An Ordinance Of The Board Of County Commissioners Of Pasco County, Florida, Establishing The “Pasco County Local Provider Participation Fund Ordinance”; Providing For A Title; Providing For Applicability; Providing For Definitions; Providing For Purpose; Providing For Alternative Method; Providing For Assessment; Providing For Computation Of Assessment; Providing For Assessment Resolution; Providing For Non-Ad Valorem Assessment Roll; Providing For Notice By Publication; Providing For Notice By Mail; Providing For Adoption Of Assessment Resolution And Non-Ad Valorem Assessment Roll; Providing For Annual Final Assessment Resolution; Providing For Effect Of Annual Final Assessment Resolution; Providing For Method Of Collection; Providing For Refunds; Providing For Enforcement; Providing For Correction Of Errors And Omissions; Providing For Limitations On Surcharges; Providing For Repeal Of Laws In Conflict; Providing For Severability; Providing For Inclusion In The Code Of Laws And Ordinances; Providing For Captions; And Providing For An Effective Date.

5:35Okay. So on better advice than I had myself We will go to P58 if that person will come forward. We'll get it taken care of.

5:50Sorry,

5:50sir. That's all right. How quiet.

5:55Alright. Good afternoon, Commissioner. Paul Racaldo Support Services. Item P fifty eight is an ordinance by the Board of County Commissioners of Pasco County, Florida, creating a section to be numbered Chapter 94, Article 4, establishing a local provider participation fund providing for the authorization of non-Apollorum special assessments to be imposed, levied, collected, and enforced against real property owned or leased by private for-profit and not-for-profit hospitals to Fund the non federal share of supplemental payments benefiting hospitals, providing healthcare services to Medicaid,

6:26indigent, and uninsured members of the Pasco County community. Providing for the procedure for adopting the annual non-advalorium special assessments to be deposited into the local provider participation fund. Providing for the authorized uses for the local provider participation fund proceeds, providing for severability, providing for areas embraced, providing for inclusion in the code, and providing for an effective date. And we

6:48have proof of publication of hearing of this matter in the Tampa Bay Times July seventeenth, twenty twenty four. Okay.

6:57This item comes to you with a recommendation of approval. We do have a presentation for you if it is the board's pleasure.

7:05Sorry?

7:08We have Colleen Ernst from Atlanta Healthcare Ventures who will be doing the presentation today.

7:12Okay.

7:16Might be it might be good

7:17for the public to hear what we're doing, I think. Good thing. Thank you. Uh my name is Colleen Ernst and I'm with Adelanto Healthcare Ventures. That is a company that offers technical expertise in the area of accessing reimbursement for care for the Medicaid population and for the indigent and uninsured. In a nutshell, our goal in working with the hospitals here in Pasco County and around the state of Florida. Is to ensure that every citizen has access to quality care

7:47regardless of income. And so we're here today to talk about an opportunity for Pasco County to partner with its hospitals and to work to ensure that the federal tax dollars our citizens are paying here in Pasco and across the state of Florida come back into the state of Florida to facilitate access to care for everyone. Mm-hmm. So historically Florida's hospitals are limited in the reimbursement they receive when they're providing care to the Medicaid

8:18and indigent population. Typically, when a hospital performs a procedure for someone who qualifies for Medicaid, that's an individual who is low income and who has a qualifying disability or condition or is in a qualifying phase of life, hospitals in Florida were only able to get about 60 cents on the dollar in reimbursement for those services. So every time that a hospital was providing these services, were losing 40 cents on the dollar in actual cost. So

8:48a $10,000 labor and delivery, and in Florida one in two births is a Medicaid birth. But a $10,000 labor and delivery procedure would result in the hospital losing $4,000 out of pocket because they were not receiving reimbursement to cover the full cost. That problem, of course, is compounded by the fact that hospitals are only receiving very limited reimbursement for charity care. So for the individuals who walk in who are low income and do

9:18not have any form of insurance, hospitals were writing off these costs as charity care. That amount statewide resulted in about a $3 billion loss every year. So these were limitations on hospitals. Difficulties.

9:35In November of 2020, Governor DeSantis included in his recommended budget direction for the state's Medicaid agency to seek federal approval for a program to help address this problem that was known as the Directed Payment Program. And the function was to help access federal dollars that Florida had historically left on the table and to use those dollars to help. narrow the reimbursement gap. The dollars follow the patient. Now of course the issue was was how

10:06do you come up with state dollars to bring in the federal dollars? How do you come up with the state dollar that qualifies for federal match? And the answer to that was looking to local governments to collect from the hospitals only. So to levy a special assessment only on hospitals, not on any other business, not on any individual citizen, but to collect from the hospitals in the jurisdiction Those dollars then serving to unlock federal dollars, helping

10:36hospitals to narrow that reimbursement gap. So essentially The governmental entities, like Pasco County, if you choose to proceed, would collect these dollars through a special assessment against the hospitals only, Those dollars come to the county, the county submits them to the state, and then those dollars qualify for federal match. Again, dollars Florida had historically left on the table, and then those funds follow the patient. So hospitals receive a reimbursement increase,

11:06getting them closer to 80 cents on the dollar for Medicaid services, and taking them into getting some reimbursement for. their charity care. Instead of the historical 1% that most hospitals received, it will be about 8%. So again, not solving the problem entirely by any means, but helping hospitals provide this quality care. Uh so Pasco County now has an ordinance before it that would establish this assessment on hospitals only. Now nobody gets a bill today. The

