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 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.