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PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD

COMMITTEE MEETINGS AGENDAS December 13, 2012

Ira C. Clark Diagnostic Treatment Center 1080 N. W. 19th Street Miami, Florida 33128


COMMITTEE MEETINGS SCHEDULE (December 13, 2012)

LOCATION SITE Ira C. Clark Diagnostic Treatment Center (DTC)

1080 N. W. 19th Street Miami, Florida 33128

The Purchasing Subcommittee meeting is scheduled to begin at 7:15 a.m. in the Diagnostic Treatment Center (DTC) Conference Room 270 and the Facilities Subcommittee meeting is scheduled to begin at 7:45 a.m. in DTC Conference Room 259. The Audit and Compliance Subcommittee meeting shall immediately follow the Facilities Subcommittee in DTC Conference Room 259, which will then be followed by the standing committee meetings. A special Public Health Trust Financial Recovery Board meeting is scheduled to follow the Jackson Health System Health Plans Committee meeting in DTC Conference Room 259.

Thursday, December 13, 2012 Subcommittees Time Conference Room Purchasing Subcommittee 7:15 a.m. to adjournment DTC 270 Facilities Subcommittee 7:45 a.m. to adjournment DTC 259 Audit and Compliance Subcommittee Immediately following the DTC 259 Facilities Subcommittee meeting Standing Committees Fiscal Committee Immediately following the DTC 259 Audit & Compliance Subcommittee

meeting Joint Conference Immediately following the Fiscal DTC 259 & Efficiencies Committee Committee meeting Trust/FIU Medical School Annual Immediately following the Joint DTC 259 Operating Agreement Committee Conference & Efficiencies Committee

Jackson Health System Immediately following the Trust/FIU DTC 259 Health Plans Committee Medical School AOA Committee Special PHT Financial Immediately following the Jackson DTC 259 Recovery Board Health System Health Plans Committee As of December 6, 2012

PURCHASING SUBCOMMITTEE

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD Purchasing Subcommittee Joaquin del Cueto, Chairperson Stephen S. Nuell, Vice Chairperson Michael Bileca Date, Time and Location December 13, 2012 – 7:15 a.m. to adjournment Ira C. Clark Diagnostic Treatment Center Conference Room 270

AGENDA Action Items: 1. Approval of the Previous Meeting Minutes (Joaquin del Cueto, Chairperson, Purchasing Subcommittee)

(a) * Meeting Minutes as of November 15, 2012

2. Review and Recommend Approval of the Purchasing Report (Mark T. Knight, Executive Vice President and Chief Financial Officer, Jackson Health System)

(a) * Purchasing Report as of December 2012 Informational Items: 3. *Monthly Report of Competitive Contracts Awarded or Renewed Over the Chief Procurement

Officer Authority in Accordance to Procurement Regulations – November 1, 2012 through November 31, 2012 (Fidel Alvarez, Manager, Procurement Management Department, Jackson Memorial Hospital)

4. *Monthly Report of Non-Competitive Contracts Awarded or Renewed Under $250,000 –

November 1, 2012 through November 31, 2012 (Fidel Alvarez, Manager, Procurement Management Department, Jackson Memorial Hospital)

5. *Key Performance Indicators (KPI) for Procurement Update (Rosa Costanzo, Vice President and

Chief Procurement Officer, Strategic Sourcing and Supply Chain Management Division, Jackson Health System)

6. *Direct Payments as Approved Pursuant to Resolution No. PHT 10/12 - 078 Resolution

authorizing and approving the revision of the Procurement Policy/Regulation as amended on November 29, 2012 (Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic Sourcing and Supply Chain Management Division, Jackson Health System)

Agenda items noted with an asterisk (*) indicates that the supporting documents are attached.

1. Approval of the Previous Meeting Minutes

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD Purchasing Subcommittee Joaquin del Cueto, Chairperson Stephen S. Nuell, Vice Chairperson Michael Bileca Date, Time and Place November 15, 2012 – 7:15 a.m. to adjournment Ira C. Clark Diagnostic Treatment Center Conference Room 259

ATTENDANCE Purchasing Subcommittee

Joaquin del Cueto Stephen S. Nuell

Excused Michael Bileca Financial Recovery Board Mojdeh L. Khaghan

Jackson Health System Rosa Costanzo Mark T. Knight

Carlos A. Migoya Don S. Steigman

Miami-Dade County Attorneys Jeffrey Poppel

Eugene Shy, Jr. Christopher Kokoruda

Purchasing Subcommittee Meeting November 15, 2012 Page 2 Meeting Call to Order With a quorum being present the Purchasing Subcommittee meeting was called to order at 7:26 a.m. by Joaquin del Cueto, Chairperson, Purchasing Subcommittee. 1. Approval of the Previous Meeting Minutes

(a) Meeting minutes as of October 18, 2012

Mr. del Cueto requested a motion approving the meeting minutes as of October 18, 2012.

Mr. Nuell moved approval; seconded by Mr. del Cueto, and carried without dissent.

2. Review and Recommend Approval of the Purchasing Report

Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic Sourcing and Supply Chain Management Division, Jackson Health System presented for approval the November 2012 Purchasing Report. A detailed copy of the report was included with the agenda.

Discussion Section V. Awards Under a Waiver of Formal Competition E. Miscellaneous Bid Waiver

3. (525013-MR) The Executive Office requests additional funding to the Agreement with Maxor National Pharmacy Services Corporation (“Maxor”) for the operation of the Specialty Pharmacy (ongoing purchase).

Maxor National Pharmacy Services Corporation: Previously approved amount: $ 6,608,211 This request for funding: $ 4,562,154 Total approved funding: $11,170,365

Purchasing Subcommittee Meeting November 15, 2012 Page 3

With regards to the item, Mr. del Cueto questioned whether or not the Compliance Office reviewed it as an amended transaction. In response to the question, Jeffrey Poppel, Assistant Miami-Dade County Attorney stated that the item is an amendment to an existing underline agreement with Maxor and to the best of his knowledge there was no stark analysis completed. In further discussion it was mentioned that the Compliance Office did review the item. The Subcommittee engaged in discussion having to do with a fair market analysis to determine whether or not the hospital fees are reasonable, expansion of pharmacy services program located at the Ambulatory Care Center, time line to begin operations of the program, focus and purpose of the Specialty Pharmacy Program, SEIU cost proposal, fees associated with Maxor, ability of JHS staff being able to provide the same level of service that is proposed by Maxor at a lower cost, services provided by Maxor, outsourcing versus in-sourcing and JHS getting the best value for its dollar, conditions and risks of the agreement, and the concern was raised regarding outsourcing activity and how it weakens the hospital’s position for the future. Mr. Knight stated that the item has been fully vetted and is comfortable with the agreement as it relates to what is going on within the institution and the healthcare industry and going forward with the agreement is in the best interest of the hospital as well as generating a bottom line profit. Assuming that the item is approved and implemented, Mr. Nuell requested a quarterly update showing the performance of the program. Mr. Migoya reminded everyone that from time-to-time the PHT Financial Recovery Board (PHT FRB) is provided with a pharmaceutical update, going forward an update regarding the program performance will be incorporated in the pharmaceutical update report.

Following the discussion, Mr. del Cueto moved approval of the November 2012 Purchasing Report; there was no second to the motion. The motion to approve the November 2012 Purchasing Report failed.

Eugene Shy, Jr., Assistant Miami-Dade County Attorney recommended a motion to forward the November 2012 Purchasing Report to the Fiscal Committee without a recommendation.

After discussion, Mr. del Cueto moved to accept and approve the November 2012 Purchasing Report with the exclusion of item 3; seconded by Mr. Nuell, and carried without dissent. Mr. Nuell moved to forward item 3 of the November 2012 Purchasing Report to the Fiscal Committee without a recommendation; seconded by Mr. del Cueto, and carried without dissent.

Purchasing Subcommittee Meeting November 15, 2012 Page 4 3. Monthly Report of Competitive Contracts Awarded or Renewed Over the Chief

Procurement Officer Authority in Accordance to Procurement Regulations – October 1 through October 31, 2012

Ms. Costanzo presented an overview of the report, showing eight items that resulted in standard terms and conditions for UAP and two items having SBE participation. A copy of the report was included with the agenda.

4. Monthly Report of Non-Competitive Contracts Awarded or Renewed Under $100,000 – October 1 through October 31, 2012

Ms. Costanzo presented an overview of the report which showed seven items with nothing significant to report. A copy of the report was included with the agenda. In accordance with the Procurement Policy/Regulation re-write future reports will show in greater detail all contracts that are awarded under $250,000.

5. Key Performance Indicators (KPI) for Procurement Update

With regards to the Key Performance Indicators for Procurement, Ms. Costanzo reported that staff continues to complete projects. To date 24 projects have been completed with a procurement cycle time of 45-days and savings totaling $601,692 which is attributed to the valued work of the staff. Mr. del Cueto stated that the savings is significant and thanked staff for all of their work.

6. Vendor/Contract Performance Monitoring Report At the request of the Subcommittee Ms. Costanzo presented the report with greater detail particularly as it related to the breakdown of ratings for the contract evaluations. Included as part of the report were Additional contracts that were reviewed during the month of October in the non-patient care areas. A copy of the contract performances was included with the agenda.

7. Direct Payments as Approved Pursuant to Resolution No. PHT 10/12-078 Resolution authorizing and approving the revision of the Procurement Policy/Regulation as amended on October 29, 2012 Ms. Costanzo stated that future reporting will include the above item.

Meeting Adjourned The meeting of the Purchasing Subcommittee adjourned at 7:53 a.m. Transcribed by Ivenette Cobb Executive Assistant Public Health Trust Financial Recovery Board

2. Review and Recommend Approval of the Purchasing Report

December 2012 PHT Financial Recovery Board 1

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD PURCHASING REPORT

December 13, 2012

TO: PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD FROM: PROCUREMENT MANAGEMENT DEPARTMENT The following recommendations are made in accordance with the Trust’s “Procurement Policy” and it’s implementing “Procurement Regulation.” This report includes competitively solicited contract awards over $3,000,000, waivers of formal competition over $250,000 and other categories for Board approval as prescribed by the Procurement Regulation. The entire report has been screened and assembled by the Procurement Management Department with the direct participation of the Administrator and staff, all subject to review by the Vice President, Strategic Sourcing Division, consultation with the President as needed, and review for legal sufficiency by the County Attorney’s Office. SECTION I. AWARDS UNDER INVITATIONS TO BID (ITB’s) This section consists of awards under competitively solicited Invitations to Bid (ITB’s) over $3,000,000. No items to report. SECTION II. AWARDS UNDER REQUESTS FOR PROPOSALS (RFP’s) This section consists of awards under competitively solicited Requests for Proposals (RFP’s) over $3,000,000. 1. (465269-TW) The Revenue Cycle Division, Health Information Management

Department requests a contract award to Siemens Medical Solutions USA, Inc. resulting from a competitive Request for Proposals (RFP 12-10403-HT) for the provision of ICD-10 Implementation and Professional Services (new purchase).

Siemens Medical Solutions USA, Inc.:

This request for funding: $7,000,000

(for 3 years)

Total approved funding: $7,000,000


SECTION II. (cont’d.)

Background

This competitive procurement was solicited and administered by the Procurement Management Department through a competitive Request for Proposals process. The RFP document was distributed to twenty-three firms. Responses were received from the following five firms:

• Beacon Partners • Deloitte • Optum Insight • PriceWaterhouseCoopers (“PWC”) • Siemens Medical Solutions, Inc. (“Siemens”)

The Selection Committee held six meetings during the evaluation process and the three highest ranked firms were short listed, Deloitte, PWC and Siemens. Deloitte was found to be non-responsive as they provided pricing only for the assessment phase of the project but could not provide an estimated cost for the entire project as required by the RFP. The Selection Committee determined that a parallel negotiation between the two highest ranked firms was in the best interest of the Trust. The negotiation team reached an agreement and recommended the award of the contract to Siemens Medical Solutions, Inc. The proposed contract with Siemens offers a fixed fee for the entire project, including physician peer-to-peer trainings, administrative costs, travel and living expenses. The project is expected to commence on January 1, 2013 with a go-live target date of October 1, 2014. The contract term will be for a period of thirty-six (36) months with a termination for breach provision , in the best interest of the Trust. The following are some of the key features included in the recommended contract award:

• Siemens will lead the ICD-10 Conversion Project. The Trust and Siemens shall work together throughout the implementation so that education and knowledge transfer take place to enable the Trust to assume full operation and support of the system(s) and processes upon completion of this engagement. The methodology and its tools support the Trust and Siemens implementation team with artifacts, information and Project Workplans.

• Project Leadership. Siemens will direct the project and provide cross-functional coordination and alignment of Siemens’ resources. Siemens will work with the Trust’s project manager to assist the Trust in meeting its defined objectives and Project Workplan. Siemens’ and the Trust’s project managers will be the point of contacts for issue resolution and will continuously monitor progress to help reduce potential risks.



• Implementation Consulting. The Siemens Consultants will assume a lead role and will provide the Trust with process considerations, analytical direction, and support during the implementation.

o Within the Planning phase, Siemens will direct and perform the efforts including the requirements and planning of workflow, organizational, application and technical specifications as the Trust compiles its analysis.

o Knowledge Transfer: Siemens will work with the Trust to develop and maintain a knowledge transfer strategy and process for the Trust’s project team members. This strategy and related tasks will focus on imparting an appropriate understanding of operational and system-related decisions.

o Within the Implementation Phase, Siemens will provide direction, support and coordination to the Trust in translating its clinical and business requirements into system related decisions. As part of the collaboration process, Siemens will contribute recommendations based on best practice experiences.

o Within the Testing phase, Siemens will lead the effort in developing Unit Test, and Integration Test plans, as appropriate. Siemens will provide direction, support and coordination for the Trust during the testing period.

o Within the Training phase, Siemens will provide oversight in Core Training. Siemens will provide guidance and direction for the Trust in Core Trainer education planning, and the Core Training event.

o Within the Post-Live/ Audit phase, Siemens will provide support, direction and recommendation to the Trust for issue resolution for any open issues which fall within the scope of work as described.

Recommendation

The 5-member Selection Committee, in collaboration with Procurement Management, has prepared the final contract and this award recommendation in accordance with the Procurement Regulation. Contract negotiations resulted in a total savings of $394,154, which is inclusive of $135,202 for the 2% UAP Fee. The negotiated pricing includes forty (40) sessions and up to ten days of Peer-to-Peer Training.


SECTION II. (cont’d.) This contract has been approved by the County Attorney’s Office for Legal sufficiency and by Risk Management as to insurance and indemnification. It includes the UAP and OIG provisions. (M. Knight)

SECTION III. AWARDS UNDER THE COMPETITIVELY SOLICITED CONTRACTS OF OTHER PUBLIC PROCUREMENT ENTITIES This section consists of awards over $3000,000 under competitively solicited (“ITB,” “RFP” or equivalent) contracts of other public and nonprofit entities. No items to report. SECTION IV. AWARDS UNDER GROUP PURCHASING ORGANIZATION (“GPO”) CONTRACTS This section consists of awards over $3,000,000 under Group Purchasing Organization (“GPO”) contracts. GPOs are organizations that aggregate the purchasing volume of their members consisting of hospitals and other health care providers to leverage discounts with manufacturers, distributors and other vendors to realize administrative savings and efficiencies. The Trust’s GPO is MedAssets. No items to report. SECTION V. AWARDS UNDER A WAIVER OF FORMAL COMPETITION

This section consists of awards over $250,000 without the formal solicitation of competitive bids or proposals. All award recommendations in this section have the approval of the President, are based on a finding that the waiver of competitive bidding is in the best interests of the Public Health Trust, and require a two-thirds affirmative vote of the Trustees present for approval. A. Sole Source 2. (465674-TW) The Pathology Division, M ic rob io logy Depar tment requests a

contract award to Ortho Clinical Diagnostics, Inc. for a period of six (6) years for the provision of Clinical Chemistry and Immunodiagnostics (ongoing purchase).

Ortho Clinical Diagnostics, Inc. This request for funding: $12,000,000

(for 6 years)



SECTION V. (cont’d.) Background

Ortho Clinical Diagnostics, Inc. (“OCD”) has provided dry chemistry analyzers to the Public Health Trust for the past 27 years. These instruments produce the bulk of all routine chemistry panels at Jackson Memorial Hospital’s Core Lab as well as Jackson North Medical Center and will be implemented at Jackson South Community Hospital. OCD is the sole source for dry chemistry technology, which is a standard at JHS’ laboratories. Jackson Health System benefits from the fact that this type of analyzer does not use water. The highlights of a dry chemistry analyzer are as follows:

• It provides the convenience of not depending on deionized water for critical chemistry test during a hurricane.

• It eliminates the cost of water treatment units.

• There is no product preparation which translates to labor savings.

• Product stability which results in less calibration, this is also a labor savings which PHT has benefited from the last 2 decades.

• The system is very stable with calibration curves lasting over 6 months, there are significant labor and reagent savings associated with less instrument calibrations.

• Inventory storage is minimized because reagents are all built into a dry kodachrome slide originally developed by Kodak. Water based products require large refrigeration space and can be contaminated easily increasing waste.

• It does not have liquid chemical or biohazard waste, thereby eliminating the need for biohazard waste removal.

Recommendation

This contract award represents an estimated saving of approximately $1.1 million over the six year contract term, due to negotiated price reductions from current spend estimated at $182,000 annually for all three campuses. This contract provides a Cost Per Reportable Result (CPRR) equipment lease which allows the PHT to add state of art equipment without the capital expense. Additionally, the Trust will be able to order supplies and instead of being billed when the supplies are received, the Trust will be billed when tests are reported.


SECTION V. (cont’d.) This contract includes 4 analyzers for the Jackson Main lab, 2 analyzers for Jackson North and 2 analyzers for Jackson South. This is the first time that it became possible to include Jackson South in this platform; previously lack of space did not allow for this integration. There is no other manufacturer that can provide the efficiencies, technology, quality and convenience obtained from OCD. MDBuyline data indicates that OCD is leading the market in customer satisfaction at the lowest price. This contract has been approved by Risk as to Insurance and Liability and by the County Attorney’s Office for Legal sufficiency.

This contract can be terminated for convenience with a thirty (30) day notice and includes UAP and OIG provisions. A Sole Source Bid Waiver Justification has been provided and Conflict of Interest Declarations signed by David Sholehvar, Ortho Clinical Diagnostics, Inc., Vice President of Marketing North America and Maria Quintana, Senior Clinical Lab Manager, Jackson Health System with no reported disclosures. MD Buyline reported that OCD is leading the market in customer satisfaction at the lowest price. (A. Contreras)

3. (473558-TW) The Pathology Division, Immunology Department at Jackson

Memorial Hospital requests a contract award to Sebia, Inc. for a period of five (5) years with one option to renew of five years for the provision of Clinical Laboratory Test for Electrophoresis (ongoing purchase).

Sebia, Inc. This request for funding: $523,567.41

(for 5 years)

Total approved funding: $523,567.41

Background

Electrophoresis tests are performed on instruments from Sebia, Inc. for diagnosis of monoclonal gammopathies such as Multiple Myeloma, Bence Jones proteins. The use of this product enables the Trust’s Laboratory to consolidate benches in order to meet the turnaround time of some demanding physicians. Sebia is the only vendor in the market with the latest technology in electrophoresis. This new capillary technology allows a much needed improvement in efficiency and shortens turnaround time for the Trust.


SECTION V. (cont’d.) The highlights of the electrophoresis contract are as follows:

• Sebia will provide to the Trust Capillarys 2 instruments which are manufactured and sold by Sebia. This product has been cleared by FDA for the following assays:

Serum Protein Electrophoresis

Urine Protein electrophoresis

Serum Immunotyping (Automated IFE)

Urine Immunotyping

Hemoglobinopathy

Thalassemia testing

• The Capillarys 2 utilizes capillary electrophoresis methodology to perform all of the above mentioned assays.

• The Capillarys 2, along with Sebia’s MINICAP instrument, are the only instruments cleared by FDA on the market today that use capillary electrophoresis (CE) technology for electrophoresis testing.

• The Capillarys 2 instrument is designed for larger volume facilities such as Jackson Memorial Hospital.

• The contract offers, Monday-Friday, 8:00 A.M. – 5:00 P.M. services and Preventative Maintenance

Recommendation This Sole Source contract award is recommended in the best interest of the Trust. This contract has been approved by Risk as to Insurance and Liability and by the County Attorney’s Office for Legal sufficiency.

This contract can be terminated for convenience with a thirty (30) day notice and includes UAP and OIG provisions.


SECTION V. (cont’d.) A Sole Source Bid Waiver Justification has been provided and Conflict of Interest Declarations signed by Theresa Heflin, President of Sebia, Inc. and Huy Dinh, Microbiology Department Supervisor, Jackson Health System with no reported disclosures. ECRI reported that reported that the pricing offered to Jackson by Sebia is the lowest price seen within the past year. (A. Contreras).

B. Physician’s Preference Staff requests a waiver of formal competition for the contract items listed in this category because a physician or clinician has requested the particular item or service without which the physician or clinician cannot successfully and safely render patient care. No items to report. C. Standardization Items in this category have been established as the Trust standard. No items to report. SECTION V. (cont’d.) D. Non-Competitive Cooperative Purchasing This subsection consists of awards under the contracts of other public entities that were not competitively solicited. No items to report. E. Miscellaneous Bid Waiver This subsection consists of awards not falling in the other categories of waiver of formal competition but where waiver is deemed to be in the best interests of the Trust. No items to report.

