Subject:
Title
Letters of Agreement and questionnaires in substantially similar forms as required to allow participation in hospital supplemental pay programs for local hospitals for the new program year.
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Recommended Action:
Recommended Action
Approval of the Letters of Agreement (LOA) and LOA questionnaires in substantially similar form as required to allow participation in hospital supplemental pay programs for local hospitals for the new program year.
Additionally, delegate authority to the County Administrator for the execution of amendments to the LOA and questionnaires during the program year.
• Executed LOA agreements are required to be submitted to the State Agency for Health Care Administration (AHCA) by October 1, 2026, to participate in the 2026-2027 State Fiscal Year.
• Due to the anticipated timing of receipt for final agreements, this item seeks approval of the LOA and delegation to the Chair to execute the final LOA when received from AHCA.
• In addition, in order to allow responsiveness during the program year, this item seeks delegated authority to the County Administrator to execute amendments to the initial LOA and questionnaires when changes are required.
• A resolution will still be required on a future Board agenda to establish a non-ad valorem special assessment on specific non-public hospital properties for use as Intergovernmental Transfers (IGTs) under the supplemental payment enhancement programs. The resolution will be presented to the Board for review and adoption upon final model approval at the federal and state level in the coming months.
• The LOA will precede the resolution for the new program year necessitating execution prior to Board resolution adoption. IGTs will not exceed the total available funding in the Local Provider Participation Fund (LPPF) following adoption of the assessment resolution.
• Funding in the amount of $364,273,450.00 is included in the Fiscal Year 2027 Proposed Budget appropriation request as a pass-through payment to AHCA for the LPPF. The County will receive up to $150,000.00 for administration of this program.
Authorize the Chairman to sign the LOA and LOA questionaries.
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Strategic Plan:
Healthy and Safe Communities
2.1 Improve Public Health.
2.2 Enhance Community Safety.
Summary:
Summary
Executed LOA agreements are required to be submitted to the State Agency for Healthcare Administration (AHCA) by October 1, 2026, to participate in the 2026-2027 State Fiscal Year (SFY26-27).
Due to the anticipated timing of receipt for final agreements, this item seeks approval of the LOA and delegation to the Chair to execute the final LOA when received from AHCA.
In addition, in order to allow responsiveness during the program year to meet critical deadlines, this item seeks delegated authority to the County Administrator to execute amendments to the initial LOA and questionnaires when changes are required.
A resolution will still be required on a future Board agenda to establish a non-ad valorem special assessment on specific non-public hospital properties for use as Intergovernmental Transfers (IGTs) under the supplemental payment enhancement programs. The resolution will be presented to the Board for review and adoption upon final model approval at the federal and state level in the coming months.
The LOA will precede the resolution for the new program year necessitating execution prior to Board resolution adoption. IGTs will not exceed the total available funding in the LPPF following adoption of the assessment resolution.
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Background Information:
Local hospitals experience a significant gap in Medicaid reimbursements when delivering critical services for low income, vulnerable residents. Typically, the hospitals receive approximately 61% of their Medicaid costs. Statewide, without programs to reduce the shortfall, hospitals provide over $3.4 Billion in unreimbursed Medicaid costs and over $2.8 Billion in unreimbursed Charity Care each year.
To help close this reimbursement gap, the State of Florida and the Center for Medicare and Medicaid Services (CMS) authorize supplemental pay programs such as the Hospital Directed Payment Program (HDPP) and Low Income Pool (LIP) programs to allow the use of IGTs to help draw down enhanced funding for hospitals.
In April 2024, at the request of local hospital partners, the Board of County Commissioners (BCC) adopted Ordinance 24-16, establishing the LPPF and defining a structure for annual special assessments.
Pinellas County has facilitated participation for local hospitals for 3 program years:
• SFY23-24 - Resolution for $108,534,798 assessment with estimated $200 million in enhanced revenues for hospitals.
• SFY24-25 - Resolution for $151,115,221 assessment with estimated $309.9 million in enhanced revenues for hospitals.
• SFY25-26 - Resolution for $355,646,140 assessment with estimated $700 million in enhanced revenues to hospitals.
Pinellas County local assessments cover Medicaid region five (5) which includes sixteen (16) Pinellas hospitals:
• AdventHealth North Pinellas
• Baycare Alliant Hospital
• Mease Countryside Hospital
• Mease Dunedin Hospital
• Morton Plant Hospital
• St. Anthony’s Hospital
• Encompass Rehabilitation Hospital of Largo
• Largo Medical Center
• Largo Medical Center - Indian Rocks
• Northside Hospital
• Palms of Pasadena Hospital
• St. Petersburg General Hospital
• All Children’s Hospital
• Kindred Hospital - Bay Area - St. Petersburg
• Bayfront Health - St. Petersburg
• Windmoor Healthcare of Clearwater
Pinellas County requires adoption of a new resolution each year to allow for authorization and continuation of the assessments to participate in the supplemental pay programs for hospitals.
Fiscal Impact:
Funding in the amount of $364,273,450.00 has been initially included in the FY27 Proposed Budget appropriation request to allow the LPPF to be passed through as IGTs to AHCA. Any IGT request over the additional FY27 appropriation will require a budget amendment.
An administrative fee amount totaling $150,000.00 will be available to reimburse County efforts to support the program. Appropriate amendments will be proposed for these funds following completion of the assessment.
Staff Member Responsible:
Karen Yatchum, Director, Human Services
Partners:
Non-Public Hospitals
Florida Agency for Healthcare Administration
Attachments:
Example Directed Payment Program SFY25-26 LOA
Example Low Income Pool SFY25-26 LOA
Example Directed Payment Program Questionnaire Pinellas
Example Low Income Pool Questionnaire Pinellas