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Item C41BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: 4-15-09 Division: Communijy Services Bulk Item: Yes X No _ Department: Social Services Staff Contact Person: Sheryl Graham x4510 AGENDA ITEM WORDING: Approval of a recurring expense as required by Florida Statute 409.915. ITEM BACKGROUND: This is a required expense that is required by Florida Statute 409.915. Each year this expense is budgeted in the Welfare Services budget. FS409.915 dictates that "although the state is responsible for the full portion of the state share of the matching funds required for the Medicaid program, in order to acquire a certain portion of the funds, the state shall charge the counties for certain items of care and services as provided in this section. (1) Each county shall participate in the following items of cares and service." (see attached FS 409.915). PREVIOUS RELEVANT BOCC ACTION: Prior approval for Medicaid Hospital and Nursing Home recurring expense granted by BOCC on 11-14-07. CONTRACT/AGREEMENT CHANGES: $439,000 Medicaid Hospital and $42,000.00 Medicaid Nursing Home. Total $481,000.00 STAFF RECOMMENDATIONS: Approval TOTAL COST: $481,000 BUDGETED: Yes X No _ COST TO COUNTY: $481,000 SOURCE OF FUNDS: _General Fund REVENUE PRODUCING: Yes _ No X_ AMOUNT PER MONTH140083.33 Year $481,000 APPROVED BY: County Aft A Z�rchasing DOCUMENTATION: Included X Not Required. DISPOSITION: Revised 8/06 Risk Management (Y� To Follow AGENDA ITEM # MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CONTRACT SUMMARY Contract with: State of Florida (AHCA) Contract Effective Date: 10-01-08 Expiration Date: 9-30-09 Contract Purpose/Description: Florida Statute 409.915 requires each county to pay a portion of the Medicaid Nursing Home and Medicaid Hospital payments. By FS 409.915, Monroe County is required to pay 35% of Medicaid Hospital payments and $55.00 per month, per client for Medicaid Nursing Home expenses. Contract Manager: Sheryl 4510 Social Services/Stop 1 (Name)Graham (Ext.) (Department/Stop #) For BOCC meeting on 4-15-09 Agenda Deadline: 3-31-09 CONTRACT COSTS Total Dollar Value of Contract: approx. $481,000 Budgeted? Yes X No Account Codes: County Match: 0 Additional Match: Total Match $0 Estimated Ongoing Costs: $ /yr of included in dollar value above Current Year Portion: $_ _61502-530311-$439,000. _61502-530312 $42,000_ ADDITIONAL COSTS For: CONTRACT REVIEW Changes Date Out Division Director Date In Needed Yes N vievy� 3 Risk Manage ent O. MB lPurc acing 3�3a 001 Yes No Yes No -- — County Attorney �� a��o � Yes N Z � —� Comments: OMB Form Revised 2/27/01 MCP #2 Statutes & Constitution :View Statutes :->2008->Ch0409->Section 915 : Online Sunshine Page 1 of 2 Select Year: 2008No The 2oo8 Florida Statutes �,�2s� r� Eiv IVIe_ J Title XXX Chapter 409 View Entire Chapter SOCIAL WELFARE SOCIAL AND ECONOMIC ASSISTANCE 409.915 County contributions to Medicaid. --Although the state is responsible for the full portion of the state share of the matching funds required for the Medicaid program, in order to acquire a certain portion of these funds, the state shall charge the counties for certain items of care and service as provided in this section. (1) Each county shall participate in the following items of care and service: (a) For both health maintenance members and fee -for -service beneficiaries, payments for inpatient hospitalization in excess of 10 days, but not in excess of 45 days, with the exception of pregnant women and children whose income is in excess of the federal poverty level and who do not participate in the Medicaid medically needy program, and for adult lung transplant services. (b) For both health maintenance members and fee -for -service beneficiaries, payments for nursing home or intermediate facilities care in excess of $170 per month, with the exception of skilled nursing care for children under age 21. (2) A county's participation must be 35 percent of the total cost, or the applicable discounted cost paid by the state for Medicaid recipients enrolled in health maintenance organizations or prepaid health plans, of providing the items listed in subsection (1), except that the payments for items listed in paragraph (1)(b) may not exceed $55 per month per