SECTION VII. OPTIONS-TO-RENEW AND CONTRACT MODIFICATIONS FOR CONTRACTS THAT WERE AWARDED UNDER A WAIVER OF FORMAL COMPETITION This section refers to existing contracts that were not competitively bid at their origin and consists of either (a) the exercise of established options-to renew or (b)


SECTION VII. (cont’d.) the execution of contract modifications for which the Procurement Policy requires prior Board approval. All contracts in this section are renewals not previously authorized by the Board have the written approval of the President, are based on a finding that the waiver of full and competitive bidding is in the best interest of the Public Health Trust, and require a two-thirds affirmative vote of the Trustees present for approval.

No items to report.

SECTION VIII. MISCELLANEOUS

This section consists of procurement actions that require Board approval not included under any other section of the Purchasing Report. No items to report. A. Vendor Name Change This section refers to existing contracts requiring a vendor name change under any circumstance at any time after contract award and for the duration of contract performance. The Chief Procurement Officer is the approving authority when the original award of the subject contract was within the approval authority of the Chief Procurement Officer, and the Board of Trustees is the approving authority when the original award of the subject contract required the approval of the Board. The County Attorney’s Office has been consulted and has provided a determination of legal sufficiency. No items to report.

Monthly Report of Competitive Contracts Awarded or Renewed under the Chief Procurement Officer Authority in Accordance to Procurement RegulationsNovember 1, 2012 - November 30, 2012

For Information Only

Vendor Name DescriptionCost Center & Director/VP

Contract Number Contract Date Contract Value Contract Term Procurement Method UAP

Varian Medical System IncMove and install Varian Radiology equipment from Jackson South to Main Campus

94913 M Valdes

4101604 CAPS 11/21/2012 180,083.00$ One Time MedAssets Contract#

BM03635Yes

Standard Register Company Printing of Patient Appointment Reminders 92812

M Garcia 8106291 SERV 11/16/2012 109,281.00$ One Year

MedAssets Contract# MS01100A

Yes

HD Smith Secondary Wholesaler for Medications73005

A Contreras8106321 SERV 11/29/2012 300,000.00$ One Year

MedAssets Contract# PH90030

Yes

Cardinal Health Pharmaceutical Radiopharmaceutical for Jackson North Medical Center Nuclear Med Department

57160 S Sears

8301273 SERV 11/8/2012 300,000.00$ One YearMedAssets Contract#

MS02127Yes

1. "MedAssets" is the Trust's primary "Group Purchasing Organization" (GPO)2. "State Contract" and "Miami-Dade Contract" mean a contract competively awarded by the State or County as a "cooperative contract".3. "US Communities" means a contract competively awarded by the U.S. Communities governmental purchasing alliance as a "cooperative contract".4. "OTR" means "Option to Renew".5. "Contract Value" corresponds to the fixed "Contract Term" that has been awarded or rewarded (not to future OTR's).6. "RFP" means competitive Request for Proposals (or Qualifications) procurement process performed by the JHS Procurement Management Department.7. "ITB" means competitive Invitation to Bid (or Quote) procurement process performed by the JHS Procurement Management Department.8. "UAP" means User Access ProgramE – Exclusion as per UAP program: ie, Federal Grant, etc.Yes – Incorporated into the purchase as either discount on invoice or discount upfrontN/A – No, did not apply to procurement. Either an emergency purchase or contract was executed or extended before UAP was implemented

Monthly Report of Non-Competitive Contracts Awarded Under 250KNovember 1, 2012 - November 30, 2012

For Information Only

Vendor DescriptionCost Center & Director/VP

Contract Number Contract Date Contract Value Contract Term Procurement

Method UAP

A1 Label, IncLabeling Supplies for Riva robot for the Pharmacy department

73005A Contreras

8106296 SERV 11/16/2012 20,000.00$ 1 Year Sole Source N/A

Bayshore Dura Medical Durable medical supplies71104

K Andrews8106315 SERV 11/27/2012 25,000.00$ One Time Bidwaiver N/A

Cranel IncorporatedMaintenance and support services of existing scanners intergrated Information & Records Management

91000Mike Garcia

8106280 SERV 11/14/2012 94,673.70$ 1 Year Sole Source Yes

Ekos CorporationUltrasound catheter for Radiology Special Procedures department

83746Martha Garcia

2072595 11/14/2012 11,975.00$ One Time Sole Source Yes

Kratos Public Safety SecurityInstallation of 9 fire alarms systems for various schools, clinically hosted by JHS

89300M Butler

8106299 SERV 11/20/2012 15,149.00$ One TimeBidwaiver

(Grant Funded -Standardization)

Yes

Pharmedium Services, LlcEmergency order of patient drugs - current vendor (Ameridose) has gone out of business, a new agreement is being negotiated

73005A Behr

8106292 SERV 11/16/2012 50,000.00$ One TimeEmergency

(Patient Care)N/A

Simplex Grinnell Fire alarm maintenance for Main Campus80114

M Valdes4101591 CAPS 11/08/2012 200,000.00$ 18 Months

Bidwaiver(Standardization)

Yes

Smart Data SolutionsMaintenance and support of JMH Health Plan claims payments system

99420B Dean

8106323 SERV 11/29/2012 40,000.00$ One Time Sole Source Yes

Trans Union CorpInterface service for credit checks and address verifications for registration and charity care purposes

93611C Pla

8106302 SERV 11/20/2012 68,690.27$ One Time Bidwaiver Yes

Note: "Non-competitive" procurement category includes: Sole Source, Physician's Preference, Standardization, Non-Competitive Cooperate Purchasing, and Miscellaneous Bid Waiver.UAP - User Access Program:Exempt – Exclusion as per UAP program: i.e., Federal Grant, etc.Yes – Incorporated into the purchase as either discount on invoice or discount upfrontN/A – No, did not apply to procurement. Either an emergency purchase or contract was executed or extended before UAP was implemented

Procurement / Strategic Sourcing KPI

*Procurement process begins upon receipt of fully completed / approved documents, per Procurement Regulation

Purchase Order Activity (Monthly)

July August September October November Grand TotalAverage

PO'sJuly August September October November Grand Total

Average Lines

Opti & Omnicell Activity:

7,068 7,303 6,658 7,274 7,117 35,420 7,084 111,823 117,724 108,014 115,930 109,925 563,416 112,683

Total Buyers & Omnicell:

9,530 9,939 8,861 9,878 9,451 47,659 9,532 124,216 130,920 118,306 128,990 121,919 624,351 124,870

727 9,378

Contracting Activity (Weekly)# of

ContractsPending

Documents*Approved Documents

5-Dec-12 128 77 3127-Nov-12 135 77 335-Nov-12 104 83 3325-Oct-12 125 75 3110-Oct-12 125 66 414-Sep-12 129 65 35

31-Aug-12 129 65 3523 56 24 31-Jul-12 121 66 3819 177 45 4-Jul-12 118 62 3226 68 20 27-Jun-12 130 56 389 99 53 5-Jun-12 119 57 324 31 99 25-May-12 110 60 358 70 41 17-May-12 116 59 29

10 98 10 4-May-12 128 54 241 1 158 19-Apr-12 113 54 264 58 83 6-Apr-12 107 47 24

Total: 104 Average: 121 64 32

November 2012 Projects Completed: 24*Average cycle time for completed projects: 12 daysSavings: $453,685.15

AdministrativeCapital / Support ServicesClinical Support ServicesHospitals (JNMC/JSCH/Holtz)ITDLong Term Care / Quality / SafetyOR / Surgery / AnesthesiaPharmacyRevenue Cycle

# of Projects with Approved Documents*: 31# of Projects Pending Procurement Documents: 73

Average # of Weekdays in Process with

# of Contracts

Pending Documents

*Approved Documents

Week of 12/05/2012

2012 PO's 2012 PO Lines

Monthly Average Number of PO's by FTE for November = Monthly Average Number of PO's Lines by FTE for November=

Average # of Weekdays in Process with

Direct Payment as Approved Pursuant to Resolution No. PHT 10/12-078November 1, 2012 to November 30, 2012

Vendor DescriptionCost Code

VPInvoice Amout

Dale Carnegie High impact presentation for JHS (initial deposit - total $50,625)

99301M Knight

12,656.25$

FACILITIES SUBCOMMITTEE

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD Facilities Subcommittee

Darryl K. Sharpton, Chairperson Mojdeh L. Khaghan, Vice Chairperson Joe Arriola

Date, Time and Location December 13, 2012 – 7:45 a.m. to adjournment Ira C. Clark Diagnostic Treatment Center Conference Room 259

AGENDA

1. Approval of the Previous Meeting Minutes (Darryl K. Sharpton, Chairperson, Facilities Subcommittee)

(a) **Meeting Minutes as of November 15, 2012 2. Chairperson’s Report (Darryl K. Sharpton, Chairperson, Facilities Subcommittee) 3. * Financial and Budget Tracking Status Report – October 2012 (Aurelio Gonzalez, Budget Director, Jackson Memorial Hospital) 4. *Capital Projects Construction Projects Update – December 2012

(David Clark, Director, Capital Projects, Jackson Health System) 5. ** Resolution authorizing the President or his designee to enter into a new Lease Agreement with The

Trustees of Columbia University in the City of New York, a New York Non-Profit Corporation for the rental of Two Hundred and Forty-Three (243) square feet of space in the Ambulatory Care Center East Building, Room CLU at 1611 NW 12 Avenue, Miami, Florida 33136 for a period of two (2) years and eight (8) months commencing January 1, 2013 and expiring on August 31, 2015, for an annual payment of Six Thousand Eight Hundred Four Dollars ($6,804) with an annual increase in base rent of one percent (1%) and common area maintenance (Madeline Valdes, Corporate Director, Property Management Division, Jackson Health System)

The item(s) noted with an asterisk (*) indicates that the supporting documents are attached.

The items noted with two asterisks (**) indicates that voting is required by the Subcommittee.


Facilities Subcommittee Darryl K. Sharpton, Chairperson Mojdeh L. Khaghan, Vice Chairperson Joe Arriola

Date, Time and Place November 15, 2012– 7:45 a.m. to adjournment Ira C. Clark Diagnostic Treatment Center Conference Room 259

ATTENDANCE

Facilities Subcommittee Darryl K. Sharpton Mojdeh L. Khaghan Joe Arriola Financial Recovery Board Marcos Lapciuc Joaquin Del Cueto Steven S. Nuell

Jackson Health System Carlos Migoya Don S. Steigman Aurelio Gonzalez Madeline Valdes David Clark Zari Watkins

John Repique

Miami-Dade County Attorneys Jeffrey Poppel Eugene Shy, Jr.

Facilities Subcommittee Meeting November 15, 2012 Page 2 Call to Order With a quorum being present, the meeting of the Facilities Subcommittee was called to order at 8:07 a.m. by Darryl K. Sharpton, Chairperson, Facilities Subcommittee. 1. Approval of the Previous Meeting Minutes

(a) Meeting Minutes of September 13, 2012 (b) Meeting Minutes of October 18, 2012

Mr. Sharpton requested a motion approving the meeting minutes of September 13, and October 18, 2012. Mr. Arriola moved approval;

seconded by Ms. Khaghan, and carried without dissent.

2. Chairperson’s Report No report.

3. Resolution Recommended to be Approved Add-on agenda item

Resolution authorizing to rename the Jackson Mental Health Hospital Center as the “Jackson Behavioral Health Hospital” and authorizing the President of the Public Health Trust to obtain approval of the Board of County Commissioners. (Madeline Valdes, Corporate Director, Property Management, Jackson Health System)

Mr. Sharpton requested a motion approving the item

Mr. Arriola moved approval;

seconded by Mrs. Khaghan, and carried without dissent.

Facilities Subcommittee Meeting November 15, 2012 Page 3 4. Resolution Recommended to be Approved

(a) Resolution providing for the delegation of authority from the Financial Recovery Board of the Public Health Trust (“Trust”) to the President or his designee to negotiate and execute Revocable License Agreements (“RLA”) for the time share space with qualified community physicians for an initial term of at least one (1) year, revocable at will by either party, and at fair market value. (Madeline Valdes, Corporate Director, Property Management, Jackson Health System)




5. Resolution Recommended to be Approved

(a) Resolution authorizing the President or his designee to be granted authorization to move forward with developing the design, permitting, and construction of a new Level II Trauma Center at Jackson North Medical Center in the amount of Nine Hundred Thirty Thousand Five Hundred Sixty-Nine Dollars and Thirty-Five Cents ($930,569.35) from Capital Contributions budget for Year 2013. (Madeline Valdes, Corporate Director, Property Management Division, Jackson Health System)

(b) SUBSTITUTE Resolution authorizing the President or his designee authorization to move forward with developing the design, permitting, and construction of a new Level II Trauma Center at Jackson North Medical Center in an amount not to exceed One Million Dollars ($1,000,000) from the Capital Contributions budget for Year 2013. (Madeline Valdes, Corporate Director, Property Management Division, Jackson Health System)




6. Financial & Budget Tracking Status Report Aurelio Gonzalez, Corporate Director of Productivity, Jackson Memorial Hospital presented the Financial & Budget Tracking Status Report for the month of September 2012. Mr. Sharpton requested that future reports explain highlights and utilize the Interactive Map to depict areas under construction where dollars are being spent. A copy of the Financial & Budget Tracking report was included in the agenda packet.

Facilities Subcommittee Meeting November 15, 2012 Page 4 7. Capital Projects Construction Projects Update – November 2012

David Clark, Director of Capital Projects, Jackson Health System, reported that the Capital Projects Department has made significant progress with the Highland Professional Transplant Project. The sixth floor is substantially complete. Immediately after furniture installation, the ninety-day (90) schedule will be turned over on or around the week of November 26, 2012. Once this phase is complete the lobby portion of the project will be mobilized. Infrastructure projects are being carefully monitored particularly mechanical and electrical upgrades to the health system both at Jackson North and Jackson South Campus.

Adjournment The meeting of the Facilities Subcommittee adjourned at 8:20 a.m. Transcribed by Monica Severiche Executive Assistant Property Management Division

2. Chairperson’s Report

FINANCIAL & BUDGET TRACKING STATUS REPORT OCTOBER 2012 Capital Contribution (aka funded depreciation): The FY 2013 budget programs $20 million of expenditure to occur during the year for all Capital items funded with Capital Contribution. For the month end October 2012 active projects total $15.2 million. Of this amount, $4.1 million was spent in prior years leaving just over $11.1 million to be spent. Of that $7.7 million is expected to be spent this year with $89,365 spent in October 2012. Foundation: Active Foundation funded projects continue this year totaling $2.6 million of prior and current year funding commitments. The bulk of the project dollars are represented by the Holtz Pathology Lab Renovation at $2 million. $17,441 was spent in October 2012 with additional $720,000 left to spend. County GOB: Included in the report was a summary of active Building Better Communities General Obligation Bond funded projects which continue with an all years’ budget of $57 million; prior years’ spending on these projects including Jackson South Community Hospital (JSCH) totals $33 with $24 million left to spend. Series 2005 Revenue Bonds: Active Series 2005 projects total $13.8 million of which $5.0 million was spent in prior years leaving $8.8 million to spend this year. All of the funding is programmed and forecast to be spent by the end of the fiscal year. $474,638 was spent in October with the bulk of the spending made on the DTC MRI. Series 2009 Revenue Bonds: Active Series 2009 projects total $54.0 million of which $24.8 million was spent in prior years leaving $29.1 million left to spend. Of that amount, $370,405 was spent in October 2012 with the bulk of the spending made on the Fire Alarm Upgrade. Trust Funds and Grants: The active budgets total $7 million with most of this resource represented by the ongoing Ryder Trauma Center Hardening project. $11,848 was spent in October 2012 with an additional $6.6 million left to spend.

Original Total Total Projected Revised V.P.# of NEW Project Budget Project Start Compl. Compl. Fund. Project Project Exec. Actuals FY13 Total YTD Life to Date Amount left

Proj. Proj.# Activity# Project Name Budget Changes Budget Date Date Date Source Manager Manager Spons. Oct.12 Oct.12 thru Oct.13 to Spend

MULTIFUNDING SOURCE PROJECTS

1 C P-00632 52005003 J.South Community Hptal 102,425,000 100,000 102,525,000 CO Aug-05 Dec.10 Apr.12 Multi Clark JMH Garcia - - 100,930,244 1,594,756 2 J P-00949 51009046 WW-B Pharmacy Phase I 250,927 583,669 834,596 CN May-09 Mar.10 Feb.13 Multi Arnaldo JMH Contreras 1,080 1,080 583,874 250,722 4 L P-00836 51007017 Rehab Building Renovation 16,670,411 (111,864) 16,558,547 DEF Sep-07 Aug.10 TBD Multi Frank JMH Contreras - - 158,547 16,400,000 5 M P-00904 51008026 C-4 Cath Lab #6 2,833,500 196,500 3,030,000 DEF Jul-08 Oct.09 TBD Multi Alana JMH Contreras - - 102,277 2,927,723 6 O P-00566 51001001 Elevator Modernization 3,000,000 253,043 3,253,043 CN May-01 Mar.08 Jun.13 Multi Frank JMH Burghart - - 2,172,270 1,080,773 7 R P-00763 59007009 JMT Elevator Modern#141-146 1,057,183 243,574 1,300,757 CN Jul-07 Sept.10 Jan.13 Multi Frank JMH Valdes (176,004) (176,004) 1,030,093 270,664 8 S P-00827 53008015 Jack.No Elevators 1 & 2 490,050 (431,070) 58,980 DEF Feb-08 Jan.09 Oct.10 Multi TBD JMH Sears - - 58,980 - 9 T P-00834 51008016 ADA Compl.#Pkg1 Restrooms 991,763 692,000 1,683,763 CN Oct-07 Apr.08 Dec.13 Multi Arnaldo JMH Valdes 141,555 141,555 896,772 786,991 10 U P-00854 53008020 Jack.No. Window Replacement 2,057,220 1,088,750 3,145,970 CN Jan-08 Jan.09 Feb.13 Multi Arnaldo JMH Sears 17,268 17,268 2,837,180 308,790 11 V P-00606 59004002 JMT Elevators Moderniz. 931,591 (30,291) 901,300 D May-04 Feb.08 May.13 Multi Frank JMH Valdes - - 79,968 821,332 12 W P-00655 56006004 JNCMHC Emerg. Generator 331,839 (314,369) 17,470 DEF Jul-06 Aug.07 Jun.11 Multi Camero JMH Valdes - - 17,470 - 13 X P-00724 51007008 Kitchen Equipment Modification 791,164 (711,679) 79,485 DEF Nov-06 Jun.07 TBD Multi Rob JMH Valdes - - 79,485 (0) 14 Y 51011105 Ryder Trauma Ext. Hardening 8,589,588 - 8,589,588 D Dec-10 Aug.13 Multi Clark JMH Valdes 15,797 15,797 640,531 7,949,057 15 AB PIP 31009002 Telecommunication 8,188,100 1,765,000 9,953,100 PIP Aug.09 Dec.11 Multi Overton JMH Garcia - - 9,238,124 714,976 16 AC P-00997 51009089 4160 Volt Oil Switch Repl 7,350,000 (2,565,000) 4,785,000 D Sep-09 Dec.12 Dec.13 Multi Douglas JMH Valdes - - 375,957 4,409,043 17 AD 51012109 DTC-1 Linear Accelerator Relo 692,228 - 692,228 D Sep-12 Nov.13 Multi Alana JMH Contreras - - - 692,228 18 AE 52013100 Jackson South 2nd Cath Lab 692,307 - 692,307 D Oct-12 TBD Multi Frank JMH Garcia - - - 692,307

Total Mutifunding Source 157,342,871 758,263 158,101,134 (304) (304) 119,201,771 38,899,363

CAPITAL CONTRIBUTION PROJECTS

Stat

us

BUDGET TRACKING REPORT FY 2013BY FUNDING SOURCE

1 O P-00566 51001001 Elevator Modernization 1,608,153 - 1,608,153 CN May-01 Mar.08 Jun.13 CC Frank JMH Burghart - 1,608,153 (0) 2 X P-00724 51007008 Kitchen Equipment Modification 79,485 - 79,485 DEF Nov-06 Jun.07 TBD CC TBD JMH Valdes - 79,485 (0) 3 T P-00834 51008016 ADA Compliance Package#1 378,757 - 378,757 CN Oct-07 Apr.08 Dec.13 CC Arnaldo JMH Valdes - 378,757 -

4 AC P-00997 51009089 4160 Volt Oil Switch Repl - 1,000,000 1,000,000 D Sep-09 Dec.12 Dec.13 CC Douglas JMH Valdes - - 1,000,000

5 51011100 Highland Prof.Financ.Assessm 740,000 - 740,000 D Oct-10 Sep.11 Hold CC Clark JMH Contreras - 297,318 442,682 6 51011104 WW-15 Nursing Unit Moder 2,588,568 - 2,588,568 D Dec-10 Aug.12 Sep.13 CC Clark JMH Contreras 2,852 2,852 175,101 2,413,467 7 Y 51011105 Ryder Trauma Ext Hardening 2,147,397 - 2,147,397 D Dec-10 Aug.13 CC Clark JMH Valdes 3,949 3,949 160,133 1,987,264

