Agenda 10/14/2008 Item #10EAgenda Item No. 10E
October 14, 2008
Page 1 of 7
EXECUTIVE SUMMARY
Recommendation that the Board of County Commissioners approve and authorize the
Chairman to sign an agreement with the Agency for Health Care Administration in the
amount of $2,789,131 to participate in the Medicaid Low Income Pool Program for
services provided on behalf of the Housing and Human Services Department in order to
generate an additional $485,309 in Federal matching funds.
OBJECTIVE: That the Board of County Commissioners approve and authorize the Chairman
to sign an agreement with the Agency for Health Care Administration (AHCA) to participate in
the Medicaid Low Income Pool (LIP) program.
CONSIDERATIONS: The Agency for Health Care Administration (AHCA) is the State entity
that provides Medicaid services in Florida and operates the Hospital Low Income Pool (LIP)
program. This program takes local funds and through an agreement between local government
and AHCA uses these funds to obtain Federal matching dollars.
These dollars are returned to the community through an inpatient hospital in the form of special
medicaid payments in order to provide enhanced services to low - income individuals.
Physician's Regional Medical Center will continue to participate in this program to receive these
special Medicaid payments and serve as the Third Party Administrator for Collier County. The
Board of County Commissioners approved an agreement with Physicians Regional Medical
Center on November 17, 2006 outlining the costs associated with the administration of this
agreement. The costs remain the same for this new agreement. The agreement with AHCA is
for $2,789,131 of existing funds within the Housing and Human Services, Health Department
and Mental Health FY 2008 -09 budgets.
The FY09 County budget for this program was prepared based on inforination from AHCA that
the match percentage would remain at 20° o for the FY09 program year. However, after
receiving the agreement and allocation from AHCA for the FY09 program year, the match will
be funded at 17.4 %. This reduced match percentage will result in a shortfall of $72,517 for this
fiscal year as shown in the table below.
Program
County
Commitment
AHCA Match
at 17.4%
Original AHCA
Match at 20%
AHCA Match
Shortfall
Collier County
Health Department
$1,126,400
$195,994
$225,280
($29,286)
David Lawrence
Center
$ 899,300
$156,478
$179,860
($23,382)
Social Services
$ 763,431
$132.837
$152,686
($19,849)
Total
$2,789,131
1 $485,309
1 5557,826
($72,517)
,— FISCAL IMPACT: Participation in the Low Income Payment Program will provide $485,309
in additional revenue for healthcare resources to Collier County. However, each program will
receive a decreased allocation based on the reduced match percentage.
Agenda Item Igo. 10E
October 14, 2008
Page 2 of 7
LEGAL CONSIDERATIONS: This item has been reviewed by the County Attorney's Office
and is legally sufficient for Board action. - CMG
GROWTH MANAGEMENT IMPACT: There is no growth management impact associated
with this executive summary.
RECOMMENDATION: Staff recommends that the Board of County Commissioners approve
and authorize the Chairman to sign the agreement with the Agency on Health Care
Administration.
Prepared by: Terri Daniels, Accounting Supervisor, Housing and Human Services Department
Agenda Item Rio. 10E
October 14, 2008
Paae 3 of 7
Letter of Agreement
THIS LETTER OF AGREEMENT made and entered into in duplicate on the 14th day of
October 2008, 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 2008 -2009,
passed by the 2008 Florida Legislature, County and the Agency, agree that County will remit
to the State an amount not to exceed a grand total of $2,789,131.
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 health 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.
Letter of Agreement for SFY 2008 -04
COLLIER COUNTY
Agenda ftenn No. 10E
October 14, 20C!S
Page 4 of 7
2. The County will pay the State an amount not to exceed the grand total amount of
$2,789,131. The County will transfer payments to the State in the following manner:
a) The first quarterly payment of $697,285 for the months of July, August,
and September is due upon notification by the Agency.
b) Each successive payment of $697,282 is due no later than, December 31,
2008, March 31, 2009 and June 15, 2009.
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 2008 -2009.
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, 2008 through June 30, 2009.
Letter of Agreemen t for SFY 2006.09
COLLIER COUNTY
Agenda Item No. 10E
October 14, 2008
Page 5 of 7
WITNESSETH:
IN WITNESS WHEREOF the parties have duly executed this Letter of Agreement on the day
and year above first written.
ATTEST:
DWIGHT E. BROCK, Clerk
By:
Deputy Clerk
Approved as to form and
legal sufficiency
0O
Assistant County Attorney
Collier County
Letter of Agreement for SFY 200"
COLLIER COUNTY
COLLIER COUNTY HOUSING AND HUMAN SERVICES
BY:
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
By:
Tom Henning, Chairman
Board of County Commissioners
Date: October 14 2008
STATE OF FLORIDA:
By:
Phil E. Williams
Assistant Deputy Secretary for Medicaid Finance
Agency for Health Care Administration
Date: October 14 2008
agenda Item No, ICE
October 14, 2003
Page o of 7
Local Government Inter
overnmentai Transfers
Program /Amount I State Fiscal Year 2008 -2009
DSH
LIP
$1,640,311
Exem tions
$1,148,820
Statewide Issues
Nursing Home SMP
Total Funding
$2,789,131
Letter of Agreement for SFY 2008 -09
COLLIER COUNTY
Page 1 of 1
Agenda Item No. 10E
October 14, 2008
Page 7 of 7
COLLIER COUNTY
BOARD OF COUNTY COMMISSIONERS
Item Number:
10E
Item Summary:
Recommendation that the Board of County Commissioners approve and authorize the
Chairman to sign an agreement with the Agency for Health Care Administration in the
Karla Ramsey
amount of $2,789,131 to participate in the Medicaid Low Income Pool Program for services
Date
provided on behalf of the Housing and Human Services Department in order to generate an
Public Services Admin.
additional $485,309 in Federal matching funds. (Marcy Krumbine. Housing and Human
Approved By
Services Director)
Meeting Date:
10/14/2008 9:00:00 AM
Prepared By
Date
Terri A. Daniels
Grants Coordinator Date
Public Services
Housing & Human Services 9/2312008 6:55:16 PM
Approved By
Marcy Krumbine
Director Date
Public Services
Housing & Human Services 9/24/2008 1:25 PM
.Approved By
Colleen Greene
Assistant County AAttorner Date
County Attorney
County Attorney Office
9,12412008 2:41 PM
Approved By
Karla Ramsey
Public Services Administrator
Date
Public Services
Public Services Admin.
9129/2008 4:32 PM
Approved By
Oh1EB Coordinator
OMB Coordinator
Date
County Manager's Office
Office of Management & Budget
9130/2008 8:33 AM
Approved By
Sherry Pryor Management & Budget Analyst Date
County Manager's Office Office of Management & Budget 9 ,13012008 11:32 AM
Approved By
James V. Mudd County Manager Date
Board of County
County Manager's Office 9130/2008 7:06 PM
Commissioners
file: //C : \AgendaTest \Export\ 114- October %2014. %202008\ 10. %20C OUNTY %20MAN AG ... 10/8/2008