120099:24 AM Agenda Item No. 16D1 December 15, 2009 Paqe 5 of 13 AGREEMENT THIS AGREEMENT is made and entered on the day of 2009, 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 to contract with the Center to provide payments for health care services for the medicaliy needy residents of the County. WHEREAS, The Center is willing to 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 payment up to $207,127 for the following services in the manner as described : a. The Center and/or its sub-contractor shall provide payments for heaith prevention programs identified by the County to the Collier County Health Department. b. The Center and/or its sub-contractor shall provide timely responses to contract requirements. Responses to inquiries from the Public Services Division, County Health Department or designee regarding any aspect of payment of services being provided shall be as indicated below. c. The Center and/or its sub-contractor shall provide payments for 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. 2. The obligation of the Center to provide any services pursuant to this Agreement, or to pay for services provided by other parties approved by the County pursuant to this Agreement, shall be contingent upon designated funds being paid to Center by the state or county in advance of the obligation of the Center to provide any services or to pay for any services. In the event that sufficient designated funds are not on deposit with the Center, the Center shall have no obligations under this Agreement. 1 Agenda Item No. 1601 December 15, 2009 Page 6 of 13 ARTICLE II PAYMENTS 1. The County shail make four quarterly payments to the State of Florida under the Inter Governmental Transfer Program (lGT): The County wiil transfer payments to the State in the fOllowing manner: a) The first quarterly payment of $51,784 for the months of July, August, and September is due upon notification by the State. b) Each successive payment of $51,781 is due no later than, December 31, 200S, March 31,2009 and June 15, 2009. c) The State will bill the County each quarter payments are due. 2. 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. 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, 2009 through September 30, 2010 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 shail pay for services rendered, prorated to the date of temnination. The County shall continue to pay for any inpatient receiving services on the date of termination until the discharge of such payment. 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. 4. 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 shail 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 Agenda Item No. 16D1 December 15, 2009 Pa"e 7 of 13 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 !9xpressly 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 1. 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, .f!' rules or regulations occurs in payments made pursuant to this Agreement. cotlierCOltn-llj'S ind~nm(l:d1/JV1 i.. ~LJ-\Ii!'U- +0 fU- U/>1.rtr "" . 2. Insurance Required. t,c.B.z.6, "",u"jn ;/"Yl/1'lW1'l' The Center maintains insurance as described in the attached Insurance Exhibit 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 snail use reasonable efforts to pay invoices approved by the County within thirty (30) days of County approval. 3 Aoenda Item No. 1601 - December 15, 2009 Page 8 of 13 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 1. 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 ~hall 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 Ori9in, 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 empioyees 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 Agenda Item No. 16D1 December 15, 2009 Palle 9 of 13 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 locai 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 Heaith 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 BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY, FLORIDA By: By: Donna Fiala, Chairman Deputy Clerk Date: December 15.2009 COLLIER HEALTH SERVICES Approved as to form and legal sufficiency By: r.~~ Q Assistant County Attorney Collier County Richard B. Akin, President and CEO Date' December 15. 2009 5 Agenda item No. 16D1 December 15, 2009 Page 10 of 13 Letter of Agreement THIS LETTER OF AGREEMENT made and entered into in duplicate on the day of 2009, by and between Collier County (the County), and the State of Florida, through its Agency for Health Care Administration (the Agency), 1. Per Senate Bill 2600, the General Appropriations Act of State Fiscal Year 2009-2010, passed by the 2009 Florida Legislature, County and the Agency, agree that County will remit to the State an amount not to exceed a grand total of $207,127. 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. Agenda Item No. 16D1 December 15, 2009 Pag'l 11 of 13 2. The County will pay the State an amount not to exceed the grand total amount of $207,127. The County will transfer payments to the State in the following manner: a) The first quarterly payment of $51 ,764 for the months of July, August, and September is due upon notification by the Agency. b) Each successive payment of $51,761 is due no later than, December 31, 2009, March 31, 2010 and June 15, 2010. c) The State will bill the County each quarter payments are due. 3. Attached are the DSH and LIP schedules reflecting the anticipated annual distributions for State Fiscal Year 2009-2010. 4. 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. 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 providers to re-direct any portion of these aforementioned Medicaid supplemental payments in order to satisfy non- Medicaid, non-uninsured, and non-underinsured activities. 7. 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. 8. This Letter of Agreement covers the period of July 1,2009 through June 30, 2010. 2 Agenda Item No. 16D1 December 15, 2009 Page 12 of 13 WITNESSETH: IN WITNESS WHEREOF the parties have duly executed this Letter of Agreement on the day and year above first written. A TIEST: DWIGHT E. BROCK, Clerk BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY, FLORIDA By: By: Donna Fiala, Chairman Board of County Commissioners Deputy Clerk Date: December 15. 2009 STATE OF FLORIDA: Approved as to form and legal sufficiency By: r~~ Assistant County Attorney Collier County Phil E. Williams Assistant Deputy Secretary for Medicaid Finance Agency for Health Care Administration Date: December 15, 2009 3 Agenda Item No. 16D1 December 15, 2009 Page 13 of 13 Local Government Intergovernmental Transfers Program I Amount State Fiscal Year 2009.2010 DSH UP, Exemptions & SWI 207,127 Nursing Home SMP Total Funding $207.127 4