8 51011106 Highland Prof. 6TH Floor 542,625 - 542,625 D Dec-10 Sep.11 Jan.13 CC Clark JMH Contreras 33,645 33,645 76,090 466,535 9 51011112 DTC PET Scan 2,467,000 (343,000) 2,124,000 CN Jan-11 Jul.12 Dec.12 CC Alana JMH Contreras - 1,896,600 227,400 10 51012100 Human Resources Relocation 300,000 - 300,000 CN Dec-11 Nov.12 Dec.12 CC Lourdes JMH Hout-Barriento 37,130 37,130 222,671 77,329

11 51012106 Inst.Anne-5 Physician Svces 31,350 - 31,350 CN Jul-12 Dec.12 CC Diaz JMH Andrews 2,374 2,374 23,736 7,614

12 AD 51012109 DTC-1 Linear Accelerator Rel 213,328 - 213,328 D Sep-12 Nov.13 CC Alana JMH Contreras - - 213,328 13 C P-00632 52005003 J.South Community Hptal(661) 82,254 - 82,254 CO Aug-06 Dec.10 Apr.12 CC Clark JMH Garcia - 82,254 -

14 52012104 Jackson South Helistop 137,101 1,321,971 1,459,072 D Jul-12 Oct.13 CC Clark JMH Garcia - 4,786 1,454,286

15 AE 52013100 Jackson South 2nd Cath Lab 492,307 - 492,307 D Oct-12 TBD CC Frank JMH Garcia - - 492,307 16 S P-00827 53008015 Jack.No Elevators 1 & 2 52,317 - 52,317 DEF Feb-08 Jan.09 Jun.10 CC TBD JMH Sears - 52,317 - 17 U P-00854 53008020 Jack.No. Window Replacement 85,608 - 85,608 CN Jan-08 Jan.09 Feb.13 CC Arnaldo JMH Sears - 85,608 -

18 53012105 Jackson No.Helistop Reloc 82,841 128,810 211,651 D Jul-12 Oct.13 CC Arnaldo JMH Sears 9,300 9,300 11,312 200,339

19 53012108 JNMC Cardio Cath Lab Repl 1,170,431 - 1,170,431 D Sep-12 TBD CC Arnaldo JMH Sears 115 115 115 1,170,316 20 W P-00655 56006004 JNCMHC Emerg. Generator 17,470 - 17,470 DEF Jul-06 Aug.07 Jun.11 CC Camero JMH Valdes - 17,470 - 21 V P-00606 59004002 JMT Elevators Moderniz. 23,713 - 23,713 D May-04 Feb.08 May.13 CC Frank JMH Valdes - 23,713 -

Page 1 of 6


Proj. Proj.# Activity# Project Name Budget Changes Budget Date Date Date Source Manager Manager Spons. Oct.12 Oct.12 thru Oct.13 to Spend Stat

us


22 R P-00763 59007009 JMT Elevator Modern#141-146 24,135 - 24,135 CN Jul-07 Sept.10 Jan.13 CC Frank JMH Valdes - 24,135 -

23 59012110 PPE Main Corridor Moderniz 152,222 - 152,222 D Sep-12 TBD CC Frank JMH Valdes - - 152,222

24 AB PIP 31009002 Telecommunication 2,000,000 - 2,000,000 PIP Aug.09 Dec.11 CC Overton JMH Garcia - 1,285,024 714,976

15,417,062 2,107,781 17,524,843 89,365 89,365 6,504,779 11,020,064

CAPITAL CONTRIBUTION

CLOSED PROJECT FY 2012-2013

- - - - - - -

24 SUB TOTAL CAPITAL CONTRIBUTION PROJECTS 15,417,062 2,107,781 17,524,843 89,365 89,365 6,504,779 11,020,064

FOUNDATION

1 P-00659 51006005 Holtz-2 Pathology Renovat 2,000,000 54,350 2,054,350 CO Jul-06 Jul.08 Mar.13 F Frank JMH Contreras - 1,878,978 175,373

2 51011117 DTC-1 Taylor Breast Ctr Reno 276,000 - 276,000 D Jul-11 Jul.12 July.13 F Alana JMH Contreras 17,441 17,441 28,578 247,422

3 51011118 C 5 NICU I t d M d 100 000 200 000 300 000 D A 11 A 13 J 13 F Al JMH B h t 3 187 296 813

Total Capital Contribution

Total Closed Capital Contribution

3 51011118 C-5 NICU Intermed.Modern 100,000 200,000 300,000 D Aug-11 Apr.13 Jun.13 F Alana JMH Burghart - 3,187 296,813

2,376,000 254,350 2,630,350 17,441 17,441 1,910,742 719,608

GOB GENERAL OBLIGATION BONDS

1 L P-00836 51007017 Rehab Building Renovation 16,400,000 16,400,000 DEF Sep-07 Aug.10 TBD GOB JS Frank JMH Contreras - - 16,400,000

2 P-00867 51008024 Campus Wide Pneumatic Tube Sys 3,629,400 - 3,629,400 CN Apr-08 Aug.10 Dec.13 GOB ED Scott JMH Valdes (26,558) (26,558) 1,652,479 1,976,921

3 M P-00904 51008026 C-4 Cath Lab # 6 2,833,500 86,645 2,920,145 DEF Jul-08 Oct.09 TBD GOB ED Alana JMH Contreras - - 2,920,145

4 P-00928 51008032 ET- 1 Ortho Suite & ERA 1,706,000 700,000 2,406,000 CN Sep-08 Sep.09 Mar.13 GOB ED Frank JMH Contreras 14 14 1,359,952 1,046,048

C P-00632 52005003 J.South Community Hptal 52,000,000 - 52,000,000 CO Aug-05 Dec.10 Apr.12 GOB JS Clark JMH Garcia - 30,144,427 21,855,573

C P-00632 52005003 J.South Community Hptal (20,260,817) (20,260,817) CO Aug-05 Dec.10 Apr.12 GOB JS Clark JMH Garcia - - (20,260,817)

60,168,900 (3,074,172) 57,094,728 (26,544) (26,544) 33,156,859 23,937,869

2005 REVENUE BOND

L P-00836 51007017 Rehab Building Renovation 16,670,411 (111,864) 16,558,547 DEF Sep-07 Aug.10 TBD RB REH Frank JMH Contreras - 158,547 16,400,000

Total Foundation

Total GOB Bonds

Page 2 of 6



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L P-00836 51007017 Rehab Building Renovation (16,400,000) (16,400,000) DEF Sep-07 Aug.10 TBD RB REH Frank JMH Contreras - - (16,400,000)

M P-00904 51008026 C-4 Cath Lab # 6 109,855 109,855 DEF Jul-08 Oct.09 TBD IRB INTER Alana JMH Contreras - 102,277 7,578

1 P-00932 51009033 HCH ET-5 Intake, ET-7 BMT Ph.I 1,758,649 (141,649) 1,617,000 CO Dec-08 May.10 Jul.12 RB PEDI Alana JMH Burghart (20,071) (20,071) 1,500,379 116,621

2 P-00947 51009044 ET-5 Adolescen Unit 1,236,193 (200,000) 1,036,193 D May-09 May.10 Dec.12 RB REH Alana JMH Burghart 188,409 188,409 360,837 675,356

3 J P-00949 51009046 WW-B Pharmacy Phase I 250,927 470,000 720,927 CN May-09 Mar.10 Feb.13 RB ACU Arnaldo JMH Contreras - 582,794 138,133

J P-00949 51009046 WW-B Pharmacy Phase I - 113,669 113,669 CN May-09 Mar.10 Feb.13 IRB INTER Arnaldo JMH Contreras 1,080 1,080 1,080 112,589

4 P-00959 51009054 ET-4 LDOR Fetal Surg.OR's 2,083,950 - 2,083,950 D May-09 Aug.10 Apr.13 RB PEDI Alana JMH Burghart - 401,853 1,682,097

5 51010096 WW-2 Angio Suite 2,000,000 2,000,000 D May-10 Oct.10 Jun.13 RB PEDI Alana JMH Contreras - 1,321,479 678,521

6 51010097 DTC new MRI 2,500,000 2,500,000 CN May-10 Oct.10 Dec.12 RB PEDI Alana JMH Contreras 299,783 299,783 517,189 1,982,811

7 51011116 C-4 Cath Lab #5 454,000 - 454,000 CN Apr.11 Oct.11 Feb.13 RB INTER Alana JMH Contreras 1,898 1,898 69,558 384,442

8 51012101 WW-6 Modernization 1,553,000 - 1,553,000 hold Feb.12 Dec.12 TBD RB INTER Arnaldo JMH Contreras 1,900 1,900 48,879 1,504,121

9 51012102 SW-6 Modernization 482,320 - 482,320 D Feb.12 Nov.12 Sep.12 RB INTER Alana JMH Contreras 1,640 1,640 94,311 388,009

C P-00632 52005003 J.South Community Hptal 50,000,000 - 50,000,000 CO Aug-05 Dec.10 Apr.12 RB JS Clark JMH Garcia - 50,000,000 (0)

C P-00632 52005003 J.South Community Hptal 16,400,000 16,400,000 CO Aug-05 Dec.10 Apr.12 RB REH Clark JMH Garcia - 16,400,000 (0)

C P-00632 52005003 J.South Community Hptal 210,817 210,817 CO Aug-05 Dec.10 Apr.12 RB ACU Clark JMH Garcia - 210,817 -

C P-00632 52005003 J.South Community Hptal 3,650,000 3,650,000 CO Aug-05 Dec.10 Apr.12 RB INTER Clark JMH Garcia - 3,650,000 0

C P-00632 52005003 J South Community Hptal 100,000 100,000 CO Aug-05 Dec.10 Apr.12 RB INTER Clark JMH Garcia - 100,000 -

AE 52013100 Jackson South 2nd Cath Lab 200,000 - 200,000 D Oct-12 TBD RB Frank JMH Garcia - - 200,000

10 53010091 JN Pharmacy Clean Room - 361,000 361,000 CO Jan-10 Feb.11 Aug.12 RB INTER Arnaldo JMH Sears - 340,326 20,674

11 53012107 J.No. AHU Replacement 258,000 - 258,000 D Jul.12 TBD RB Scott JMH Sears - 55 257,945

12 PIP 31012001 Xcelera Enterprise Solution 150,000 - 150,000 D Feb.12 TBD RB INTER Fuentes JMH Garcia - - 150,000

75,097,450 9,061,828 84,159,278 474,638 474,638 75,860,381 8,298,897

2009 INFRASTRUCTURE BOND

O P-00566 51001001 Elevator Modernization 1,391,847 253,043 1,644,890 CN May-01 Mar.08 Jun.13 IRB Frank JMH Burghart - 564,116 1,080,774 T P-00834 51008016 ADA Compliance Package#1 613,006 692,000 1,305,006 CN Oct-07 Apr.08 Dec.13 IRB Arnaldo JMH Valdes 141,555 141,555 518,015 786,991

1 P-00938 51009036 WW Fire Alarm 2,000,000 350,000 2,350,000 CO Apr-09 Sep.10 Nov.12 IRB David JMH Valdes - 1,935,868 414,132

2 P-00958 51009053 ET A/C Repl177-180,181Inst 2,653,370 465,710 3,119,080 CO Sep-09 Nov.10 Jan.13 IRB Frank JMH Valdes - 3,069,760 49,320

3 P-00961 51009056 Replace Paralleling Gear 4,361,250 928,122 5,289,372 D Sep-09 Dec.12 Feb.14 IRB Douglas JMH Valdes 53 53 482,582 4,806,790

4 P-00962 51009057 Utility Ctr-2 Emerg.Generat 2,135,000 123,215 2,258,215 CO Sep-09 Jan.12 Sep.12 IRB Douglas JMH Valdes - 2,202,424 55,791

5 P-00967 51009062 Fire Alarm Upgrade Campus 4,815,000 (385,505) 4,429,495 CN Sep-09 Dec.12 Mar.13 IRB Douglas JMH Valdes 218,842 218,842 516,634 3,912,861

6 P-00969 51009064 DTC,T,Rehab,WW&ACC-W AHU Re 6,541,500 - 6,541,500 CN Sep-09 Nov.12 Sep.14 IRB Scott JMH Valdes - 2,983,103 3,558,397

7 P-00974 51009069 Campus Wide Roofing Repl. 1,500,000 - 1,500,000 D Sep-09 Dec.10 Aug.13 IRB Scott JMH Valdes 4,935 4,935 383,355 1,116,645

8 P-00978 51009072 Fire Sprinkler Upgrade Campus 2,000,000 - 2,000,000 D Sep-09 Dec.12 Mar.14 IRB David JMH Valdes - 254,225 1,745,775

9 P-00982 51009076 UC Emerg.Well Boilers 2,331,000 350,325 2,681,325 CO Sep-09 Jun.11 Apr.12 IRB David JMH Valdes - 2,524,421 156,904

10 P-00992 51009084 BackFl.&Byp.DomWater 250,000 117,000 367,000 D Sep-09 Mar.10 Aug.13 IRB Frank JMH Valdes - 7,863 359,137

11 AC P-00997 51009089 4160 Volt Oil Switch Repl 7,350,000 (3,565,000) 3,785,000 D Sep-09 Dec.12 Dec.13 IRB Douglas JMH Valdes - 375,957 3,409,043

12 51010098 Above Ground Tank Replacem - 369,580 369,580 D Jun-10 TBD IRB Camero JMH Valdes - - 369,580

13 51010099 Concrete Struct Tank Farm - 100,000 100,000 CO Jun-10 Mar-11 Oct.12 IRB Arnaldo JMH Valdes 20,810 20,810 51,609 48,391

Total 2005 Revenue Bond

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14 51010100 CampusW Underg Utilities - 3,200,000 3,200,000 CO Jul-10 Dec.11 Nov.12 IRB Allen Heery Valdes 17,917 17,917 2,486,332 713,668

15 51011113 Reduction of NAP Utilization 300,000 394,769 694,769 D Apr-11 Sep.11 Mar.13 IRB Frank JMH Garcia 31,917 31,917 458,487 236,282

16 AD 51012109 DTC-1 Linear Accelerator Relo 478,900 - 478,900 D Sep-12 Nov.13 IRB Alana JMH Contreras - - 478,900 C P-00632 52005003 J.South Community Hptal (661) 342,746 - 342,746 CO Aug-06 Dec.10 Apr.12 IRB Clark JMH Garcia - 342,746 -

U P-00854 53008020 Jack.No. Window Replacement 1,971,612 1,088,750 3,060,362 CN Jan-08 Jan.09 Feb.13 IRB Arnaldo JMH Sears 17,268 17,268 2,751,572 308,790

17 P-00960 53009055 Main/JNMC-outside. lights 922,500 (141,820) 780,680 CN Sep-09 Sep.10 Jun.13 IRB Arnaldo JMH Valdes - 140,691 639,989

18 P-00970 53009065 JNMC Hot Water/Boiler/Chiller 630,000 2,470,000 3,100,000 CN Sep-09 Jun.11 Dec.13 IRB Scott JMH Sears 85,935 85,935 1,844,565 1,255,435

19 P-00972 53009067 JNMC Remaining Roof 527,383 (427,071) 100,312 D Sep-09 Mar.10 Jan.13 IRB Scott JMH Sears - - 100,312

20 P-00989 53009081 JNMC ICU Commode Rep 52,500 400,000 452,500 CO Sep-09 Mar.10 Jul.12 IRB Arnaldo JMH Sears - 447,232 5,268

21 P-00996 53009088 JNMC Emer.Switchgear 1,650,000 95,000 1,745,000 D Sep-09 Dec.12 Dec.13 IRB Douglas JMH Sears 2,000 2,000 74,409 1,670,591

22 53010101 JNMC 40 Year Certification - 446,272 446,272 D Jul-10 Sep.12 Jan.13 IRB Scott JMH Valdes 5,177 5,177 70,537 375,735 V P-00606 59004002 JMT Elevators Moderniz. 907,878 (30,291) 877,587 D May-04 Feb.08 May.13 IRB Frank JMH Valdes - 56,255 821,332

R P-00763 59007009 JMT Elevator Modern#141-146 1,033,048 243,574 1,276,622 CN Jul-07 Sept.10 Jan.13 IRB Frank JMH Valdes (176,004) (176,004) 1,005,958 270,664

23 AB PIP 31009002 Telecommunication 6,000,000 1,765,000 7,765,000 PIP Aug.09 Dec.11 IRB Overton JMH Garcia - 7,765,000 -

52,758,540 9,302,673 62,061,213 370,405 370,405 33,313,714 28,747,499

2009 INFRASTRUCTURE REVENUE BOND DEFERRED PROJECTS

X P-00724 51007008 Kitchen Equipment Modification 711,679 (711,679) - DEF Nov-06 Jun.07 TBD IRB TBD JMH Valdes - - -

1 P-00964 51009059 Utility Ctr Chiller Replacem 2,810,370 (2,810,370) - DEF Sep-09 Dec.12 IRB TBD JMH Valdes - - -

Total 2009 Infrastructure Rev.Bond

2 P-00965 51009060 Chilled Water Loop Valves 315,000 (315,000) - DEF Sep-09 Dec.12 IRB TBD JMH Valdes - - -

3 P-00975 51009070 Heat Exchangers 420,000 (420,000) - DEF Sep-09 Mar.10 Oct.10 IRB Camero JMH Valdes - - -

4 P-00979 51009073 Public Area Bathrooms 210,000 (210,000) - DEF Sep-09 Oct.10 IRB TBD JMH Valdes - - -

5 P-00981 51009075 WW & C AHU Repl (14) 1,995,000 (1,899,074) 95,926 DEF Sep-09 Dec.12 IRB TBD JMH Valdes - 95,926 (0)

6 P-00991 52009083 J.South Repl.2 Vacuum P 25,000 (25,000) - DEF Sep-09 Mar.10 Oct.10 IRB TBD JMH Garcia - - -

S P-00827 53008015 Jack.No Elevators 1 & 2 437,733 (431,070) 6,663 DEF Feb-08 Jan.09 Jun.10 IRB TBD JMH Sears - 6,663 -

7 P-00968 53009063 JNMC AHU Replacement 2,908,500 (2,908,500) - DEF Sep-09 Dec.12 IRB TBD JMH Sears - - -

8 P-00971 53009066 JNMC Med. Air Compres 130,000 (130,000) - DEF Sep-09 Mar.10 Oct.10 IRB TBD JMH Sears - - -

9 P-00977 53009071 JNMC Repl.Conden.Coils 52,500 (52,500) - DEF Sep-09 Mar.11 IRB TBD JMH Sears - - -

10 P-00988 53009080 JNMC SICU Med Gas Colum 126,000 (126,000) - DEF Sep-09 Mar.10 Oct.10 IRB TBD JMH Sears - - -

11 P-00990 53009082 JNMC Vacuum System 78,750 (78,750) - DEF Sep-09 Mar.10 Oct.10 IRB TBD JMH Sears - - -

12 P-00993 53009085 JNMC Pat.R.Fan Coils 2,940,000 (2,940,000) - DEF Sep-09 Dec.12 IRB TBD JMH Sears - - -

W P-00655 56006004 JNCMHC Emerg. Generator 314,369 (314,369) - DEF Jul-06 Aug.07 Jun.11 IRB TBD JMH Valdes - - -

13 P-00994 56009086 Rose Lee W. Exp.Exam R 262,500 (262,500) - DEF Sep-09 Mar.10 Oct.10 IRB Camero JMH Contreras - - -

14 P-00995 56009087 Rose Lee W Med.Record 31,500 (31,500) - DEF Sep-09 Mar.10 Oct.10 IRB Camero JMH Contreras - - -

13,768,901 (13,666,312) 102,589 - - 102,589 (0)

TRUST FUND / GRANTS

Total 2009 Infrastructure Rev.Bond DEFERRED

Page 4 of 6



us


AB PIP 31009002 Telecommunication 188,100 - 188,100 PIP Aug.09 Dec.11 TF Overton JMH Garcia - 188,100 -

188,100 - 188,100 - - 188,100 -

FEMA Grants

IN CONSTRUCTION

Y 51011105 Ryder Trauma Ext Hardening 6,442,191 - 6,442,191 D Dec-10 Aug.13 FEMA Clark JMH Valdes 11,848 11,848 480,398 5,961,793

1 56012103 Jefferson Reaves Wind Retro 601,281 - 601,281 D Mar.12 Feb.13 FEMA Arnaldo JMH Valdes - 140 601,141

7,043,472 - 7,043,472 11,848 11,848 480,538 6,562,934

ALL OTHER FUNDING SOURCES

Closed/Cancelled and Partially Capitalized FY 11-12

- - - - - - -

Total Trust Fund

Total FEMA Grants

Total Closed Other Fundings

18 TOTAL FOR OTHER FUNDINGS 211,401,363 1,878,367 213,279,730 847,788 847,788 145,012,923 68,266,807

42 GRAND TOTAL 226,818,425 3,986,148 230,804,574 937,153 937,153 151,517,702 79,286,871

LETTERS Denotes Multi Funding Sources (The sum of all sources equals the Total Funded Commitment or Total Project Budget)

New: Denotes a new project opened in the current month

Hold: Projects placed on hold by Capital Projects Department Bold project numbers: Denotes changes in the project stages i.e.. From Design to Construction etc.

