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Board of County Commissioners Meeting Minutes - Final September 14, 2021 to a return of additional Federal match funding, and the administration fee of up to $150,000, which would be included in the non -ad valorem assessment and was designed to cover the County's cost of managing the Program and the possible increased Medicaid contribution: Mr. Warren Fuller, Chief Financial Officer, Cleveland Clinic Indian River Hospital Ms. Colleen Ernst, Counsel, Adelanto HealthCare Ventures Mr. Ron Bierman, Chief Administrative Officer, Sebastian River Medical Center Mr. Steven Snyder, Chief Financial Officer, Sebastian River Medical Center Attorney Reingold and County Administrator Jason Brown felt the Ordinance should be modified to provide transparency regarding the County receiving an administration fee of up to $150,000, built into the assessment paid by the three (3) hospitals, that could be used to offset an increase to the Medicaid contribution. In response to an inquiry from Vice Chairman O'Bryan, Administrator Brown made it clear that Encompass Health would be assessed, but would not be receiving funds back since they do not accept Medicaid as a form of payment for services at the present time. Ms. Ernst added that Encompass Health would receive funds if or when they begin accepting Medicaid patients. A detailed discussion ensued among members of the Board, Ms. Ernst, and the hospital representatives regarding the complexity of hospital billing/finance, the local hospitals which were in need of financial support, that Encompass Health was a rehabilitation hospital receiving their patients from the local hospitals, and the County's limited liability if the Program was implemented. Chairman Flescher remained hesitant throughout the discussion and he made it clear that the process to generate additional funds from the Federal government did not sound logical to him. Commissioner Adams stated that she was not opposed to approving the ordinance to move forward, noting that the two (2) main hospitals had requested and Encompass Health had consented to an assessment being imposed on them, and the County could see an increase to their Medicaid contribution whether or not they participated in the Program. Administrator Brown agreed with Attorney Reingold regarding the request for separate agreements between the County and the hospitals for the purpose of showing the hospital's full support of the County if the assessment or the administrative fee would become an issue in the future. Mr. Josh Miller, a resident of Fellsmere, voiced his concern regarding the local hospitals and their commitment to remain a Medicaid provider, and the possibility that taxpayers, rather than hospitals only, would be responsible for Indian River County Florida Page 12