11:36hospitals will bring a rate recommendation before this board at a later point, but this is the framework. creating this assessment. Uh Pasco is not the first county to have this opportunity. In 2021, 15 jurisdictions started with this program and they've all come back. In fact, it's only grown. So by the end of this year, we could have a total of 26 jurisdictions. At the time this slide was created, Okaloosa was just considering. They've now scheduled

12:07September 3rd to be when their vote on the ordinance would be decided. So 26 jurisdictions. Doing a program just like this, assessing the hospitals, helping them access the federal match. The hospitals will be before you again September 17th. That's when they'll bring the rate recommendation. The board will vote on that rate recommendation, and if you decide to proceed, that's when the hospitals get the bill. Again, those dollars come to the county, go to the state, unlock federal match,

12:38and help the hospitals continue providing this type of care. And then October 1st is when the county is set. Messages: yes, state of Florida, yes, State Medicaid Agency. We in Pasco County want our hospitals to be part of this program. We do intend to levy the special assessment. We do intend to help our hospitals access those federal dollars. Now, this program is of significance to the hospitals in Pasco County. Letters of support were signed by all that would be subject to the assessment. And

13:08here today in the room we have representatives of Baycare and from Advent Health speaking for all of the hospitals in Pasco County. We have Mike Merle. He is the president and CEO of Zephyrhills, Dade City, and Conerton, the Advent facilities there. Mike, if you would mind.

13:31Good afternoon, Commissioner. Good to see you this afternoon, Commissioner Oakley and the rest of the uh commissioners. It's a pleasure to be here with you this morning. And uh as Colleen mentioned, my name is Mike Merle, and I'm uh CEO within Advent Health. And I'm also speaking on behalf of my CEO colleagues within Pasco County, hospital colleagues within Pasco County this afternoon. Thank you for uh for considering this proposal and I'm speaking on behalf of them in support of the local provider participation fund ordinance that you

14:01are considering today. This ordinance will allow private hospitals like ours to provide care to those in greatest need by unlocking federal funding to address our charity and uncompensated care. Private hospitals and healthcare systems across Pasco County provide critical needed healthcare services to our local community. Florida's growing network of local hospitals special assessments has been a tremendous success, generating

14:31funds to support hospitals and bolster regional economic impact at no cost to residents or businesses. This funding provides hospitals within Pasco County the ability to meet the growing needs of our underserved community and provide high-quality care to patients within Pasco County. So again, thank you for your support on this matter and we incredibly look forward to working with you together within the county on this critical program. Thank you.

15:04Are there any questions? Any questions? No?

15:10Well I well I had asked um her if we would we would see anything but no, it's just between you And the patients and the feds

15:20pay for it.

15:21Right?

15:21That's correct.

15:22The the dollars are distributed by the state of Florida. So after they get the federal match, the dollars are distributed by them to the hospitals with with the limitation that they follow the patients. They track the volume of care. So when Advent Health is providing care to Medicaid patients or to low-income uninsured, those dollars are designed to follow those patients. So it's designed to incentivize and increase. access to care. I wish we were doing this earlier,

15:50so I'm glad it's coming to us.

15:52Yeah.

15:53Um I did mention that at the national level I was trying to get the name of the um of what it's called and maybe the county attorney can help me, but uh when someone is arrested and they come to our county jail and if they're on federal um medical benefits they're they're um ended. And they could be in there for months, they could be in there for weeks, but their their federal benefits are ended and so are their families. So um at the national level I've been working to fix this and so

16:23has the National Sheriffs Association. We've managed to fix it to the point where states who suspend those benefits get to have their get to have them reinstated, but states who suspend benefits um No, we're not taken care of yet, so love for you to take that on too. Uh 'cause it costs us millions and millions of dollars. And I think it really adds to recidivism when people who are jailed and aren't getting their medicine um when they get out, you know, they they go right back in. So

16:54So be good to get that fixed once and for all. Okay. Mr. Sharon. Yes

16:59or Mr. Mariano? Mr.

17:00Sharon is right on point two. We'd love to work with you on that. We've brought this up this year over and over and everybody's on board to get a change. I think with your power I'll say. And your your group will probably get together and make these things happen.

17:15Yeah. When it was presented to us we all felt the same way. We wanted this to happen and And uh tie that gap together that that hospitals won't without that money. So it's very important for y'all and we know that. So thank you. Okay. Thank you so much.

17:31Thank you. So with that do we take a motion

17:35hearing public hearing. This is a public hearing. Anyone here wish to speak to this item before we take a vote?

17:43Seeing no one come forward. I got a motion to approve. Mr. Chairman

17:48Mariano. Yes. Just for point of clarification, we have provided the clerk's office with a revised effective date for the ordinance that is consistent with excuse me, consistent with your board motion allowing them to file an electronic copy rather than a certified copy.

18:07Excuse me, Jeffy, if I may also add we also have a revised release that's also part of your packets today.

18:13Okay. Uh also I forgot to ask, do we have anybody on WebEx that wish to speak or

18:18not to speak to this item.

18:19To this item. Okay. So with that, I'll accept a motion.

18:24I did I did a motion and I think some seconds. And um under discussion that that policy that I was talking about that we're trying to change is called the Medicaid Inmate Exclusion Policy.

18:35Okay. So I have a motion and a second. All those in favor vote. Uh roll call vote.

18:41Uh District Two, Commissioner Weightman. Aye. District three, Commissioner Starkey. Aye. District four, Commissioner Yeager. Aye. District five, Commissioner Mariano. Aye. District one, Chairman Oakley.