Bold budget amount: Denotes a change in the Total Project Budget 142,279,579 ac290 10/2012Bold date: Denotes changes in the projected completion/ revised completion date in the current monthStatus CAN Cancelled Project CL Closed CN Construction CO Close-OutD DesignDEF DeferredPC Partial Capitalization

Page 5 of 6



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Page 6 of 6

JACKSON MEMORIAL HOSPITAL

MONTHLY STATUS REPORT

DECEMBER 2012

JACKSON MEMORIAL HOSPITAL 51006005 EAST TOWER 2nd FLOOR PATHOLOGY LAB Funding Source: JMH Foundation Total Project Budget: $ 2,054,350 Anticipated substantial completion date: March 2013 Scope of the Work:

To upgrade and refurbish the existing Pathology Laboratory. Project Designed in Five (5) construction phases: 1.-UM Chairman Office/Bathroom, 2.-Conference Room, 3.-North Lab, 4.-South Lab/Grossing Stations 5.-Residencies Lab.

November 2012 • Project On Hold

December 2012

• Procurement to release additional professional PO

January 2013 • Architect of Record to revise drawings

51008032 EAST TOWER FLOOR – ER-RENOVATION Funding Source: GOB Total Project Budget: $ 2,406,000 Anticipated substantial completion date Phase 3: March 2013 PHASE 3 Scope of the Work

To refurbish and upgrade the ER-B & ER-C Patient Units including all existing bathrooms within the Department, discharge/cashier’s office and staff lounge.

November 2012

• Phase 3-B entails the following areas: East Tower-Ryder Trauma Center Corridor Connection, East Tower-Central Building Corridor Connection, ER-Ward “F” (soil room, clean room, and patient bathrooms), ER-Staff Lounge, New ADA Bathrooms

December 2012

• To pull Fire Alarm Permit • To complete Fire Alarm upgrade thru Phases 3A and 3B

January 2013

• To commence Phase 3-C Suture Treatment Suite



DECEMBER 2012

JACKSON MEMORIAL HOSPITAL 51009044 HCH ADOLESCENT UNIT RELOCATION Funding Source: 2005 RB Total Project Budget: $ 1,036,193 Projected Construction Completion Date: December 2012 Scope of work Renovation of an existing area on the East Tower 5th floor in the Infant Toddler Pediatric Patient Rooms for Adolescents. Remodel existing (6) six crib nursery and convert it into four (4) Private Patient rooms including the addition of four (4) new head walls and additional new ADA patient rest rooms by converting existing closets. Upgrade of existing Private and Semi-Private patient Rooms, staff lounge and corridor. November 2012

• Construction Continues

December 2012 • Construction Continues • Design Team Site coordination meetings • AHCA 100% inspection

January 2013

• Begin project closeout 51011116 CARDIAC CATH LAB #5 EQUIPMENT REPLACEMENT Funding Source: 2005 RB Total Project Budget: $454,000 Projected Construction Completion Date: February 2013 Construction to be performed by JOC Scope of work Replace Cardiac Cath Lab equipment for room 5 on Central 4th floor. Existing equipment is 23 years old and has not functioned for almost two years. November 2012

• Install Base Plate for GE equipment • Lawson input to increase PO for design team to update plans based on End User required items • Construction Continues

December 2012


January 2013 • GE Deliver Equipment • GE program equipment • Prepare for AHCA inspection



DECEMBER 2012

JACKSON MEMORIAL HOSPITAL 51011117 TAYLOR BREAST CENTER RENOVATIONS Funding Source: JMH Foundation Total Project Budget: $276,000 Anticipated Construction Completion Date: July 2013 This scope of work entails the renovation of the Taylor Breast Center located in the Diagnostic Treatment Center 1st floor. The upgrade will include renovation of the entrance / Reception Room. The Patient Changing Rooms will be relocated and converted into 3 Patient Intake areas. The Radiologist and Reading rooms will be relocated to accommodate new equipment. The upgrade will also include new furniture, paint, and lighting.

November 2012

• AHCA Review • Incorporate AHCA comments and send to AHCA / City of Miami for 100% review

December 2012

• City of Miami Plan review

January 2013 • Engage JOC Contractor for Proposal

51011118 NICU B, C AND INTERMEDIATE MODERNIZATION Funding Source: JMH Foundation Total Project Budget: $300,000 Anticipated Construction Completion Date: June 2013 The Scope of Work entails the modernization of the NICU B, C and Intermediate Units. This includes the complete renovation of the Nursing Stations, Refurbishment of Patient Bays and Replacement of flooring and Wall protection to match the existing NICU Unit A. November 2012

• Pre – Design Meeting #4 – AHCA functional program narrative • Design continues • Pre- T &B survey performed • AHCA Stage I review, November 30th, 2012

December 2012

• Design Continues • Design Team proceed with Construction Documents

January 2013

• JMH in-house review • Incorporate JMH comments and submit to AHCA / City of Miami



DECEMBER 2012

JACKSON MEMORIAL HOSPITAL 51009054 ET-4 LABOR AND DELIVERY OPERATING ROOMS Funding Source: 2005 RB Total Project Budget: $2,083,950 Anticipated substantial completion date: April 2013 Scope of Work Remodeling and Renovation of 5 Labor and Delivery Operating Rooms and surrounding support areas at the East Tower 4th Floor – Holtz Children’s Hospital. Four (4) Operating Rooms will maintain the same size and configuration. Operating Room Five (5) will be demolished and redesigned to higher standards. Total Square footage under this contract is approximately 5,450 Sq. Ft. November 2012

• Ongoing Procurement and Contractor review new terms and conditions • Contractor Award / PO issued • Lawson Input for Behar Font Work Order to update plans for AHCA Stage III review

December 2012

• Construction Mobilization meeting #1 • Purchase Order issued for Behar Font

January 2013

• AHCA Stage III review • Construction Mobilization

51010096 WW-2 ANGIO SUITE Funding Source: 2005 RB Total Project Budget: $ 2,000,000 Anticipated substantial completion date: June 2013 Construction to be performed by JOC Scope of work Removal of existing C-arm and replace with a new Siemens’ Zee in Interventional Radiology room #25. Renovation of abandoned Interventional Radiology area on WW2 to create a new recovery unit for Interventional Radiology. November 2012

• City of Miami confirms plan review not expired • Submit EDP special request letter to Procurement for review increase Design team existing Work Order • Procurement approves letter and revise based on EDP recommendation. Procurement Submit letter to EDP

December 2012

• EDP special request letter approved • PO issuance to Design Team to update plans for AHCA

January 2013

• Design Team update plans for AHCA



DECEMBER 2012

JACKSON MEMORIAL HOSPITAL 51009053 EAST TOWER 2 FLOOR A/C REPLACEMENT Funding Source: IRB Total Project Budget: $ 3,119,080 Anticipated substantial completion date: January 2013 Scope of the Work:

To furnish the Five (5) custom Air Handling Units at the East Tower 2nd Floor of Holtz Children’s Hospital.

November 2012 • On Hold

December 2012

• Engineering Department to execute additional scope requested by AHCA

January 2013 • Construction in progress

51009072 FIRE SPRINKLER UPGRADE CAMPUS WIDE Funding Source: IRB Total Project Budget: $2,000,000 Anticipated substantial completion date: March 2013 Scope of the Work The campus-wide fire protection upgrades are to address all existing NFPA fire sprinkler codes in addition to installing new automatic sprinkler systems and other system components for each building as determined deficient by state and local authority having jurisdiction. These main campus building include Central, East Tower, North Wing, Rehabilitation, South Wing, West Wing, and Utility buildings. November 2012

• PHT Board approval – Agenda Items (>$1M) December 2012

• Lawson Requisition • PO Issuance

January 2013

• Pre-Construction Meetings • Contractor planning and mobilization



DECEMBER 2012

JACKSON MEMORIAL HOSPITAL 51011105 RYDER TRAUMA CENTER EXTERIOR HARDENING PROJECT Funding Source: FEMA (75%) / Capital Contribution (25%) Total Project Budget: $8,589,588 Anticipated substantial completion date: August 20, 2013 Scope of the Work The project scope of work is to structurally retrofit the building envelope. The project will be designed to install a wind abatement system of lightweight glass fiber reinforced concrete (GFRC) panels onto the Ryder Trauma Center. The components used for this wind retrofit project will meet the current Florida Building Code and Miami-Dade County specifications to withstand extreme hurricane conditions (Category IV storm conditions). November 2012

• Cone-of Silence (Extended) • Bid Due Date (Extended • Bid proposals are due

December 2012

• Proposal review and qualifications (Responsive and/or Non-Responsive) • Award Recommendation • Proposal Negotiation •

January 2013

• Legal, risk management, CAO review • PHT Approval

51011106 HIGHLAND PROFESSIONAL BUILDING – TRANSPLANT RENOVATIONS Funding Source: Capital Contribution Total Project Budget: $542,625 Anticipated substantial completion date: January 2013 Scope of the Work The scope of work is to renovate various areas of the 6th floor transplant floor of the Highland Professional Building in order to add Patient Exams room and work station to support the 6th Floor Transplant department. Additionally the scope of work includes interior renovations to the 1st floor lobby area, elevator lighting upgrade, interior/exterior signage and renovations to an unoccupied area to support daily clerical activities. November 2012

• To complete Phase 1 Renovation (Patient Transplant Suite)

December 2012 • To commence Phase 2 Lobby Renovation and Elevator’s Interior Cabin Upgrade

January 2013

• To complete Phase 2 Renovation



DECEMBER 2012

JACKSON MEMORIAL HOSPITAL 51010097 DTC NEW MRI Funding Source: 2005 RB Total Project Budget: $ 2,500,000 Anticipated substantial completion date: December 2012 Construction to be performed by JOC Scope of the Work: Replacement of existing MRI in DTC 1st floor. Includes expansion of room and new back up chiller. November 2012

• Siemens Deliver new MR equipment 10/30/12 • Contractor Complete not complete with Construction as scheduled on 11/6/12 • Notice of Deficiency #1 issued for FH Paschen • AHCA 100% inspection , 11/19/12 • Siemens begin calibration • Siemens “applications” training for end user

December 2012

• Begin project closeout January 2013

• Project Closed 51010100 CAMPUS WIDE UNDERGROUND UTILITY SITE-WORK IMPROVEMENTS Funding Source: IRB Total Project Budget: $ 3,200,000 Anticipated substantial completion date: November 2012 (Contractors revised completion date is now November 2012) Scope of the Work:

To upgrade water and fire lines in and around the Alamo Plaza along with canopy replacement, improvements to hardscape, lighting and landscape.

November 2012

• Continue Construction Activities

December 2012 • Continue Construction Activities • Begin Canopy Installation

January 2013

• Continue Construction Activities • Complete Canopy Installation • Project Close-out



DECEMBER 2012

JACKSON MEMORIAL HOSPITAL 51009046 WEST WING BASEMENT PHARMACY CLEANROOM PHASE I / CAROUSELS PHASE II Funding Source: 2005 RB Total Project Budget: $ 834,596 Projected Construction Completion Date: Phase I July 2011 / Phase II February 2013 Phase I Construction Status: 100% Phase II Construction Status: 0% Scope of Work: Phase I: Installation of a new USP 797 complaint pharmacy clean-room in the West Wing basement. Phase II: Demolition of the old cleanroom to create an open space within the pharmacy to receive (3) new pharmaceutical carousel. This includes new finishes throughout the basement pharmacy. November 2012

• Negotiations with next responsive bidder • Contractor award recommendation

December 2012

• Purchase Order Issued • Building permit obtained • Project submittal process begins • Commence Construction

January 2013




DECEMBER 2012

JACKSON MEMORIAL HOSPITAL 51009089/E10-JMH-01 MEDIUM VOLTAGE OIL SWITCHES REPLACEMENT AND ELECTRICAL SWITCHGEARS AT CENTRAL AND SOUTH WING REPLACEMENT: Funding Source: IRB/CC Total project Budget: $4,785,000 Anticipated substantial completion date: Design September 2012 Construction December 2013

Scope of the Work Replace medium voltage oil switches in Central, South Wing, Institute, Rehabilitation and North Building. Central and South Wing: replace normal and emergency substations and main switchgears.

November 2012

• Submit CSBE for construction phase-I • Phase-I plans to be submitted to AHCA • Negotiation with consultant phase-II design (Central and South Wing: replace normal and emergency

substations and main switchgears) December 2012

• ITB of Phase-I project are at Procurement • Phase-I waiting for AHCA’s comments • Phase-I permit submitted to city of Miami • Begin phase-II design (Central building: replacement of normal and emergency substations and retrofill

main switchgear)

January 2013 • ITB of Phase-I project are at Procurement • Phase-I waiting for AHCA’s comments • Phase-I permit submitted to city of Miami • Continue phase-II design (Central building: replacement of normal and emergency substations and retrofill

main switchgear)



DECEMBER 2012

JACKSON MEMORIAL HOSPITAL 51009056/E10-JMH-02 ENERGY CENTER REPLACE PARALLELING GEAR AND NEW EMERGENCY GENERATORS Funding Source: IRB Total project Budget: $ 5,289,372 Anticipated substantial completion date: Design August 2012 Construction February 2014

Scope of the Work Replace paralleling system and emergency distribution switchboard; provide new engines with the capability to operate in dual-fuel mode (natural gas component). Ryder Trauma Center emergency power system will be increased, with the intention of having the entire building on emergency power.

November 2012

• ITB-Campus wide Energy Monitoring and Control System (EMCS) was cancelled • UC-Integration of the Portable unit with ASCO essential gear: construction continues: City of Miami and

DERM are approved • Continue with design stage for new generator at UC, emergency power upgrades at Energy Center and

Ryder Trauma

December 2012 • New ITB for Campus wide Energy Monitoring and Control System (EMCS) • UC-Integration of the Portable unit with ASCO essential gear: construction continues • Continue with design stage for new generator at UC, emergency power upgrades at Energy Center and

Ryder Trauma

January 2013 • Cone of silence for Campus wide Energy Monitoring and Control System (EMCS) phase project • UC-Integration of the Portable unit with ASCO essential gear: construction continues • Continue with construction plans for new generator at UC, emergency power upgrades at Energy Center

and Ryder Trauma 51009064 REPLACEMENT OF 30 AIR HANDLING UNITS Funding Source: IRB Total Project Budget: $6,541,500 Anticipated substantial completion date: September 2014 Scope of the Work:

To furnish and install thirty one (31) custom Air Handling Units:

November 2012 • Bids due November 1, 2012 for AHU#9 • Procurement to prepare Invitation to Bid for AHU#154, 156, 160, 161, 164, 230 package

December 2012

• Award contract for AHU #9 January 2013

• Advertise ITB for 6 AHU project

• Trauma JACKSON MEMORIAL HOSPITAL


DECEMBER 2012


59007009 JMT ELEVATOR MODERNIZATIONS #141 TO #146 Funding Source: Capital Contribution / IRB Total Project Budget: $1,276,622 Projected Completion Date: January 2013 Scope of Work Modernization and cab upgrade to Elevators #141-146 in Jackson Medical Towers November 2012

• To complete last Car #143

December 2012 • To Relocate Fire Sprinkler Piping inside the elevator’s shaft

January 2013

• To Upgrade elevators 141-146 interior cabins 51011104 WEST WING 15 NURSING UNIT MODERNIZATION Funding Source: Capital Contribution Total Project Budget: $2,588,568 Projected Completion Date September 2013 Scope of Work The West Wing 15 Nursing Unit Modernization project has a vision towards creating a greater offering of single-occupancy rooms at Jackson Health System. The projects’ interior renovation would create twenty-five (25) single-occupancy rooms, one (1) VIP room, and other clinical support areas to current codes, hospital standards, and modernized finishes. November 2012

• Ongoing procurement process – “ITB for Qualified Contractor” • Pre-Bid meeting and site walk through • Cone of Silence

December 2012

• Bidding process – Open RFI responses • Received contractor proposals

January 2013

• Proposal negotiations/reviews • Bid qualifications



DECEMBER 2012

JACKSON MEMORIAL HOSPITAL 51009062/E10-JMH-03 P-00967 FIRE ALARM UPGRADE AT JACKSON MEMORIAL HOSPITAL Funding Source: IRB Total project Budget: $ 4,429,495 Anticipated substantial completion date: March 2013

Scope of the Work Design and upgrade of existing hospital and business occupancy floor for: Rehabilitation, Trauma, Mental Health and Jackson Medical Towers buildings, replace all audio/visual devices provide new speakers, all older model addressable ceiling smoke detectors, heat sensors, manual pull station and duct detectors must be replaced, flow and tamper annunciation modules must be upgraded. Connect these building to the fire alarm loop/network. November 2012

• Ongoing Construction at Patient Towers: NW 75% & Rehab 65% • Mental Health construction Fire Alarm Panel CPU Upgrade has been installed • Park Plaza East Fire Alarm Construction Documents - COMPLETE • Tracking ongoing design services for Jackson Medical Towers

December 2012 • Ongoing Construction at Patient Towers: NW & Rehab pending percentage completion information • Tracking ongoing design services for Jackson Medical Towers

January 2013 • Fiber optic plans submitted for staff review • Ongoing Design Services – Track the completion of non-patient towers: Park Plaza East and Jackson

Medical Towers • Ongoing Construction at Patient Towers (e.g. ET, Highland, NW, MH & Rehab)

51009036 WEST WING AND CENTRAL FIRE ALARM UPGRADE PROJECT Funding Source: IRB Total Project Budget: $2,350,000 Projected Completion Date November 2012 Scope of Work Design and upgrade of existing patient occupancy towers for: West Wing and Central buildings, replace all audio/visual devices provide new speakers, all older model addressable ceiling smoke detectors, heat sensors, manual pull station and duct detectors must be replaced, flow and tamper annunciation modules must be upgraded. Connect these building to the fire alarm loop/network. November 2012

• Central completing the fire detection in the shafts and the new addressable relay tie ins for elevator recall and Testing and certification regarding the elevator fire alarm interface will be completed by end of this month

• WW tamper and Flow testing is at 50% completion • Ongoing Fire Alarm installation, programming, trim-out for the Central Building • Address the existing condition Central damper operations

December 2012 • Ongoing City of Miami Fire Marshall inspections for the West Wing Tower • Ongoing City of Miami Fire Marshall inspections for the Central Building

January 2013 • Ongoing City of Miami Fire Marshall inspections for the West Wing Tower • Ongoing City of Miami Fire Marshall inspections for the Central Building



DECEMBER 2012

JACKSON MEMORIAL HOSPITAL 53009055 MAIN CAMPUS / JNMC CAMPUS-WIDE LIGHTING UPGRADE Funding Source: IRB Total Project Budget: $ 780,680 Projected Construction Completion Date: June 2013 Percentage of Construction Completed 0% Scope of Work: Campus wide outdoor lighting upgrade throughout the JMH main campus and the Jackson North Medical Center. The first phase of this project will cover the Alamo plaza and 16th street portion of the project. November 2012

• ITB Pre-bid meeting December 2012

• Respond to bid RFI’s • Bids received • Bid review process

January 2013

• Procurement contractor award recommendation • Purchase order • Commence submittal and procurement of equipment

51009069 CAMPUS WIDE ROOFING REPLACEMENT – EAST TOWER Funding Source: IRB Total Project Budget: $1,500,000 Projected Completion Date: August 2013 Scope of Work Replacement of East Tower Roof, approximately 90,000 SQFT November 2012

• Revise specification to more cost effective solution • Resubmit the AHCA

December 2012

• Advertise new roof specification

January 2013 • Open bids on revised roof specification



DECEMBER 2012

JACKSON NORTH MEDICAL CENTER 53008020 JACKSON NORTH WINDOW REPLACEMENT Funding Source: Capital Contribution & IRB Total Project Budget: $ 3,060,362 Anticipated substantial completion date: February 2013 Scope of Work: Replacement of all windows with new hurricane windows. Unforeseen conditions have been encountered and the wall systems on pavilion, pediatrics and Labor and delivery are being reconstructed and shored. November 2012

• Construction continues 2nd Floor L&D, 75% complete • Unforeseen structural issue found at the south and east elevation of the L&D unit • JOC supplemental price negotiated • Purchase order issued for additional work

December 2012

• Construction continues 2nd Floor L&D, 80% complete • JOC supplemental

January 2013

• Construction continues 2nd Floor L&D, 95% complete 53009065 JACKSON NORTH MEDICAL CENTER UTILITY PLANT REPLACEMENT Funding Source: IRB Total Project Budget: $3,100,000 Anticipated substantial completion date: December 2013 Scope of Work: Replacement of three chillers, two boilers and supporting systems, installation of a new cooling tower. Installation of new energy management system. November 2012

• Issue Purchase Order to engineering firm to commence design change December 2012

• Continue study for redesign to hot water boiler system January 2013

• Finalize design and AHCA submission for remaining work

Agenda Item 5 Facilities Subcommittee December 13, 2012

RESOLUTION NO. PHT 12/12 –

RESOLUTION AUTHORIZING THE PRESIDENT OR HIS DESIGNEE TO ENTER INTO A LEASE AGREEMENT WITH THE TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK, A NEW YORK NON-PROFIT CORPORATION FOR THE RENTAL OF TWO HUNDRED AND FORTY-THREE (243) SQUARE FEET OF SPACE IN THE AMBULATORY CARE CENTER EAST BUILDING, ROOM CLU AT 1611 NW 12 AVENUE, MIAMI, FLORIDA 33136 FOR A PERIOD OF TWO YEARS AND EIGHT MONTHS COMMENCING ON JANUARY 1, 2013 AND EXPIRING ON AUGUST 31, 2015 FOR AN ANNUAL PAYMENT OF SIX THOUSAND EIGHT HUNDRED FOUR DOLLARS ($6,804) WITH ANNUAL INCREASE IN BASE RENT OF ONE PERCENT (1%) AND COMMON AREA MAINTENANCE

(Madeline Valdes, Corporate Director, Property Management Division)

WHEREAS, the Public Health Trust is authorized pursuant to Chapter 25A of the Code of Miami-Dade

County to lease real property either as lessor or as lessee; and

WHEREAS, the President, Facilities Subcommittee and Fiscal Committee recommend approval.