person. (3) Each county shall set aside sufficient funds to pay for items of care and service provided to the county's eligible recipients for which county contributions are required, regardless of where in the state the care or service is rendered. (4) Each county shall pay into the General Revenue Fund, unallocated, its pro rata share of the total county participation based upon statements rendered by the agency in consultation with the counties. (5) The Department of Financial Services shalt withhold from the cigarette tax receipts or any other funds to be distributed to the counties the individual county share that has not been remitted within 60 days after billing. (6) In any county in which a special taxing district or authority is located which will benefit from the medical assistance programs covered by this section, the board of county commissioners may divide the county's financial responsibility for this purpose proportionately, and each such district or authority http://www.leg.state.fl.us/STATUTES/index.cftn?App_mode=Display_Statute&Search St... 3/24/2009 Statutes & Constitution :View Statutes :->2008->Ch0409->Section 915 : Online Sunshine Page 2 of 2 must furnish its share to the board of county commissioners in time for the board to comply with the provisions of subsection (3). Any appeal of the proration made by the board of county commissioners must be made to the Department of Financial Services, which shall then set the proportionate share of each party. (7) Counties are exempt from contributing toward the cost of new exemptions on inpatient ceilings for statutory teaching hospitals, specialty hospitals, and community hospital education program hospitals that came into effect July 1, 2000, and for special Medicaid payments that came into effect on or after July 1, 2000. History.--s. 46, ch. 91-282; s. 8, ch. 96-417; s. 190, ch. 99-8; s. 26, ch. 2000-171; s. 11, ch. 2001-104; s. 3, ch. 2002-35; s. 452, ch. 2003-261; s. 3, ch. 2007-82. Copyright ® 1995-2009 The Florida legislature • Privacy Statement • Contact Us http://www.leg.state.fl.us/STATUTES/index.cfin?App_mode=Display_Statute&Search St... 3/24/2009 Statutes & Constitution :View Statutes :->2008->Ch0409->Section 915 : Online Sunshine Page 1 of 2 Select Year: 2008 The 2oo8 Florida Statutes Title XXX Chapter 409 SOCIAL WELFARE SOCIAL AND ECONOMIC ASSISTANCE I View Entire Chapter 409.915 County contributions to Medicaid. --Although the state is responsible for the full portion of the state share of the matching funds required for the Medicaid program, in order to acquire a certain portion of these funds, the state shall charge the counties for certain items of care and service as provided in this section. (1) Each county shall participate in the following items of care and service: (a) For both health maintenance members and fee -for -service beneficiaries, payments for inpatient hospitalization in excess of 10 days, but not in excess of 45 days, with the exception of pregnant women and children whose income is in excess of the federal poverty level and who do not participate in the Medicaid medically needy program, and for adult lung transplant services. (b) For both health maintenance members and fee -for -service beneficiaries, payments for nursing home or intermediate facilities care in excess of $170 per month, with the exception of skilled nursing care for children under age 21. (2) A county's participation must be 35 percent of the total cost, or the applicable discounted cost paid by the state for Medicaid recipients enrolled in health maintenance organizations or prepaid health plans, of providing the items listed in subsection (1), except that the payments for items listed in paragraph (1)(b) may not exceed $55 per month per person. (3) Each county shall set aside sufficient funds to pay for items of care and service provided to the county's eligible recipients for which county contributions are required, regardless of where in the state the care or service is rendered. (4) Each county shall pay into the General Revenue Fund, unallocated, its pro rata share of the total county participation based upon statements rendered by the agency in consultation with the counties. (5) The Department of Financial Services shall withhold from the cigarette