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Board of County Commissioners Meeting Minutes - Final September 14, 2021 Attachments: Staff Report Letter from Daniel Knell President/Florida Market President Letter from J Gregory Rosencrance MD, FACP Email from Andrew Wilburn Encompass Health Memo on Special Assessments & Medicaid Funding Draft LPPF Ordinance County Attorney Dylan Reingold referred to staffs memorandum dated August 26, 2021, while presenting the Board with a proposed draft ordinance, required for participation in the Medicaid Directed Payment Program (the Program). He reflected on the August 17, 2021 Commission meeting when he had introduced a request from local hospitals that the County establish the Local Provider Participation Fund (LPPF) to assist in recovering the shortfall of Medicaid reimbursement funds. He explained the County's role of collecting a non -ad valorem special tax assessment on the properties where the hospitals were located, and the revenue generated would be placed in the LPPF to be overseen by the Florida Agency for Health Care Administration (AHCA), for the purpose of drawing down additional Medicaid match dollars from the Federal government. Attorney Reingold confirmed that he had received support of the proposed assessment from Sebastian River Medical Center and Cleveland Clinic Indian River Hospital, and that Encompass Health Rehabilitation Hospital (Encompass Health) had sent an email to express consent to an assessment, noting that they did not want to present an obstacle to the Program being implemented. Attorney Reingold made it clear to the Board that Encompass Health would not benefit at the present time. He advised that if the ordinance was adopted, the execution of indemnity agreements between the County and the two (2) main hospitals were suggested, and a public hearing would be scheduled on September 21, 2021 to consider a resolution, which would be presented to the Board annually to set the assessment roll. Attorney Reingold pointed out that he had recently been informed by a representative from AHCA that the County could see a negative impact of up to $100,000 to their Medicaid contribution. It was Commissioner Adams' understanding that due to the Program participation in other counties within the State, there could be an increase to the County's Medicaid contribution even if the Board did not vote to move forward with establishing the LPPF. Attorney Reingold was in agreement with Commissioner Adams' analysis. Chairman Flescher opened the public hearing. The following individuals addressed the Board to offer clarification on topics such as reducing losses related to Medicaid reimbursement gaps, special exception payments to the State for Medicaid reimbursement that would lead Indian River County Florida Page 11