NOW, THEREFORE BE IT RESOLVED BY THE FINANCIAL RECOVERY BOARD OF THE

PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby authorizes the

President or his designee to enter into a new Lease Agreement with The Trustees of Columbia University in the City

of New York, a New York Non-Profit Corporation for the rental of Two Hundred and Forty-Three (243) square feet

of space in the Ambulatory Care Center East Building, Room CLU at 1611 NW 12 Avenue, Miami, Florida 33136

for a period of two (2) years and eight (8) months commencing January 1, 2013 and expiring on August 31, 2015,

for an annual payment of Six Thousand Eight Hundred Four Dollars ($6,804) with an annual increase in base rent of

one percent (1%) and common area maintenance, in accordance with the recommendation set forth in the agenda

item attached hereto and incorporated herein by reference.

FACILITIES SUBCOMMITTEE 12-13-12 FISCAL COMMITTEE 12-13-12

REQUEST

Staff requests authorization for the President or his designee to enter into a new Lease Agreement with The Trustees of Columbia University in the City of New York, a New York Non-Profit Corporation for the rental of Two Hundred and Forty-Three (243) square feet of space in the Ambulatory Care Center East Building, Room CLU at 1611 NW 12 Avenue, Miami, Florida 33136 for a period of two (2) years and eight (8) months commencing January 1, 2013 and expiring on August 31, 2015, for an annual payment of Six Thousand Eight Hundred Four Dollars ($6,804) with an annual increase in base rent of one percent (1%) and common area maintenance. BACKGROUND The PHT is the main provider of HIV care in Miami-Dade County, Florida. The adult HIV clinics are located in the Ambulatory Care Center (ACC) East within Jackson Memorial Hospital. The Columbia University Department of Socio-medical Sciences Miami Research Center will occupy the office space co-located with the adult HIV clinics in ACC East. The space will be used as part of the Project Retain which provides integrated care for an HIV infected drug users study. Specifically, it will be used for conducting intervention sessions (e.g., counseling sessions) as well as baseline and follow-up visits involving face-to-face interviews with study participants. The space will likely be equipped to accommodate a maximum of 2 staff and 2 participants at a time. RECOMMENDATION Staff recommends authorizing the President or his designee to enter into a new Lease Agreement with The Trustees of Columbia University in the City of New York, a New York Non-Profit Corporation for the rental of Two Hundred and Forty-Three (243) square feet of space in the Ambulatory Care Center East Building, Room CLU at 1611 NW 12 Avenue, Miami, Florida 33136 for a period of two (2) years and eight (8) months commencing January 1, 2013 and expiring on August 31, 2015, for an annual payment of Six Thousand Eight Hundred Four Dollars ($6,804) with an annual increase in base rent of one percent (1%) and common area maintenance as it is in the best interest of the Public Health Trust to grant this authorization as the space will be used for Columbia University Grant project.

AUDIT AND COMPLIANCE SUBCOMMITTEE


Audit & Compliance Subcommittee Mojdeh L. Khaghan, Chairperson Darryl K. Sharpton, Vice Chairperson Michael Bileca Marcos Jose Lapciuc

Date, Time and Location December 13, 2012 – To follow the Facilities Subcommittee Meeting Ira C. Clark Diagnostic Treatment Center Conference Room 259

AGENDA

1. Approval of the Previous Meeting Minutes (Mojdeh L. Khaghan, Chairperson, Audit & Compliance Subcommittee)

(a) *Meeting Minutes as of November 15, 2012 (b) *Supporting Document to the Meeting Minutes as of November 15, 2012 2. Corporate Compliance Program Department Update

(Diana Salinas, Corporate Director and Chief Compliance Officer, Compliance Department, Jackson Health System)

(a) *FY13 Audit Plan Update

(b) Review of Finalized Audit Reports

(1) * #2 Short Stay Medical Necessity – Quarter 1 – Jackson North Medical Center (2) *#3 Short Stay Medical Necessity – Quarter 1 – Jackson South Community Hospital (3) *#4 Short Stay Medical Necessity – Quarter 1 – Holtz Children’s Hospital

3. Internal Audit Update

(Stephen J. Weimer, Corporate Director, Internal Audit Department, Jackson Health System)

(a) *FY13 Audit Plan Update (b) Review of Finalized Audit Reports

(1) *Maxor Outpatient Pharmacy Services (2) *Monthly Audit Follow-up Report

4. JMH Health Plan Preliminary CMS Audit Report

(Paul Marineau, Executive Director, JMH Health Plan and Brian Dean, Vice President, Finance Division)

(a) *Overview, Preliminary CMS Audit Report

Agenda items(s) noted with an asterisk (*) indicates that the supporting documents are attached.

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD Audit & Compliance Subcommittee Mojdeh L. Khaghan, Chairperson Darryl K. Sharpton, Vice Chairperson Michael Bileca Marcos Jose Lapciuc Date, Time & Place November 15, 2012 – Followed the Facilities Subcommittee meeting Ira C. Clark Diagnostic Treatment Center Conference Room 259

ATTENDANCE

Audit & Compliance Subcommittee Darryl K. Sharpton Mojdeh L. Khaghan Marcos Jose Lapciuc Excused Michael Bileca Financial Recovery Board Members

Joaquin del Cueto Joe Arriola

Jackson Health System Mark T. Knight Diana Salinas Stephen J. Weimer Carlos A. Migoya Don S. Steigman

Miami-Dade County Attorney’s Christopher Kokoruda Valda Christian

Audit & Compliance Subcommittee Meeting November 15, 2012 Page 2 Meeting Called to Order With a quorum being present, the Audit & Compliance Subcommittee meeting was called to order at 8:30 a.m. by Mojdeh L. Khaghan, Chairperson, Audit & Compliance Subcommittee. 1. Approval of the Previous Meeting Minutes (a) Meeting Minutes as of October 18, 2012 (b) Supporting Document to the Meeting Minutes as of October 18, 2012

Ms. Khaghan requested approval of the meeting minutes and supporting document as of October 18, 2012. Mr. Sharpton moved approval; seconded by Mr. Lapciuc, and carried without dissent.

2. Corporate Compliance Program Department Update

Diana Salinas, Corporate Director and Chief Compliance Officer, Compliance Department, Jackson Health System presented the following updates and reports:

(a) FY13 Audit Plan Update One (1) audit was completed which resulted in 2% of the Audit Plan being completed.

(b) Audit Report (1) Short Stay Medical Necessity - #1 Jackson Memorial Hospital

The scope of the audit was to review documentation associated with the RAC/Reassessment and validate the medical necessity of short stay admissions. Medicare only pays for inpatient hospital services that are medically necessary for the setting billed and that are coded correctly. Medical documentation was reviewed to determine that the services rendered were medically necessary and billed correctly. The results of the audit showed an error rate higher than previous audits and ongoing monitoring of the short stay medical necessity identified areas that need improvements. A corrective plan was developed to correct the identified gaps. Outlined in the audit report was the methodology, audit results, findings and observations, recommendations, corrective action plans/process improvements, and manager’s response. A detailed copy of the report was included with the agenda.

Audit & Compliance Subcommittee Meeting November 15, 2012 Page 3

(c) Executive Summary-JHS Corporate Compliance Program 2012 Annual Report (October 1, 2011 to September 20, 2012) The 2012 Annual Report for October 1, 2011 to September 30, 2012 showed the results of the audits performed during the fiscal year. This is the third annual report on the activities of the Corporate Compliance Program which showed the responsibilities of the Corporate Compliance Office as it relates to organizational goals and the corresponding communications to the hospital leaders, and report actions taken to address several system wide compliance risks during the fiscal year. A summary of the Corporate Compliance Program 2012 Annual Report was included with the agenda.

Ms. Khaghan congratulated Ms. Salinas and the Corporate Compliance Department staff for an excellent Corporate Compliance Program report for fiscal year 2012.


Stephen J. Weimer, Corporate Director, Internal Audit Department, Jackson Health System presented the following Internal Audit update reports and recommend approval of the FY13 Audit Plan:

(a) FY12 Internal Audit Plan Update

There remains one (1) audit in progress. It is anticipated that the remaining audit will be completed at the end of November or beginning of December 2012. The fieldwork for completion remain on the following audits: Maxor Pharmacy services (report will go out within the next 2-weeks and report back in the month January 2013), and Perdue Medical Center (since the completion of the Audit Plan update report the fieldwork was completed and will be rolled into the audit of the long term care centers, report back in January 2013 which will complete the FY12 Internal Audit Plan). A detailed copy of the FY12 Internal Audit Plan was included with the agenda.

(b) FY12 Audit Analysis During the fiscal years 2011 and 2011, a total of 65 internal audits were performed. From an audit rating standpoint year over year results showed marked improvements with the following results: 19% increase in FY 12 good/satisfactory ratings versus FY11, good increased from 1 in FY11 to 5 in FY12. A summary of the FY12 Audit Analysis was included with the agenda. Mr. Sharpton thanked Mr. Weimer for the presentation of the FY12 Audit Analysis.

Mr. Sharpton requested that future reports define the rating by the risk category.

In response to Mr. Sharpton’s request, Mr. Weimer stated that future reports will include a combination of the audit rating and risk factor and show a combined number. He also stated that the analysis will be updated and presented at the next meeting as a follow up to Mr. Sharpton’s request.

Audit & Compliance Subcommittee Meeting November 15, 2012 Page 4

(c) Review and Recommend Approval of FY13 Audit Plan The FY13 Internal Audit Plan for Jackson Health System was presented for approval. The FY13 Audit Plan is a combination of Assurance planned and unplanned audits, Advisory Services and Investigative Services, proposed resources necessary to complete the audits, and proposed internal audit hours budgeted (10,900) to complete the audits. (See attached FY13 Audit Plan.) With regards to the audit managers for Information Technology System Division (IT), Mr. Sharpton pointed out the challenges and expressed concern regarding the resources to provide the necessary assistance to timely complete the audits.

Mr. Weimer stated that from an assurance standpoint he is confident that the number of assigned staff is sufficient to timely and efficiently complete the audits. From an advisory standpoint, he stated that the Internal Audit representatives (1 auditor and approximately 7 individuals) and himself participate in the audit projects.

Mr. Sharpton requested to further discuss the matter with Mr. Weimer over the next week to ten (10) days to assure the appropriate number of staff is allocated for the IT projects.

With regards to the external audit process, Mr. Sharpton requested that he and Mr. Weimer review JHS efforts to better coordinate and utilize resources.

Mr. del Cueto spoke about him and Mr. Weimer’s discussion regarding conducting a consultant services performance audit particularly having to do with Emergency Room Services and University of Miami Health System Specialist and Outsource Division Services. Mr. del Cueto questioned if a consultant services audit could be included as part of the FY13 Audit Plan.

Mr. Weimer stated that he will develop a full scope and schedule a meeting with Mr. del Cueto to better understand next steps to moving forward with a consultant services performance audit.

After discussion, Ms. Khaghan requested approval of the FY13 Audit Plan.

Mr. Sharpton moved approval; seconded by Mr. Lapciuc, and carried without dissent.

(d) Review of Finalized Audit Reports HIPPA Security Rule audit was the single audit reported. All issues were corrected during the audit with no significant information to report. The trend continues to correct issues outlined in the management’s response related to prior audits.

Audit & Compliance Subcommittee Meeting November 15, 2012 Page 5 Meeting Adjourned The meeting of the Audit & Compliance Subcommittee adjourned at 8:47 a.m. Transcribed by Ivenette Cobb, Executive Assistant Public Health Trust Financial Recovery Board

FY13 Internal Audit Plan

Jackson Health System

10/24/12

The FY13 Internal Audit Plan is a combination of -

• Assurance (Planned Audits) – audits scheduled as a result of our Five Year Audit Plan (FY11 – FY15) and through ongoing discussion with executive/senior leadership and the Financial Recovery Board. Audits are performed to determine the effectiveness and efficiency of operational and financial processes, adherence to regulatory requirements and integrity of financial and operating information. The proposed FY13 plan contains 27 audits totaling 7,900 hours.

• Assurance (Unplanned Audits) – hours are available to perform internal audits and investigations as a result of management or Board recommendation, Internal Audit determination, external recommendations (ie. KPMG, OIG, etc.), or particular situations that are encountered during the year. The proposed FY13 plan contains a pool of 1,000 hours available to handle unplanned audit and investigative opportunities as presented during the year.

• Advisory Services – defined as consulting services to mitigate risk, improve operations, and/or assist management in achieving its business objectives. Advisory services may include informational resources counsel, participation on various committees and task forces (including design/development of new business and computer systems - Process Life Cycle). The FY13 Audit Plan contains planned activities that are known at time of publication, however, it is anticipated that additional advisory time will be scheduled during the fiscal year. We have hours budgeted to handle opportunities as presented during the year. The proposed FY13 plan contains 38 advisory projects totaling 1,720 hours plus a pool of 280 hours for unplanned advisory projects.

• Investigative Services – Investigations evaluate allegations of unethical business practices and/or financial and operational misconduct to determine if allegations are substantiated and to prevent future occurrences. The proposed FY13 plan contains a pool of 1,000 hours available to handle unplanned audit and investigative opportunities as presented during the year.

FY13 Internal Audit Plan - SummaryJackson Health System

11/8/2012

Activity Reference Location Quarter Hours % to Total

Assurance Services (planned) see Assurance worksheet JHS 1 - 4 7,900 72%

Assurance, Investigative Services (unplanned) see Assurance worksheet JHS 1 - 4 1,000 9%

Advisory Services (planned) see Advisory Services worksheet JHS 1 - 4 1,720 16%

Advisory Services (unplanned) see Advisory Services worksheet JHS 1 - 4 280 3%

Total Internal Audit hours budgeted - FY13 JHS 10,900

Resources Number of EmployeesCorporate Director & Chief Audit Executive 1Audit Manager - Financial & Operational 1Audit Manager - IT 1Senior Auditor 3Staff Auditor 1

Jackson Health SystemInternal Audit Plan - FY13

Assurance Services

11/8/2012

Assurance - Audit Title Scope/Objective Location Quarter HoursPatient Referrals Perform analysis of patients referred from JHS to UM from 2007-2012. JHS 1 300External Audit Assistance On an annual basis, provide 1000 hours audit assistance to KPMG. JHS 1 840

Community Health Inc. ("CHI")Review contract/agreement management process to determine if contract exists for services, proper procurement processes were followed, compliance with SLA, and effectiveness of payment controls.

PCC 1 250

Jackson Long-term Care Center/Perdue Medical Center(Operational and Clinical Process Review)

Assess and evaluate internal controls related to nursing home functions:• Admissions/Registration Process• Billing and Collections• Contractual and Purchased Services Management• Inventory Management (Medical and Pharmaceutical)• Physical Security• System Access (SOD, Appropriate Access Rights, HIPPA, Etc…)

Jackson Long Term Care

Center/Perdue Medical Center

1 600

Change Management (Part 2) Evaluate effectiveness of controls surrounding the patch management software. JHS 1 210

Cash Audit (intially audited in FY11)Audit performed in FY11; control deficiencies were identified in cash collection, internal cash transportation, and overall access to cash.

Identify risks associated with cash collection processes and practices unique to JHS’ cashier function, ascertain whether controls adequately mitigate identified risks, ensure that cash is properly safeguarded, and determine if proper segregation of duties and access exist.

JHS 2 300

Patient Intake

Determine completeness, accuracy and efficiency of the revenue cycle process by assessing patient care process controls for the following:1. Registration2. Financial Assessment3. Medical Records/Coding4. Charge Capture5. Billing6. Collections

JMH (Main Operating

Room and Holtz & Woman's

Health Center)

2 300

JMH Contractual and Purchased Services ManagementReview contract management process to determine if contracts exist for services, proper procurement processes were followed, and effectiveness of payment controls.

JMH -Executive Office 2 200

JMH Inventory & Supply Control

Assess internal controls related to storing, warehousing, and the safeguarding of inventory supplies; determine if inventories are subject to effective custodial accountability procedures and physical safeguards. Determine if appropriate segregation of duties exists.

JMH (Ambulatory Care

Pharmacy and Transfusion

Services)

2 250


Assurance Services

11/8/2012

Assurance - Audit Title Scope/Objective Location Quarter Hours

Equipment Management - Core System Maintenance Evaluate effectiveness of controls surrounding management of IT equipment. JHS 2 280

System Development Process Review new system implementation processes to include project team selection, planning, management, testing, etc. JHS 2 320

Community Mental Health General controls review of stand alone function PCC 2 100

JNH and JSH Inventory & Supply Control

Assess internal controls related to storing, warehousing, and safeguarding of inventory supplies; determine if inventories are subject to effective custodial accountability procedures and physical safeguards. Determine adequacy of segregation of duties.

JNH/JSH(Interventional

Radiology - JNH and Laboratory -

JSH)

3 240

Jackson Hospital Health Plan ReviewAssess overall effectiveness and efficiency of the department's operational/financial processes as relates to compliance with established internal/regulatory policies and procedures.

JHHP 3 240

Clinical Services

Determine completeness, accuracy and efficiency of the revenue cycle process by assessing patient care process controls for the following: 1. Registration2. Financial Assessment3. Medical Records/Coding4. Charge Capture5. Billing6. Collections

JMH Radiology and

Respiratory Therapy

3 300

Payroll (initally audited in FY11)Audit performed in FY11; control deficiencies were identified in timely removal of terminated employees, timecard review and approval, and significant overtime as a percentage of paid hours.

Review and evaluate the adequacy of internal controls surrounding payroll processes. JHS 3 300

JSH Contractual and Purchased Services Management Review contract management process to determine if contracts exist for services, proper procurement processes were followed, and effectiveness of payment controls.

JSH(Anesthesia Unit, Plant Operations, and Medical Staff)

3 300

Omnicell Audit Determine effectiveness of controls surrounding Omnicell management. JHS 3 320

Security & Privacy HIPPA Part II “Privacy Rule”, assess compliance with the Privacy Rule. JHS 3 280

Annual Operating Agreement ("AOA") Review Determine compliance with terms of AOA. JHS 4 200External Audit Assistance On an annual basis, provide 1000 hours audit assistance to KPMG. JHS 4 200


Assurance Services

11/8/2012

Assurance - Audit Title Scope/Objective Location Quarter Hours

Registration and Admissions - Inpatient/Siemens/Cerner application audit

Verify accuracy of capturing patient information and insurance verification; to include Siemens/Cerner related controls review. Verify accuracy and compliance with JHS guidelines of information input into Siemens. Determine if regulatory guidelines are followed.

JMH 4 300

Physical Inventory Observation Observe annual physical inventory count to determine adequacy of procedures. JHS 4 160

JNH Contractual and Purchased Services ManagementReview contract management process to determine if contracts exist for services, proper procurement processes were followed, and effectiveness of payment controls.

JNH(Psych Adult # 1,

Residency Program)

4 250

KRONOS application audit Evaluate the effectiveness of controls over the time keeping system. JHS 4 260

Audit Follow-ups Perform follow-up reviews of prior year's audit findings to ensure corrective action is completed as stated and adequate. JHS 1 - 4 500

Health Plan - Fraud & Abuse Examination Examine, investigate, audit and analyze data for the purpose of assessing compliance with various segments of PHT/JMH policies and procedures. JHHP 1 - 4 100

Unplanned Assurance, Investigative Services TBD JHS 1 - 4 1,000

Budgeted Hours - Assurance 8,900


Advisory Services

11/8/2012

Advisory - Process/Project Tier Location FY13 Budgeted Hours

Electronic Medical Records -Meaningful Use requirements for Stage 1 attestation Tier 1 JHS 100

Accounts Payable - GHX/AP on demand Tier 1 JHS 50Medicare Bad Debt Tier 1 JHS 60ICD-10 Tier 1 JHS 80OR inventory, charge capture, CDM, billing Tier 1 JHM 200Siemens DSS Tier 1 JHS 50Zynx Evidence Based Order Sets ZENX Tier 1 JHS 80PPW Datacenter Renovation/NAP Reduction Tier 1 JHS 403M Encompass 360 Computer Assisted Coding Tier 1 JHS 80EDI Process Procure to Pay Tier 1 JHS 80MedAssets Revenue Cycle Project. Revenue Integrity Steering Committee MedAssests crosswalk Tier 1 JHS 100

Emergency Room Task Force Tier 1 JHS 100Ambulatory Task Force Tier 1 JHS 100Health Plan Medicare Clams Processing System Implementation Tier 1 JHHP 50Ambulance - MCT Express Tier 2 JHS 50Denial Management Tier 2 JHS 80P card - Amex Tier 2 JHS 50OTTR Implementation - Transplant Database Tier 2 JHS 40Cerner reference Lab Interface with Quest Diagnostics. Tier 2 JHS 50Allscripts Care Management Tier 2 JHS 40RIVA Robot (Pharmacy) Tier 2 JHS 40Amcom Physicians On-call Tier 2 JHS 80CERNER upgrade of MUSE gate/HL7 Cardiology Tier 2 JHS 40Upgrade of Vericis and Merge systems and interface with UM Tier 2 JHS 40

Pharmacy billing software upgrades for Long Term Care Centers Tier 2 JHS 40Unplanned Advisory Services TBD JHS 280Budgeted Hours - Advisory Services 2,000

2. Corporate Compliance Program Department Update

Total340

567%0

Risk LevelHighModerate or High

Auditor Audit # Audit Name Risk Assessment Scope & Objectives Status Completion DateTMR

1

Monthly Short Stay Medical Necessity - Quarter 1 JMH High RAC/Reassessment - To review documentation to validate the medical necessity of short stay admissions. Medicare only pays for inpatient hospital services that are medically necessary for the setting billed and that are coded correctly. Medical documentation will be reviewed to determine that the services were medically necessary and were billed correctly. Completed 10/26/2012

CE

2

Monthly Short Stay Medical Necessity - Quarter 1 JNMC High RAC/Reassessment - To review documentation to validate the medical necessity of short stay admissions. Medicare only pays for inpatient hospital services that are medically necessary for the setting billed and that are coded correctly. Medical documentation will be reviewed to determine that the services were medically necessary and were billed correctly. Completed 10/29/2012

SP

3

Monthly Short Stay Medical Necessity - Quarter 1 JSCH High RAC/Reassessment - To review documentation to validate the medical necessity of short stay admissions. Medicare only pays for inpatient hospital services that are medically necessary for the setting billed and that are coded correctly. Medical documentation will be reviewed to determine that the services were medically necessary and were billed correctly. Completed 11/27/2012

R.J.