tax receipts or any other funds to be distributed to the counties the individual county share that has not been remitted within 60 days after billing. (6) In any county in which a special taxing district or authority is located which will benefit from the medical assistance programs covered by this section, the board of county commissioners may divide the county's financial responsibility for this purpose proportionately, and each such district or authority http://www.leg.state.fl.us/STATUTES/index.cfm?App_mode=Display_Statute&Search St... 3/24/2009 Statutes & Constitution :View Statutes :->2008->Ch0409->Section 915 : Online Sunshine Page 2 of 2 must furnish its share to the board of county commissioners in time for the board to comply with the provisions of subsection (3). Any appeal of the proration made by the board of county commissioners must be made to the Department of Financial Services, which shall then set the proportionate share of each party. (7) Counties are exempt from contributing toward the cost of new exemptions on inpatient ceilings for statutory teaching hospitals, specialty hospitals, and community hospital education program hospitals that came into effect July 1, 2000, and for special Medicaid payments that came into effect on or after July 1, 2000. History.--s. 46, ch. 91-282; s. 8, ch. 96-417; s. 190, ch. 99-8; s. 26, ch. 2000-171; s. 11, ch. 2001-104; s. 3, ch. 2002-35; s. 452, ch. 2003-261; s. 3, ch. 2007-82. Copyright o 1995-2009 The Florida Legislature • Privacy Statement • Contact Us http://www.leg.state.fl.us/STATUTES/index.cfm?App_ node=Display_Statute&Search St... 3/24/2009 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CONTRACT SUMMARY Contract with: State of Florida (AHCA) Contract # Effective Date: 10-1-2007 Expiration Date: 9-30-2008 Contract Purpose/Description: Florida Statute 409.915 requires each county to pay a portion of the Medicaid Nursing Home and Medicaid Hospital p4yments. By FS 409.915 Monroe County is Leguired to pay 35% of Medicaid Hospital payments AND $55 per month, per client for Medicaid Nursing Home expenses. Contract Manager: Sheryl Graham 4592 Social Services/Stop #1 (Name) (Ext.) (Department/Stop #) for BOCC meeting on 11-14-2007 Agenda Deadline: 10-30-2007 CONTRACT COSTS Total Dollar Value of Contract: $ 492,000 Current Year Portion: $ Budgeted? Yes® No ❑ Account Codes: 61502-530311- 50 000- -. Grant: $ -0- 61502-530312- 42 000- -_ County Match: $ -0- ADDITIONAL COSTS Estimated Ongoing Costs: $ /yr For: (Not included in dollar value above) (eg. maintenance, utilities, janitorial, salaries, etc. CONTRACT REVIEW Changes � Date Out Date ItV Needed - ievver � Division Director /� � � 07 Yes❑ No � ' Risk Mana nt I Yes❑ NoQ' O.M.B./Purcha�ing {� �/o Wes❑ No© County Attorney /�� � Yesn No[i� S,t i3p� ►tin e. 4i-L-"ar) ► 0 2(0 C:� Comments: �) OMB Form Revised 2/27/01 MCP #2 Graham -Sheryl To: Hutton -Suzanne Subject: RE: Medicaid Hospital/Nursing Home From: Hutton -Suzanne Sent: Friday, October 26, 2007 10:25 AM To: Graham -Sheryl Cc: Mercado -Pedro Subject: RE: Medicaid Hospital/Nursing Home Although we are statutorily required to make the payment, it is a huge amount, and probably should go before the BOCC although they have no choice but to approve. I'll copy Pedro so he knows on Monday when he gets back that I have already answered the question. It won't hurt for the public to have the opportunity to know that some of these costs are out of our control & are imposed by the State. sq, 4. Va%. County Attorney Monroe County PO Box 1026 Key West, Ff. 33041-1026 305-292-3470 10/29/2007 BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: 11-14-07 Division: Community Services Bulk Item: Yes X No Department:, Community Support Services Staff Contact Person/Phone #: Deb Barsell. 