4

Monthly Short Stay Medical Necessity - Quarter 1 Holtz High RAC/Reassessment - To review documentation to validate the medical necessity of short stay admissions. Medicare only pays for inpatient hospital services that are medically necessary for the setting billed and that are coded correctly. Medical documentation will be reviewed to determine that the services were medically necessary and were billed correctly. Completed 11/5/2012

R.J.

5

Monthly Short Stay Medical Necessity - Quarter 2 JMH High RAC/Reassessment - To review documentation to validate the medical necessity of short stay admissions. Medicare only pays for inpatient hospital services that are medically necessary for the setting billed and that are coded correctly. Medical documentation will be reviewed to determine that the services were medically necessary and were billed correctly.

TMR

6

Monthly Short Stay Medical Necessity - Quarter 2 JNMC High RAC/Reassessment - To review documentation to validate the medical necessity of short stay admissions. Medicare only pays for inpatient hospital services that are medically necessary for the setting billed and that are coded correctly. Medical documentation will be reviewed to determine that the services were medically necessary and were billed correctly.

CE

7

Monthly Short Stay Medical Necessity - Quarter 2 JSCH High RAC/Reassessment - To review documentation to validate the medical necessity of short stay admissions. Medicare only pays for inpatient hospital services that are medically necessary for the setting billed and that are coded correctly. Medical documentation will be reviewed to determine that the services were medically necessary and were billed correctly.

SP

8

Monthly Short Stay Medical Necessity - Quarter 2 Holtz High RAC/Reassessment - To review documentation to validate the medical necessity of short stay admissions. Medicare only pays for inpatient hospital services that are medically necessary for the setting billed and that are coded correctly. Medical documentation will be reviewed to determine that the services were medically necessary and were billed correctly.

CE

9

Monthly Short Stay Medical Necessity - Quarter 3 JMH High RAC/Reassessment - To review documentation to validate the medical necessity of short stay admissions. Medicare only pays for inpatient hospital services that are medically necessary for the setting billed and that are coded correctly. Medical documentation will be reviewed to determine that the services were medically necessary and were billed correctly.

SP

10

Monthly Short Stay Medical Necessity - Quarter 3 JNMC High RAC/Reassessment - To review documentation to validate the medical necessity of short stay admissions. Medicare only pays for inpatient hospital services that are medically necessary for the setting billed and that are coded correctly. Medical documentation will be reviewed to determine that the services were medically necessary and were billed correctly.

R.J.

11

Monthly Short Stay Medical Necessity - Quarter 3 JSCH High RAC/Reassessment - To review documentation to validate the medical necessity of short stay admissions. Medicare only pays for inpatient hospital services that are medically necessary for the setting billed and that are coded correctly. Medical documentation will be reviewed to determine that the services were medically necessary and were billed correctly.

TMR

12

Monthly Short Stay Medical Necessity - Quarter 3 Holtz High RAC/Reassessment - To review documentation to validate the medical necessity of short stay admissions. Medicare only pays for inpatient hospital services that are medically necessary for the setting billed and that are coded correctly. Medical documentation will be reviewed to determine that the services were medically necessary and were billed correctly.

TMR 13 Transplant - Inpatient Moderate Risk Assessment - To evaluate the inpatient Medicaid transplant program to ensure that we are in compliance to AHCA guidelines.

SP14

OIG- Inpatient Rehabiliation Facilities (IRF) - Appropriateness of Admissions and Level of Therapy

High OIG - Appropriateness of Admissions and Level of Therapy - To examine the appropriateness of admissions to IRFs. To further examine the level of therapy provided in IRFs and how much concurrent and group therapy IRFs provide.

R.J.

15

Clinical Trials High Reassessment - To review Clinical Trial Research billing and modifier usage to ensure it is in compliance with CMS regulations and guidelines. In addition, review that consent forms are completed and submitted to the Clinical Trials Office (CTO) in a timely manner by the Principle Investigator (PI) per JHS policy.

Audits that were identified through the CMS RAC Approved Issues, the OIG Work Plan or AHCAReassessments and by Internal Risk Assessment

Audit SummaryIn ProgressTotal Audits CompletedNot StartedTotal Audits on Plan% of Plan CompletedNew audits added to Original Plan

CORPORATE COMPLIANCE DEPARTMENT - FY 2013 ANNUAL AUDIT PLAN

Definition

1

Total340

567%0


Auditor Audit # Audit Name Risk Assessment Scope & Objectives Status Completion Date




Definition

KP 16 Primary Care Clinic: Jefferson Reaves Moderate Risk Assessment - Review Medicaid documentation, coding and billing for clinic services based on Medicaid guidelines. In Progress

R.J. 17 Primary Care Clinic: North Dade Moderate Risk Assessment - Review Medicaid documentation, coding and billing for clinic services based on Medicaid guidelines.

CE 18 Primary Care Clinic: Rosie Lee Wesley Moderate Risk Assessment - Review Medicaid documentation, coding and billing for clinic services based on Medicaid guidelines.

SP

19

OIG- Payments for Multidose Vials of Drug Herceptin High OIG- To review claims to Medicare for the drug Herceptin, which is used to treat breast cancer, to determine whether the drug was properly billed. For drug claims involving a single-use vial or package, if a provider must discard the remainder of a single-use vial or package after administering a dose/quantity of the drug or biological, Medicare provides payment for the amount discarded along with the amount administered, up to the amount of the drug or biological as indicated on the vial or package label.

In ProgressR.J.

20Pharmacy High RAC - Docetaxel - Dose vs Units Issue: Docetaxel (J9171) represents 1 mg per unit and

should be billed 1 unit for every 1 mg per patient. To ensure appropriate documentation and billing for outpatient hospital services.

CE 21 Evaluation and Management codes for ER Services Moderate Risk Assessment - Review coding and billing services for Medicare and Medicaid patients at Jackson Memorial ER.

AJ

22

Physician Services - Quarter 1 Moderate Risk Assessment - Review professional coding and billing of Medicare and Medicaid billing for items or services not rendered or not provided, submitting claims for services that are not medically necessary or double billing, resulting in duplicate payment.

KP

23

Physician Services - Quarter 2 Moderate Risk Assessment - Review professional coding and billing of Medicare and Medicaid billing for items or services not rendered or not provided, submitting claims for services that are not medically necessary or double billing, resulting in duplicate payment.

SP

24

Physician Services - Quarter 3 Moderate Risk Assessment - Review professional coding and billing of Medicare and Medicaid: billing for items or services not rendered or not provided, submitting claims for services that are not medically necessary or double billing, resulting in duplicate payment.

TMR

25

Physician Services - Quarter 4 Moderate Risk Assessment - Review professional coding and billing of Medicare and Medicaid: billing for items or services not rendered or not provided, submitting claims for services that are not medical necessary or double billing, resulting in duplicate payment.

KP 26 AHCA - Prescribed Pediatric Extended Care (PPEC) High AHCA: Review program coding and billing to ensure compliance with Florida Medicaid guidelines.

AJ 27 Laboratory services High OIG - Review the appropriate use of Advanced Beneficiary Notices (ABN) for laboratory services for Medicare beneficiaries.

LM28

HIPAA/Privacy: Same Name Audit - Quarter 1 Low Risk Assessment: Review employees access in Cerner when they access an account that has the same name as their own, which is in violation of JHS PHI Policy.

LM29

HIPAA/Privacy: Same Name Audit - Quarter 3 Low Risk Assessment: Review employees access in Cerner when they access an account that has the same name as their own, which is in violation of JHS PHI Policy.

2

Total340

567%0






Definition

LM 30 HIPAA/Privacy: Employee Acess Threshold - Quarter 1 Moderate Risk Assessment: Track employees access based on their assigned Cerner roles, which allow access to the application, in order to identify potential security issues.




LM 34 HIPAA/Privacy Security High Risk Assessment: Review employee process in logging out of applications on clinical units when away from their area.

LM35

BAA review with focus on Health Plan, Mental Health and International Program

Moderate HIPAA/Privacy Audit - To ensure that where a business associate agreement is required one would have been executed along with the underlying contract and that we are in compliance with JHS policies and procedures.

JD 36 Medical Directorship Contracts High Risk Assessment: Review existing Medical directorship contracts to ensure proper (updated) Fair Market Value analysis exist for each.

JD 37 Medical Directorship Contracts Moderate Risk Assessment: Review the timeliness of the submission of timesheets to ensure compliance with Jackson Health System Policy # 283.

RB 38 Maternal Fetal Service - Quarter 1 High Risk Assessment : To review the medical documentation, coding and billing of services provided by the Maternal Fetal Service Line. In Progress

RB 39 Maternal Fetal Service - Quarter 2 High Risk Assessment : To review the medical documentation, coding and billing of services provided by the Maternal Fetal Service Line.

AJ 40 Modifiers Moderate Risk Assessment: Review the use of modifiers being utilized to ensure proper usage according to CMS Medicare and Medicaid guidelines.

CE

41

Hospital to Hospital Transfers High RAC/Re-assessment - To review inpatient hospital stay discharges for accurate reporting whether patient is discharged to home or transferred to another facility (SNF, IRF, or home health) or left against medical advice (and was later admitted to another facility on same day of discharge) where the inpatient hospital claim from the transferring facility falls under the post-acute transfer policy. According to the Post Acute Transfer policy, the transferring facility should be reimbursed on a per-diem basis (up to the DRG full payment), while the receiving facility receives the full DRG or respective PPS reimbursement. All DRGs being reviewed are available in the Post Acute Transfer Policy.

CE

42

Inpatient - Interrupted Inpatient Psychiatry Facilities (IPF) Moderate Re-assessment - To review IPFs Mental Health claims for Medicare reimbursement in cases of transfers from IPFs to the same or other IPFs. To ensure that IPFs do not discharge and then re-admit patients and obtain per diem payments with higher adjustments. Interrupted stays in which a patient is discharged and then re-admitted to the same or another IPF within 3 days following the discharge will be treated as one continuous stay.

R.J.43

OIG - Payments for Canceled Surgical Procedures High OIG - Payments for Canceled Surgical Procedures - To review Medicare claims for inpatient stays where the canceled procedure was the principal reason for the initial hospital admission.

AJ

44

OIG - Partial Hospitilization Program (PHP) High OIG - Partial Hospitalization Program - Review the appropriateness of Medicare payments for PHP psychiatric services in hospital outpatient departments and freestanding community mental health centers. To determine whether the payments met Medicare requirements. This review will focus on whether payments met Medicare requirements on the basis of documentation supporting the services, including patient plans of care and physician supervision and certification requirements.

KP 45 OIG - Medicare Dual Eligible High OIG - Medicare Dual Eligible - Ensure that inpatient deductible payments from Medicaid were appropriately made for dual-eligible beneficiaries.

R.J. 46 Advance Beneficiary Notice (ABN) Review High Re-assessment - To determine if Medicare beneficiaries are provided with timely ABN notices for non-covered Medicare services.

KP/AJ47

Medicare Secondary Payer (MSP) Review High Re-assessment - To determine if the online MSP questionnaire utilized by the hospital is compliant with the rules and regulations set forth by CMS for the solicitation of MSP information from the beneficiary.

TMR48

Rehab Audit Outpatient Moderate Risk Assessment - As per CARF (Commission on Accreditation and Rehabilitation) requirements, an audit will be performed to evaluate outpatient rehabilitation services to ensure documentation supports billing appropriateness.

R.J.

49

AHCA - Emergency Medicaid for Undocumented Patients - Quarter 1

High AHCA - To evaluate emergency services provided to undocumented patients who meet all Medicaid eligibility requirements except for citizenship or alien status. Eligibility can be authorized only for the duration of the emergency. Medicaid will not pay for continuous or episodic services after the emergency has been alleviated. The focus of this audit will be patients who have been admitted as inpatient.

TMR

50



3

Total340

567%0






Definition

CE

51



SP

52



RB

53



SP

54

Long Term Care Hospital High RAC - Medicare pays for inpatient hospital services that are medically reasonable and necessary for the setting billed. Medical documentation will be reviewed to determine that services were medically reasonable and necessary. The beneficiary must demonstrate signs and/or symptoms severe enough to warrant the need for hospital-level medical care and must receive services of such intensity that they can be furnished safely and effectively only on an inpatient basis.

CE55

Observation Services - Quarter 1-2 Moderate Risk Assessment - Review Medicare and Medicaid patients in an observation status to ensure that they did not meet inpatient criteria or other outpatient criteria based on the medical documentation.

SP56

Observation Services - Quarter 3-4 Moderate Risk Assessment - Review Medicare and Medicaid patients in an observation status to ensure that they did not meet inpatient criteria or other outpatient criteria based on the medical documentation.

4

2 (b) Review of Finalized Audit Reports

OFFICE OF COMPLIANCE Jackson Medical Towers, Suite # 102

1500 NW 12 Ave Miami, Florida 33136-1094

305-585-2902

Compliance Audit Report November 29, 2012 Audit Name: #2 Short Stay Medical Necessity – Quarter 1 – Jackson North Medical

Center (JNMC) Scope: RAC/Reassessment: To review documentation to validate the medical necessity of short stay admissions. Medicare and Medicaid only pays for inpatient hospital services that are medically necessary for the setting billed and that are coded correctly. Medical documentation will be reviewed to determine that the services were medically necessary and were billed correctly. Per 59G-1.010 (166), F.A.C., medically necessary or medical necessity means that the medical or allied care, goods, or services furnished or ordered must be:

Necessary to protect life, to prevent significant illness or significant disability, or to alleviate sever pain;

Individualized, specific, consistent with symptoms or confirmed diagnosis of the illness or injury under treatment, and not in excess of the recipient’s needs;

Consistent with generally accepted professional medical standards as determined by the Medicaid program, and are not experimental or investigational;

Reflect the level of services that can be safely furnished, and for which no equally effective and more conservative or less costly treatment is available statewide; and

Furnished in a manner not primarily intended for the convenience of the recipient, the recipient’s caretaker, or the provider.

The fact that a provider has prescribed, recommended, or approved medical or allied care, goods, or services do not, in itself, make such care, goods or services medically necessary or a covered service. Methodology: Thirty (30) paid Medicaid and Medicare primary encounters were extracted from the universe of inpatient encounters for JNMC with a length of stay of one to three (1-3) days, ranging from admission dates of 6/1/2012 through 6/30/2012. The following documentation was viewed: the corresponding UB04 billed to the payer, the 835 electronic remittance advices, and the patient detail bills from Siemens EDM. Cerner PowerChart was used to verify clinical documentation and orders according to the services that were billed on the UB04; Siemens Invision and MedAssets Contract Manager were used to validate the adjustments per the payer contract. AllScripts was used to ensure medical necessity was appropriate (using InterQual criteria) for the setting that was actually charged and billed to the payer; Cerner PM Office was used to check registration accuracy and Siemens EDM to check registration forms were completed.

Relevant Regulations, Policy and Procedures and Standard Operating Procedures: JHS Admission & Disposition in the Extended Stay/23hour Observation unit

Policy # 217 JHS Patient Flow in OB Triage Policy # 500.01 JHS Case Management Protocol Policy # 287 JHS Adult ED Admissions Policy # 400.112 JHS Elective Admission Policy # 128 100-02 Medicare Claims Processing Manual: Chapter 1 CMS Publication 100-08

Medicare Program Integrity Manual Results: Total Payments $ 178,903.75 Total Potential Overpayment $ 19,995.80 Medicare Potential Overpayment $ 7,050.25 Medicaid Potential Overpayment $ 12,945.55 Payment Error Rate 11% Findings: Based on the 30 samples reviewed, the Compliance department noted the following:

Encounters number 1, 2, 16, 20 and 26: all admitted as inpatient, but did not meet

InterQual criteria for inpatient setting based on the medical documentation. The result is a Medicare overpayment amount of $7,050.25 and a Medicaid overpayment amount of $12,945.55 for a total overpayment amount of $19,995.80.

Recommendations:

The continuing development and implementation of a clinical training program regarding compliance to Medicare and Medicaid policies for clinical documentation, as well as the importance of a signed physician admission order.

Review of the Case Management Protocol for admissions at all admission points throughout the facility to identify areas for improvement and training needs and reduce the risk of assigning a patient to the in proper level of service.

Implement 100% review of all patients who are admitted as inpatient or placed in observation to ensure that the patients are in the appropriate setting per the physician order.

Ensure that Non-CPOE documentations are legible, clear, dated and signed in compliance with CMS regulations.

Corrective Action Plans/Process Improvements: Due to common elements identified at all facilities, corrective action plan (CAP) efforts to continue re-evaluation and monitoring of the current admission process has been combined to a single system wide effort with designees from all areas. The CAP will address the following common elements, including but not limited to: daily reports from IT of admission orders that require authentication, additional Interqual and case management protocol orientation, system issues related to physician in-boxes, testing functionality in Cerner for flagging

patients requiring further case management involvement, and review of admission handoff process. Managers’ Response: JNMC agrees with the findings of Corporate Compliance and will work with the Corrective Action Plan areas to identify and correct areas that are at risk for the inpatient admission and observation process. Our goal is to be compliant with the regulatory agencies that govern our facility, ensure the appropriate level of care of our patients, and reduce the risk of exposure the Health System to pre-payment and post-payment reviews.

OFFICE OF COMPLIANCE Jackson Medical Towers, Suite #102


305-585-2902

Compliance Audit Report November 27, 2012

Audit Name: #3 Short Stay Medical Necessity – Quarter 1 - Jackson South Community Hospital (JSCH) Scope: RAC/Reassessment: To review documentation to validate the medical necessity of short stay admissions. Since Medicare and Medicaid only pay for inpatient hospital services that are: 1) medically necessary for the setting billed, and 2) coded correctly, this audit will review medical documentation to determine whether the services performed were: 1) medically necessary and 2) billed correctly. Specifically pertaining to Florida Medicaid: Per 59G-1.010 (166), F.A.C., medically necessary or medical necessity means that the medical or allied care, goods, or services furnished or ordered must be:






The fact that a provider has prescribed, recommended, or approved medical or allied care, goods, or services do not, in and of itself, make such care, goods, or services medically necessary or a covered service. Methodology: Thirty (30) paid Medicare and Medicaid primary encounters were extracted from a universe of inpatient encounters for JNMC with a length of stay of one to three (1-3) days, ranging from dates of service of 06/01/2012 to 06/30/2012. The following documentation was collected and reviewed: the corresponding UB04 billed to the payer; the 835 electronic remittance advices; and the patient detail bills from Siemens EDM. The following applications were used to verify and validate the documentation: Cerner PowerChart was used to verify clinical documentation and orders according to the

services that were billed on the UB04; Siemens Invision and MedAssets Contract Manager were used to validate the adjustments per the payer contract; AllScripts was used to ensure medical necessity was appropriate (using InterQual criteria) for the setting that was actually charged and billed to the payer; Cerner PM Office was used to check registration accuracy; and Siemens EDM was used to check that the registration forms were completed. Relevant Regulations, Policy and Procedures and Standard Operating Procedures:

JHS Admission & Disposition in the Extended Stay/23hour Observation unit Policy # 217

JHS Patient Flow in OB Triage Policy # 500.01 JHS Case Management Protocol Policy # 287 JHS Adult ED Admissions Policy # 400.112 JHS Elective Admission Policy # 128 100-02 Medicare Claims Processing Manual: Chapter 1 CMS Publication 100-08

Medicare Program Integrity Manual Results: Total Payments $237,116.34 Total Potential Medicaid Overpayment $ 15,534.66 Payment Error Rate 7% Findings/Observations:

Encounter number 16 did not meet intensity of service and severity of illness for an inpatient admission. The patient would have been better served in an observation setting; this resulted in an overpayment amount of $2,589.11.

Encounter number 24 did not meet intensity of service and severity of illness for inpatient admission. The patient would have been better served in an observation status; this resulted in an overpayment amount of $7,767.33.

Encounter 25 met severity of illness, but not intensity of service. The patient would have been better served as an observation status; this resulted in an overpayment amount of $5,178.22.

Recommendations:



Implement 100% review of all patients who are admitted as inpatient or placed in observation to ensure that the patients are in the appropriate setting per Interqual or other applicable criteria and consistency with the physician order.

Corrective Action Plans/Process Improvements: Due to common elements identified at all facilities, corrective action plan (CAP) efforts to continue re-evaluation and

monitoring of the current admission process has been combined to a single system wide effort with designees from all areas. The CAP will address the following common elements, including but not limited to: daily reports from IT of admission orders that require authentication, additional Interqual and case management protocol orientation, system issues related to physician in-boxes, testing functionality in Cerner for flagging patients requiring further case management involvement, and review of admission handoff process. Manager’s Response: Jackson South agrees with the findings of Corporate Compliance and will work with the Corrective Action Plan areas to identify and correct areas that are at risk for the inpatient admission and observation process. Our goal is to be compliant with the regulatory agencies that govern our facility, ensure the appropriate level of care of our patients, and reduce the risk of exposure the Health System to pre-payment and post-payment reviews.

OFFICE OF COMPLIANCE Jackson Medical Towers, Suite #102


305-585-2902

Compliance Audit Report

November 5, 2012 Audit Name: #4 Short Stay Medical Necessity – Quarter 1 - Holtz Children’s Hospital (Holtz) Scope: RAC/Reassessment: To review documentation to validate the medical necessity of short stay admissions. Medicaid only pays for inpatient hospital services that are medically necessary for the setting billed and that are coded correctly. Medical documentation will be reviewed to determine that the services were medically necessary and were billed correctly. Per 59G-1.010 (166), F.A.C., medically necessary or medical necessity means that the medical or allied care, goods, or services furnished or ordered must be:






The fact that a provider has prescribed, recommended, or approved medical or allied care, goods, or services do not, in itself, make such care, goods or services medically necessary or a covered service. Methodology: Thirty (30) paid Medicaid primary encounters were extracted from a universe of inpatient encounters for Holtz with length of stay of one to three (1-3) days, ranging from dates of service 06/01/2012 to 06/30/2012. The following documentation was viewed: the corresponding UB04 billed to the payer, the 835 electronic remittance advices, and the patient detail bills from Siemens EDM. Cerner PowerChart was used to verify clinical documentation and orders according to the services that were billed on the UB04; Siemens Invision and MedAssets Contract Manager were used to validate the adjustments per the payer contract. AllScripts was used to ensure medical necessity was appropriate (using InterQual criteria) for the setting that was actually charged and billed

to the payer; Cerner PM Office was used to check registration accuracy and Siemens EDM to check registration forms were completed. Relevant Regulations, Policy and Procedures and Standard Operating Procedures:

JHS Admission & Disposition in the Extended Stay/23hour Observation unit Policy # 217

JHS Patient Flow in OB Triage Policy # 500.01 JHS Case Management Protocol Policy # 287 JHS Adult ED Admissions Policy # 400.112 JHS Elective Admission Policy # 128 100-02 Medicare Claims Processing Manual: Chapter 1 CMS Publication 100-08

Medicare Program Integrity Manual Results: Total Payments $171,071.26 Total Potential Medicaid Overpayment $ 23,391.99 Payment Error Rate 14% Findings/Observations:

Encounter #3, the patient was admitted to inpatient and did not meet InterQual criteria for inpatient setting. Electronic admit to inpatient order requested on 06/01/2012 at 02:21 am, electronic admit to observation order request at 02:56 the same day. Account should have been billed as outpatient. This resulted in an overpayment of $2,589.11.

Encounter #7, the patient was admitted to inpatient and did not meet InterQual criteria for inpatient setting. This resulted in an overpayment of $2,589.11.

Encounter #21, the patient was admitted to inpatient and did not meet InterQual criteria for inpatient setting. Electronic admit to inpatient activated (authenticated) by attending physician two (2) days after the initial request. This resulted in an overpayment of $2,589.11.

Encounter #9, the patient was admitted to inpatient without valid physician order. Electronic admit to inpatient order activated by attending physician four (4) days after the initial request. No written admit to inpatient order in the medical record. This resulted in an overpayment of $5,178.22.

Encounter #27, the patient was admitted to inpatient without a valid physician order. Electronic admit to inpatient order activated by attending physician two (2) days after it was requested. No written admit to inpatient order. This resulted in an overpayment of $2,589.11

Encounter #29, the patient was admitted to inpatient without a valid physician order. Electronic admit to inpatient order not activated by attending physician. No written admit to inpatient order. This resulted in an overpayment of $7,767.

Recommendations:



Implement 100% review of all patients who are admitted as inpatient or placed in observation to ensure that the patients are in the appropriate setting per InterQual or other applicable criteria and consistency with the physician order.

Corrective Action Plans/Process Improvements: Due to common elements identified at all facilities, corrective action plan (CAP) efforts to continue re-evaluation and monitoring of the current admission process has been combined to a single system wide effort with designees from all areas. The CAP will address the following common elements, including but not limited to: daily reports from IT of admission orders that require authentication, additional InterQual and case management protocol orientation, system issues related to physician in-boxes, testing functionality in Cerner for flagging patients requiring further case management involvement, and review of admission handoff process. Manager’s Response: Holtz Children’s Hospital agrees with the findings of Corporate Compliance and will work with the Corrective Action Plan areas to identify and correct areas that at risk for the inpatient admission and observation process. Our goal is to be compliant with the regulatory agencies that govern our facility, ensure the appropriate level of care of our patients, and reduce the risk of exposure the Health System to pre-payment and post-payment reviews.

1

INTERNAL AUDIT - FY13 AUDIT PLAN

Risk Level Audit Summary TotalHigh

In Progress 5Medium

Total Audits Completed 0Low Not Started 22

Total Audits on Plan 27% of Plan Completed 0%New audits added to Original Plan 0

Audit # Audit Name Risk Assessment Status Completion Date

1 Patient Referrals mediumfieldwork in process

2External Audit Assistance n/a

fieldwork in process

3

Community Health, Inc. (CHI) low

planning in process

4Change Management (Patch Management) medium

fieldwork in process

5 Perdue Medical Center & Long Term Care Center - operational/clinical process audit

mediumfieldwork in process

6

Cash Audit medium

7Patient Intake - JMH Main Operating Room, Holtz and Women's Health Center

high

8

Contractual and Purchased Services Management - JHS Executive Office

medium

9

Inventory & Supply Control - JMH Ambulatory Care Pharmacy and Transfusion Services

medium

10Equipment Management - Core System Maintenance

medium Evaulate effectiveness of controls surrounding management of IT equipment.

Assess internal controls related to storing, warehousing, and the safeguarding of inventory supplies, determine if inventories are subject to effective custodial accountability procedures and physical safeguards. Determine if appropriate segregation of duties exists.

Review contract management process to determine if contracts exist for services, proper procurement processes were followed, and effectiveness of payment controls.

Determine completeness, accuracy and efficiency of the revenue cycle process by assessing patient care process controls.

Identify risks associated with cash collection processes and practices unique to JHS' cashier function, determine if controls adequately mitigate identified risks, determine if cash is properly safeguarded and adequate segregation of duties exist.

Evaluate internal controls related to long term care facilities.

Evaluate effectiveness of controls surrounding the patch management software.

Review contract/agreement management process to determine compliance with contract, proper procurement processes were followed and effectiveness of payment controls.

On an annual basis, provide 800 hours audit assistance to KPMG.

Perform an analysis of patients referred from JHS to UM from 2008 - 2012.

as of 11/30/12

Impact to company's financial statements is considered material; non-financial risk, such as patient outcome and visibility, is considered high. Other considerations include significant change in associated management and/or process, and prior internal or external audit findings.Process impact to company's financial statements may be material; other risk as described above is considered less significant.

Definition

Minimal risk to organization from either a financial or operational risk.

Scope & Objectives

2

Audit # Audit Name Risk Assessment Status Completion DateScope & Objectives

11System Development Process high

12 Community Mental Health low

13

Inventory & Supply Control - Jackson North, Jackson South

medium

14

Jackson Health Plan low

15Clinical Services - JMH Radiology and Respiratory Therapy

medium

16Payroll high

17

Contractual and Purchased Services Management - Jackson South

medium

18Omnicell high

19 Security & Privacy medium20 Annual Operating Agreement Review - UM medium

21External Audit Assistance n/a

22Registration and Admissions - Inpatient/Siemens/Cerner application audit

high

23Physical Inventory Count Observation medium

24

Contractual and Purchased Services Management - Jackson North

medium

25KRONOS application audit high

26Audit Follow-up n/a

27Jackson Health Plan - Fraud & Abuse low


Review and evaluate the adequacy of internal controls surrounding payroll processes.

Determine completeness, accuracy and efficiency of the revenue process by assessing patient care process controls.

Assess effectiveness and efficiency of the department's operation/financial processes as relates to compliance with established internal/regulatory policies and procedures.

Assess internal controls related to storing, warehousing, and the safeguarding of inventory supplies, determine if inventories are subject to effective custodial accountability procedures and physical safeguards. Determine if appropriate segregation of duties exists.

Verify accuracy of capturing patient information and insurance verification; to include Siemens/Cerner related controls review.

On an annual basis, provide 200 hours audit assistance to KPMG.

Determine compliance with terms of AOA.HIPPA Part II "Privacy Rule".

Determine effectiveness of controls surrounding Omnicell management.

Examine, investigate, and analyze data for the purpose of assessing compliance with various segments of PHT/JMH policies and procedures.

Perform follow-up review of prior year's audit findings to ensure corrective action is completed as stated and adequate.

Observe annual physical inventory count to determine adequacy of procedures.


Evaluate the effectiveness of controls over the timekeeping system.

General controls review of stand alone function.

Review new/upgrade system implementation process to include project team selection, planning, management, testing, etc.

3 (b) Review of Finalized Audit Reports

Office of Internal Audit Jackson Medical Towers

1500 NW 12th Avenue, #102 Miami, FL 33136

To: Carlos A. Migoya, President and Chief Executive Officer

Don S. Steigman, Executive Vice President and Chief Operating Officer

Cc: Mark T. Knight, Executive Vice President and Chief Financial Officer

Jeff Crudele, Executive Vice President and Chief Strategy Officer

Rosa Costanzo, Vice President of Strategic Sourcing & Supply Chain

Alex Contreras, Chief Administrative Officer – JMH

Venessa Price, Director of Pharmacy - JMH

Sandy Sears, Chief Administrative Officer – JNMC

Martha Garcia, Chief Administrative Officer – JSH

Steve Weimer, Corporate Director of Internal Audit

From: Andre Reid, Internal Audit Manager

Date: November 26, 2012

Subject: Final Report – Maxor OP Pharmacy Services Audit ao 10/03/12

Background, Scope and Objective: Jackson Health System (“JHS”) entered into a 4 year agreement with Maxor National Pharmacy

Corporation (“Maxor”) in October 2010 to provide Out-Patient (“OP”) pharmacy management service to

JHS. The purpose of the agreement is to improve the profitability of the JHS retail pharmacy by

decreasing costs, optimizing collections and increasing revenue by expanding the funded patient business.

As part of the contract Maxor provided significant technological upgrades, remodeling of facilities, an

accounts receivable program, contracting, and on-site/remote management support with expertise in the

retail pharmacy business.

Performance standards were established for patient satisfaction, wait-time studies, and net profit

(“baseline”) to measure Maxor’s annual performance. Annual management fee to Maxor is $1.1 M with

an additional 20% shared savings in excess of the management fee.

Based on IA’s assessment of risk and materiality, we reviewed and assessed the effectiveness of

management controls in the OP pharmacy, compliance with the contractual agreement, satisfactory levels

of financial and operational performance.

Rating Based on Issues Identified: Needs Improvement

Executive Summary: Numerous issues were noted regarding lack of finance review/approval of financial transactions, lack of

surveillance coverage in the ACC Pharmacy / Central Fill Pharmacy, transportation of unsecured cash,

and lack of cycle counts being performed for pharmaceutical meds.

Our detailed observation(s) are outlined below.

2

Detailed Observations, Recommendations and Management Action Plans:

1. Lack of review and approval by Finance

A review of collections, expenses, and invoice payments is not performed by Finance personnel for

completeness and accuracy; review and approval is only performed by the Associate Director of

Pharmacy (no material errors were noted during IA review of financial transactions).

We recommend that the Project Manager coordinate with the Associate CFO to review all financial

related documents per the Maxor OP Pharmacy Management Service Agreement.

Management Response: Agreed

The Pharmacy Project Manager will coordinate with the Associate CFO or designee to review all

financial related documents.

Action Plan Owner: Implementation Date:

Venessa Price, Director of Pharmacy December 2012

2. Cash is not adequately safeguarded (Repeat finding – FY11 Cash Collections Audit)

Employee transporting of cash is unsecured. This observation was previous identified in the Cash

Collections Audit conducted at JMH in May 2011. Cash from the ACC Pharmacy average $4.5K

daily is delivered to the main banking center by employees, without a security escort.

We recommend that management coordinate with security to have cashiers escorted at all times when

delivering cash to the main banking center.

Management Response:

None required – corrected during audit.


Venessa Price, Director of Pharmacy October 2012

3. Lack of video surveillance coverage in ACC Pharmacy and Central Fill Pharmacy

There is no video surveillance coverage in the ACC Pharmacy and Central Fill Pharmacy to monitor

activity for the handling (filling) of pharmaceutical meds and the cashiering functions.

We recommend that management install cameras to monitor the handling of pharmaceutical meds and the

cashiering functions.


The Director of Pharmacy has met with the vendor proposed by JMH Security. A plan and invoices have

been prepared for cameras in the ACC Pharmacy and Central Fill Pharmacy. The plan and invoices have

been submitted to Hospital leadership for approval. The vendor indicates that the job will be completed

within 30 days of receipt of the authorization to proceed (PO).


3

Venessa Price, Director of Pharmacy January 31, 2013

4. Cycle counts are currently not performed for pharmaceutical meds

It was identified that the GuardianRx System inventory management module is not fully implemented.

The system does not have established inventory turns and par-levels for supplies. As a result, par levels

might not be appropriate, resulting in either over/under stock inventory levels. In addition, periodic cycle

counts of the ACC Pharmacy pharmaceutical meds are not performed.

We recommend that the project manager coordinate with Maxor to fully implement the inventory

management module in the GuardianRX System, perform periodic cycle counts, and establish par-levels

based on turns.

Management Response: Agreed.

An inventory control system that includes medication par levels and periodic cycle counts will be

implemented in JHS Retail Pharmacies. Current Guardian inventory monitoring capability consists of a

perpetual inventory adjustment established by continuous replenishment due to order management,

dispensing and sales. This will result in a minimum of 12 inventory turns per year. In the Central Fill

Pharmacy location, the Guardian inventory management system had previously been implemented to

maintain a record of inventory purchases and dispenses. In addition, in that area, the Guardian system is

further augmented by perpetual inventory control system maintained by the Optifill robot. Sixty-six

percent of the total outpatient pharmacy prescriptions are filled from that location. In the ACC Pharmacy

location, for over a year, high cost and controlled substances have been stored in an Omnicell machine

that assures a perpetual inventory of those medications. A full count of all high cost and controlled

substance medications within the Omnicell is performed monthly. A baseline inventory count with

subsequent quarterly cycle counts will be performed by the end of March 2013. Par levels will be

established maximized by utilization reports. Quarterly reports will be kept on file for review upon

request and emailed electronically to the Pharmacy Project Manager.


Venessa Price, Director of Pharmacy April 1, 2013

5. Lack of formal documentation or amendment for exclusion of Segall inflation factor

It was noted that the FY11 annual shared savings analysis should have included an expensed inflation

factor provided by Segall. Review of supporting documentation for the 20% shared savings payment to

Maxor revealed the inflation factor was not included.

We recommend that management obtain formal documentation/amendment from Maxor excluding the

Segall inflation factor for drug expense.


The Chairman of the Board of Maxor verbally agreed that the inflation factor established in the contract

would not be applied in year 1 saving JMH over $180,000. This agreement will be codified in the

contract amendment soon to be signed.


4

Venessa Price, Director of Pharmacy January 1, 2013

Jackson Health SystemPrior Audit Report Follow‐Up

December 2012

12/7/2012

Audit Audit Report Dated Original # of Comments Follow‐up Exceptions Noted Corrected during Audit? Exception RatioAccounts Payable Review FY12 4 0 n/a 0%Agency Staffing FY11 3 0 n/a 0% Property Lease Audit FY11 2 0 n/a 0%JMH Emergency Room Admissions FY12 3 1 no 33%Jackson Initiatives FY12 1 1 no 100%

Audit Original Finding Original Target Date Follow‐up Finding Revised Target DateResponsible

AreaJMH Emergency Room Admissions Cerner inappropriate access exists

Internal Audit identified employees withinappropriate access to privileged patient information within Cerner:

• 571 of 870 (65%) individuals tested with inappropriate JMH production access.

6/30/2012 Management has been working proactively with IT to review user access to the Cerner registration conversations on a weekly rather than quarterly basis. The last review was completed on November 26th which listed several users whose access roles had to be reassigned.

There is a continuous weekly meetings with IT to review the 36 Cerner access role profiles; to date, 19 profiles (53%) have been reviewed and updated. New target date for completion of the remaining 17 (47%) profiles is now February 2013.

In addition, all requests for access to registration conversations must be approved by Patient Access effective November 12, 2012.

2/28/2013 Carmen Pla‐ VP Revenue Cycle

Michael Garcia, CIO

Jackson Initiatives Audit Performance Logic has been designated and implemented as the system to track and manage all initiative projects. However, several issues were noted with the projects entered into the system –1. A system owner does not exist; and as a result, a lack of a standardized method of entering and updating information in the system did not exist making it difficult to determine the status of many of the ongoing projects via the system. 2. Project labor costs (labor expended outside normal job requirements) were not documented in the system; as a result, project expense was not completely captured or tracked. 3. The only “Quality” initiated projects tracked in the system are ones with IT components. 4. Numerous projects identified as Sustainable Jackson in the system project plans were not updated and/or closed. System Change Impact process requirements need improvement, The "system change impact” on the process or department was not always quantified.

8/31/2012 1 a. We have developed a standard project request form which requires a business case, and stakeholder approval before any resources are assigned and project is initiated.b. We have developed a ranking methodology in order to help prioritize projects based on organization’s needs. This process should help focus resources on priority projects.c. The executive reports are being developed in order to ensure executive oversight, which will reinforce accountability and drive timely status updates. Will be developed by January 2013.2. We are simplifying the labor cost requirements in order to capture time spent on the project by the immediate implementation team (PM, Business Analyst and the SME’s). 3.The "Quality" projects are now reflected in Performance Logic.4. Majority of the Sustainable Jackson Projects statuses have been updated with a final 2012 year end status, and archived. Several ongoing projects have been re‐assigned to the appropriate division to continue monitoring (eg. LOS, CMI, Labor and Productivity).the compliance of Performance Logic.

1/31/2012 Mike Garcia ‐ VP CIO

Mehmet Ahmet ‐ Director ‐ Project

Mgmt, Kevin Andrews ‐ Vice

President ‐ Quality

4. JMH Health Plan Preliminary CMS Audit Report

From: Robinson, Jessica (CMS/CM) [mailto:[email protected]] Sent: Friday, November 30, 2012 3:21 PM To: Baar, John P Cc: Holmes, Tawanda (CMS/CM); Blanar, Jonathan R. (CMS/CM); Young, Joann (CMS/CM); Robinson, Jessica (CMS/CM); Foltz, Lisa C. (CMS/CMHPO) Subject: Public Health Trust of Miami-Dade County - Notification of Immediate Corrective Action Required Importance: High Mr. Baar, CMS conducted an on-site and webinar audit of Public Health Trust of Miami-Dade County operations which began on Monday, November 5, 2012 and concluded on Friday, November 9, 2012. The audit revealed that Public Health Trust of Miami-Dade County is non-compliant with Part C organizational determinations, appeals, grievances, dismissals, and Part C Access to Care and these issues require immediate corrective action. The audit resulted in what CMS considers to be egregious findings that have the potential to cause significant beneficiary harm. We discussed these issues with you during the audit, and at the exit conference, and requested that these issues be corrected. Public Health Trust of Miami-Dade County needs to understand how serious we consider these issues and our expectations for immediate resolution to ensure no further beneficiary harm occurs (i.e. immediately stop inappropriate action and/or initiate manual intervention). CMS is requiring Public Health Trust of Miami-Dade County to implement immediate corrective actions to address the deficiencies outlined below within 72 hours by, Monday, December 3, 2012 at 5pm EST. Public Health Trust of Miami-Dade County must provide an explanation via email (within the 72 hours) as to how Public Health Trust of Miami-Dade County immediately stopped beneficiary harm, and the potential for significant beneficiary harm, how sponsor will implement long term correction for each issue and by when, and how Public Health Trust of Miami-Dade County will prevent them from recurring. Specifically, we require the following: Immediate Corrective Action Request – Deficiency #1 PHT does not have sufficient personnel and systems for the MA organization to organize, implement, control and evaluate the furnishing of services and the administrative and management aspects of the organization in violation of 42 CFR 422.503(b)(ii). Immediate Corrective Action Required

PHT must provide to CMS a plan of action as well as a timeline to ensure that PHT has the appropriate staffing level as well as management oversight to administer the Medicare Advantage Program in the area of Part C Organization Determinations, Appeals, Dismissals, Grievances and Part C Access to Care.