4510 AGENDA ITEM WORDING: Approval of a reoccurring expense as required by Florida Statute 409.915. ITEM BACKGROUND: This is a reoccurring expense that is required by Florida Statute 409.915. Each year this expense is budgeted in the Welfare Services budget. FS409.915 dictates that "although the state is responsible for the full portion of the state share of the matching funds required for the Medicaid program, in order to acquire a certain portion of the funds, the state shall charge the counties for certain items of care and service as provided in this section. (1) Each county shall participate in the following items of cares and service:" (see attached FS409.915). PREVIOUS RELEVANT BOCC ACTION: N/A CONTRACT/AGREEMENT CHANGES: $450,000 Medicaid Hospital and $42,000 Medicaid Nursing Home. Total $492,000. STAFF RECOMMENDATIONS: Approval TOTAL COST: $492,000. BUDGETED: Yes X No COST TO COUNTY: $492,000, SOURCE OF FUNDS: General Fund REVENUE PRODUCING: Yes L J AMOUNT PER MONTH_$11,000 Year _S492,000 APPROVED BY: County Atty OMB/Purchasing x Risk Management < DOCUMENTATION: Included X Not Required DISPOSITION: AGENDA ITEM # Revised 11/06 . r r 'ram : !+; �� + �•� L. ��,;.. �` � .. z.. l - . � }�� - �-.Pfry��.7 � '}_ � _ _ �• .'� . , �+fir, ' ' M;! t `��rB p_ _ ry 7 � •e� ` • •,Y . '_ +��J'li�� "}�y�� .... . _ ,tom :'� •, Jd4R; 6 a r ..: fff + +cam �!f` • ; I chY Lake Sqb `; - q' sr f ►'Dario r A Report on Medicaid Nursing Home County Billing: Certificate of Residency Background The Florida Medicaid program provides health care coverage to qualified low-income individuals meeting federal and state eligibility requirements. State, federal, and county governments share the costs of Medicaid nursing home services. The counties' participation level is specified in Chapter 409.915, F.S. as 35% of the total cost paid by the State for Medicaid beneficiaries, not to exceed $55.00 per month per person. Due primarily to disputes over the COR between the State and the counties concerning who is responsible for the Medicaid nursing home costs there have been issues from the inception of the Medicaid County Billing process. County participation in Medicaid nursing home expenditures are based on the number of Medicaid beneficiaries each county has that reside in a nursing home. As specified in Chapter 409.915(3), F.S. counties pay only for their residents, regardless of where in the state the nursing home care is provided. AHCA is the single state agency responsible for administering the Florida Medicaid program. AHCA bills counties for their pro rata share of Medicaid nursing home costs in accordance with the Florida Statutes. These billings are provided to the counties on a monthly basis. Currently AHCA provides the counties with information concerning each of the Medicaid beneficiaries that appears on their billing. The beneficiaries' name and residency address, the facility where the beneficiaries are located, the beneficiaries' designated representative (if any), and the public assistance specialists' name are all y provided to the counties in an electronic COR file. When the counties receive the electronic information, they review the list and confine the beneficiaries in order to avoid paying for individuals that are residents of other counties. The review process varies by county. Some do a line -by-line manual review while others have an automated application that performs various edits. After performing their reviews, counties then notify AHCA of discrepancies found. AHCA's Medicaid County Billing staff performs further research in an attempt to determine the accuracy of the information received. If AHCA finds that beneficiaries are indeed residents of other counties, an adjustment is made and the appropriate county is billed. Through their Economic Self -Sufficiency program, DCF provides assistance to low- income families through Food Stamps, Cash Assistance, and Medicaid programs. DCF staff perform eligibility determinations for the Medicaid program on behalf of the State of Florida and notifies AHCA of individuals determined eligible. DCF staff interview individuals applying for assistance and obtain basic demographic information such as name, address, city, and county of residence. Additionally, DCF staff perform a certification of residence review and provide AHCA with the COR. AHCA's staff use the COR in the county nursing home billing process to determine the appropriate county to bill for their pro rats share of Medicaid costs. For various reasons the COR is often incorrect. Because the current address is not required for Medicaid eligibility purposes, the individual applying for Medicaid services may give a post office box number, or may not give an address at all. Post Page 2 of 17 March 1, 2005