PHT must provide to CMS a plan of action as well as a timeline to ensure that PHT has the appropriate systems capabilities as well as management oversight to administer the Medicare Advantage Program in the area of Part C Organization Determinations, Appeals, Dismissals, Grievances and Part C Access to Care.

PHT must develop and provide to CMS an action plan and timeline to develop and implement internal policies and procedures to ensure compliance with CMS requirements in the areas of Part C Organizational Determinations, Appeals, Dismissals, Grievances and Part C Access to Care. In addition, PHT must provide a timeline to train staff on the newly developed policies and procedures.

DEFICIENCIES IN PART C ORGANIZATIONAL DETERMINATIONS, APPEALS, GRIEVANCES, AND

PART C ACCESS TO CARE

Organizational Determinations and Reconsiderations Immediate Corrective Action Request – Deficiency #1:

Public Health Trust (PHT) failed to process pre-service organization determinations and plan reconsiderations within the required adjudication timeframes in violation of 42 CFR 422.568(a), and 422.590(a-c), including expedited, pre-service cases, posing a serious risk of potential harm to beneficiaries. Immediate Corrective Action Required: PHT must immediately begin processing organization determinations and plan reconsiderations within the required adjudication timeframes. Immediate Corrective Action Request – Deficiency #2: PHT failed to process cases as expedited despite a physician’s request to expedite a coverage decision in violation of 42 CFR 422.570(c)(2)(ii) and 422.584(c)(2)(ii). Also see 42 CFR 422.570(c)(2)(ii) and 422.590(c)(2)(ii). Immediate Corrective Action Required: PHT must process an OD or appeal as expedited, if a physician has made or supported a request for a coverage decision (OD or reconsideration) and has indicated that the request is urgent (or any equivalent term). Immediate Corrective Action Request – Deficiency#3: PHT did not prepare a written explanation and send the case file to the independent entity contracted by CMS, within 60 calendar days from the date it received the request for a standard reconsideration, when it made a determination that affirms, in whole or in part, its adverse organization determination in violation of 42 CFR §422.590(b)(2).

Immediate Corrective Action Required: PHT must prepare a written explanation and send the case file to the independent entity contracted by CMS within 60 days from the date it received the request for a standard reconsideration when it has affirmed, in whole or in part, its adverse organization determination. Immediate Corrective Action Request – Deficiency#4: PHT is routinely processing requests from enrollees as inquiries or grievances, instead of ODs or appeals in violation of 42 CFR 422.566(c) and 422.578, delaying access to care, exposing enrollees to potential financial liability and/or denying enrollees access to the appeals process. Required Corrective Action:

PHT must immediately implement procedures to properly identify and process requests from enrollees for ODs and appeals.

PHT must review all grievances received by PHT within the last 6 months. Any grievances determined to be a request for an organization determination or appeal must be reprocessed accordingly and the enrollee immediately notified.

Immediate Corrective Action Request – Deficiency#5: PHT does not notify the enrollee of its determination expeditiously as the members health condition warrants or no later than no later than 14 calendar days after the date the plan received the request in violation of 42 CFR § 422.568(a) and The Medicare Managed Care Manual, Chapter 13, Section 40.1. Immediate Corrective Action Required: PHT must immediately begin notifying enrollees of their determination with the appropriate timeframes. Immediate Corrective Action Request – Deficiency#6: PHT’s notice of any denial does not state the specific reasons for the denial with enough information for the enrollee to understand the reason the request was denied in violation of 42 CFR § 422.568(e)(2) and The Medicare Managed Care Manual, Chapter 13, Section 40.2.2 Immediate Corrective Action Required:

PHT must immediately correct their denial notices to clearly include the reasons for denial with enough information that the member can understand the reason the request was denied. Immediate Corrective Action Request – Deficiency#7: PHT imposes authorization restrictions for emergency medical services and the resulting admission to the hospital in violation of the Medicare Managed Care Manual, Chapter 4, Section 20.3. Immediate Corrective Action Required: PHT must immediately stop imposing authorization restrictions for emergency medical services (ER room and Inpatient admissions through ER). Immediate Corrective Action Request – Deficiency#8: PHT does not use Medicare criteria (including regulatory and manual guidance or national and local coverage determinations) when making the organization determination for pre-service authorization in violation of 42 CFR §422.101(b)(1). Immediate Corrective Action Required: PHT must begin ensuring that appropriate Medicare criteria (including regulatory and manual guidance as well as national or local coverage determinations) are properly utilized when making pre-service organization determinations. Immediate Corrective Action Request – Deficiency#9: PHT failed to provide notification of the denial to the provider who submitted the request on behalf of the beneficiary in violation of The Medicare Managed Care Manual, Chapter 13, Section 40.2.1. Immediate Corrective Action Required: PHT must immediately begin providing notices of denial to the providers who submit requests on behalf of the beneficiary. Immediate Corrective Action Request – Deficiency#10: PHTs notice of any denial failed to inform non-contracted providers of their right to reconsideration in violation of The Medicare Managed Care Manual, Chapter 13, Section 40.2.3. Immediate Corrective Action Required: PHT must immediately begin providing non-contracted providers with appropriate appeal rights when they deny organization determinations. Grievances Immediate Corrective Action Request – Deficiency#1: PHT failed to implement a meaningful process for grievances that include resolving the grievance to the members satisfaction in violation of 42 C.F.R. § 422.564(a) and The Medicare Managed Care Manual, Chapter 13, Section 20.3 Immediate Corrective Action Required: PHT must develop and implement a process for grievances that include appropriate resolution. Immediate Corrective Action Request – Deficiency #2 PHT routinely failed to provide enrollees with a written response that included a description of their right to file a complaint with the Quality Improvement Organization in response to quality of care grievances in violation of 42 CFR 422.564(e)(3)(iii). Immediate Corrective Action Required PHT must immediately begin providing a written response to all quality of care complaints that include a description of the enrollee’s right to file a written complaint with the QIO.

NEXT STEPS 1. Once CMS receives notice from Public Health Trust of Miami-Dade County that the issues are

corrected, CMS will validate each area noted above. Please be prepared to submit claims data and other information to CMS in an expeditious timeframe. More direction will follow regarding the immediate corrective action validation.

2. Any other deficiencies identified during audit, will be communicated through the normal audit report process.

If you have any questions or need clarification, you should contact Joann Young at 410-786-0879 or [email protected], or you may contact Tawanda Holmes at 410-786-6601 or [email protected].

Pursuant to 42 C.F.R. §422.506(b)(3), 422.510(c) and §423.507(b)(3), 423.509(c) this notice is to inform Public Health Trust of Miami-Dade County of its opportunity to correct the deficiencies outlined above. Please note that if Public Health Trust of Miami-Dade County fails to correct these deficiencies Public Health Trust of Miami-Dade County may be subject to applicable remedies available under law, including the imposition of intermediate sanctions, civil money penalties, and/or contract termination or non-renewal as described in 42 C.F.R. Parts 422 and 423, Subparts K and O. Please reply to this email to confirm receipt. Thank you, Jessica Robinson Division of Compliance Policy & Operations Center for Medicare/Program Compliance & Oversight Group Centers for Medicare & Medicaid Services 7500 Security Blvd Baltimore, MD 21244 C1‐23‐25 410.786.1039 [email protected]

1 | P a g e

MEMORANDUM

TO: Jessica Robinson

Division of Compliance Policy & Operations

Center for Medicare/Program Compliance & Oversight Group

Centers for Medicare & Medicaid Services

FROM: John P. Baar, Interim Compliance Officer, Jackson Health Plans

CC: Brian Dean, Senior Vice President, Finance, Jackson Health System

Interim Executive Director, Jackson Health Plans

Paul Marineau, Director of Operations, Jackson Health Plans

Joe Arriola, Chairman, Health Plan Subcommittee, PHT Board Member

Carlos A. Migoya, President & CEO, Jackson Health System

Don Steigman, EVP/COO, Jackson Health System

Mark Knight, EVP/CFO, Jackson Health System

Carlos Lago, Esq., Chief of Staff, Jackson Health System

Kevin Andrews, Vice President, Quality, Jackson Health System

Diana Salinas, Esq., Chief Compliance Officer, Jackson Health System

Steve Weimer, Corporate Director, Internal Audit, Jackson Health System

DATE: 12/3/2012

SUBJECT: Public Health Trust of Miami – Dade County d/b/a Jackson Health Plans -

Corrective Action Plan

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The Public Health Trust of Miami-Dade County (“PHT” or “the Trust”) d/b/a Jackson Health Plans is in receipt of the email dated November 30th, 2012 at 3:21pm from the Division of Compliance Policy & Operations within the Centers for Medicare & Medicaid Services (“CMS”) requesting Immediate Corrective Action relating to numerous findings from the audit conducted in early November 2012.

The PHT takes these findings extremely seriously and is committed to immediate and effective remediation of deficiencies as well as ongoing operational improvement to prevent recurrence. The PHT wishes to express its over-arching commitment to beneficiary safety as its top priority.

The PHT believes the Corrective Acton Plan detailed below empirically demonstrates the commitment to immediate remediation of the deficiencies identified in the November 2012 CMS audit and noted in the electronic communication from CMS on November 30, 2012. The information in the Corrective Action Plan below contains a degree of granularity to provide evidence to CMS that the desired results to resolve deficiencies are effectuated. To further the point of commitment, the PHT has allocated additional corporate resources, including Quality and Internal Audit, to specifically monitor the implementation of the Corrective Action Plan and ensure critical improvement milestones are met. An audit report detailing the Corrective Action Plan status will be provided to the audit committee of the PHT Board on a monthly basis.

CORRECTIVE ACTION PLAN: [INSERT HERE]

CORRECTIVE ACTION PLAN: Immediate Corrective Action Request – Deficiency #1 PHT does not have sufficient personnel and systems for the MA organization to organize, implement, control and evaluate the furnishing of services and the administrative and management aspects of the organization in violation of 42 CFR 422.503(b)(ii). Immediate Corrective Action Required: PHT must provide to CMS a plan of action as well as a timeline to ensure that PHT has the appropriate staffing level as well as management oversight to administer the Medicare Advantage Program in the area of Part C Organization Determinations, Appeals, Dismissals, Grievances and Part C Access to Care. 1) Plan of Action for Appropriate Staffing Level: During the audit PHT disclosed to CMS all open management

positions that were actively being recruited. In addition PHT disclosed during the audit the verbal approval by corporate to recruit two additional positions (a Compliance Officer and Fraud Waste and Abuse Officer). Some of the positions as identified below have been filled with the respective candidate start dates identified below. PHT has been and continues to aggressively pursue the recruitment and hiring of the remaining positions as well as providing interim solutions for some of the specified vacancies (refer to details below): a) Director Government Programs, candidate identified, interviewed and decision reached to extend an

offer to hire on Friday, November 30th, 2012 prior to receiving this corrective action notice. Hire offer made and accepted verbally on Monday, December 3rd, 2012. Candidate has 16 years of business development experience with 6 years of healthcare and managed care experience. Position requires full background check and his possible start date will be as early as December 10th, 2012. During the interim John Paul Baar is the Acting Director of Government Programs.

b) Sr. Financial Analyst, candidate already hired and will be starting December 10th, 2012. This individual is an expert in our existing systems and will be able to immediately begin implementing an oversight and audit program of fraud, waste and abuse analysis in preparation for the Interim FWA Officer Consultant and permanent FWA Officer to be hired [see below].

c) HMO Provider Network Contract Manager, candidate already hired and starting December 10th, 2012. Candidate has 30 years of managed care and contracting experience.

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d) Consultant, Special Projects, candidate already hired and will be starting December 10th, 2012. This individual is an expert in policy and procedure development as well as program and new product development at the PHT. The individual will be immediately put to work reviewing all existing policies and procedures, determine changes for review and approval by management and assist in the distribution and training of staff in new policies and procedures. The individual has over 30 years of health care experience with 20 of those years in managed care and has two Masters degrees.

e) Compliance Officer and a separate Fraud, Waste and Abuse (FWA) Officer, both positions are actively being recruited for candidates. Time frame 90 days to select and hire. INTERIM SOLUTION: During the interim, John Paul (JP) Baar will continue to act as Interim Compliance Officer and FWA Officer while the PHT reviews proposals from several consulting organizations to provide us with temporary assistance with both an independent Interim Compliance Officer and Interim FWA Officer to actively review the programs, implement changes and provide audit and oversight of the program. Once the bids are in and a firm selected, a contract will be negotiated and implemented. Taking into consideration the immediate need of the PHT, two of the prospective bidders have identified staff that can begin initially on a part time basis with support from other consultant team staff and move to full time by January 9th, 2013. Implementation to select a finalist, negotiate and sign a contract is planned for completion by December 14th, 2012. Active part-time on sight by a consultant by Monday, December 17th, 2012 is anticipated but cannot be guaranteed.

f) HMO Compliance Manager, actively recruiting for candidates. Expedited and targeted timeframe of no more than 90 days to select and hire. During the interim, Inez Abreu is the Acting Compliance Manager.

g) Director Pharmacy Administration, actively recruiting for candidates. Time frame, 90 days to select and hire.

h) HMO Manager Health Services, actively recruiting for candidates. Time frame, 90 days to select and hire.

i) HMO Claims Manager, actively recruiting for candidates. Time frame 90, days to select and hire. Currently using a consultant from Devlin Consulting, Inc. to fill this role.

j) HMO Manager Sales, actively recruiting for candidates. Time frame 90, days to select and hire. k) Managed Care Facilitator, actively recruiting for candidates. Time frame 90, days to select and hire. l) HMO Claims Examiner, actively recruiting for candidates. Time frame 90 days to select and hire.

2) Plan of Action for Management Oversight: Changes organizationally have already been discussed and

disclosed to the auditors. One aspect is the upcoming promotion approved on Friday, November 9th, 2012 by the PHT’s governing board, the Financial Recovery Board (“FRB”), Sub-Committee for the Health Plan’s oversight of Paul Marineau to Executive Director. Mr. Marineau joined the organization in July 2012 and has been material in effecting positive change within the organization, identifying challenges, solutions and implementing those solutions. He brings a wealth of knowledge and experience to the organization and is looking to hire a competent, talented experienced management team as identified above in the recruitment process currently taking place for the organization. In addition, as a result of the auditors’ recommendations, corporate senior management has approved the creation of separate Compliance Officer and FWA Officer positions. The Compliance Officer will be reporting directly to the Corporate Compliance Director, Diana Salinas, with a dotted line reporting relationship to the Executive Director, Mr. Marineau. The Compliance Officer, as per the attached organizational chart will also be reporting directly to the FRB Sub-Committee for the Health Plan’s oversight. The Compliance Officer will be responsible for the Health Plan’s Compliance Committee and compliance management and will have no other operational responsibilities. As indicated above JP Baar will continue in his role as Acting Compliance Officer and FWA Officer until both the Interim Compliance and FWA Officers are supplied by the selected consulting firm and permanent candidates are recruited, selected and hired. Brian Dean, Corporate SVP for Finance will continue to provide financial oversight as CFO for the Health Plan.

3) Timeline: Ongoing oversight of the Health Plan by Diana Salinas, Corporate Compliance Officer, Kevin Andrews Corporate Quality Improvement Vice President and Steven Weimer, Corporate Internal Audit Director is being expanded as defined by Jackson Health System’s Fiscal Year 2013 Compliance Audit Plan and Internal Audit Plan. Their respective departments will be providing oversight of the corrective action plan; that audits are actually being performed, by whom and monitoring performance and results of the audits. We will be

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expanding the corporate internal Quality Improvement Committee’s role as an adjunct to the Health Plan’s Quality Committee, allowing additional resources, expertise and feedback to be utilized and applied to the corrective action plan in response to the results and auditors recommendations for changes and implementation for items identified for improvement.

* PHT must provide to CMS a plan of action as well as a timeline to ensure that PHT has the appropriate systems capabilities as well as management oversight to administer the Medicare Advantage Program in the area of Part C Organization Determinations, Appeals, Dismissals, Grievances and Part C Access to Care.

1) Plan of Action for Systems Capabilities: One of the items identified in the audit is that the PHT is not fully

utilizing the existing capabilities already built into the systems it has in place. Staff re-training on current systems is taking place now and will continue regarding appropriate recording of information into the system. One area identified for focus is clear and specific data entry of comments on decisions and determinations made as well as communication of same to all parties (enrollees, providers as well as internally to staff). Also tracking and reporting all such communication in the required timeframes. Another area the PHT is actively pursuing improvement on is the comment by the auditors to have all files associated with an event located in one system. In response, the PHT has requested proposals from several vendors to improve its document tracking systems, allow for comprehensive scanning, tracking and electronic storing of all business related documents. The intention is to attach the applicable documents to the member, provider and or claim record to allow for all associated documents to be retrievable from one system. Current systems do not allow for this capability. Therefore, as a result of the audit, the PHT is planning to make a significant system change by eliminating one of the system products and migrating the data and history to the DST/MHC “Market Prominence” product by July 1st, 2013. PHT already uses the DST/MHC programs and products for other lines of business and by migrating the Medicare line of business into the product with its enhanced “Market Prominence”, we will be eliminating the need for ikaSystems, PHT’s current Medicare software and Business Processing Organization (BPO) vendor, and avoid having to train and monitor staff on multiple systems as well as providing oversight of same. The DST “Market Prominence” product has the capability for attaching multiple files to the member, provider and or claims record.

2) Plan of Action for Management Oversight. As stipulated above, the planned hiring of the individuals and positions, effective use of consultants and the support staff available from the parent organization will provide the manpower as well as expertise required to effectively provide the oversight sought by CMS.

3) Timeline: Corporate oversight and support staff have already begun through participation and review of this response and will be ongoing. As identified above, at least three planned positions are hired and will begin December 10th, 2012. One of the candidates is pending background checks and could conceivably start as early as December 10th, 2012. The Interim Compliance Officer and FWA Officer positions will be filled by consultants beginning as early as December 17th, 2012 and will continue in those roles until permanent recruits are hired. The remaining positions are anticipated to be filled by no later than the next 90 days. Regarding systems improvements, the PHT has already received one vendor’s proposal for the document scanning tracking program described above. A second vendor has previously been scheduled to submit its proposal no later than December 5th at 3:30PM. PHT will identify and request a proposal from at least one other vendor by Tuesday, December 7th, 2012. Selection of a vendor will be done by Friday, December 21st, 2012 followed by negotiations and contract execution by no later than January 31st, 2013 with implementation, hardware purchase, installation and staff training to be completed by February 28th, 2013.

* PHT must develop and provide to CMS an action plan and timeline to develop and implement internal policies and

procedures to ensure compliance with CMS requirements in the areas of Part C Organizational Determinations, Appeals,

Dismissals, Grievances and Part C Access to Care. In addition, PHT must provide a timeline to train staff on the newly developed

policies and procedures.

1) Plan of Action for development of internal policies and procedures: As part of the oversight being provided by Corporate QI and Compliance Departments, all of the Health Plan’s current policies and procedures will be reviewed, updated, submitted for approval and implemented. Part of the action plan will be to identify and

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prioritize which policies and procedures will need to be reviewed, modified, approved and implemented with priority given to those that will ensure compliance with CMS requirements in the areas of Part C Organizational Determinations, Appeals, Dismissals, Grievances and Part C Access to Care. Actual identification and prioritization of those policies and procedures will be done within the next two weeks and no later than Monday, December 17th, 2012. Actual review, modification and approval of those identified policies will take place within the next 90 days and be completed by no later than February 28th, 2013.

2) Timeline to train staff on the newly developed policies and procedures. As each newly developed policy and procedure is approved by management, it will be immediately distributed to all applicable PHT staff via email notification with priority given to those that will ensure compliance with CMS requirements in the areas of Part C Organizational Determinations, Appeals, Dismissals, Grievances and Part C Access to Care identified, reviewed and approved for distribution within the next two weeks and training on these specific policies and procedures completed by no later than December 21st, 2012. For all other policies and procedures, within 14 days of release/publication of a policy and procedure, training will be developed and put in place with timelines and verification of completion by each affected employee/staff and or Department. Training will be provided by subject matter experts in the form of classroom time, staff meetings and or distribution of training materials for home study. Where applicable and appropriate, online training will be developed for staff to access through the corporate “Jen” Training program which also provides management with tracking and verification of each employee’s required completion of mandatory training programs. Training on all other identified newly developed policies will be completed by no later 14 days from the date the training materials become available to the employee and all other such new policy and procedure training will be completed by no later than March 29th, 2013.

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DEFICIENCIES IN PART C ORGANIZATIONAL DETERMINATIONS, APPEALS, GRIEVANCES, AND PART C ACCESS TO CARE Organizational Determinations and Reconsiderations Immediate Corrective Action Request – Deficiency #1: Public Health Trust (PHT) failed to process pre‐service organization determinations and plan reconsiderations within the required

adjudication time frames in violation of 42 CFR 422.568(a), and 422.590(a‐c), including expedited, pre‐service cases, posing a

serious risk of potential harm to beneficiaries

Immediate Corrective Action Required: PHT must immediately begin processing organization determinations and plan reconsiderations within the required adjudication timeframes.

Response: PHT agrees with the findings and will be in complete compliance with this requirement by no later than this Wednesday by 5:00 PM, December 5th, 2012. PHT is taking the following action: PHT is now processing organization determinations and plan reconsiderations within the required adjudication timeframes. Current policy and procedure requirements for this activity have been verbally reinforced to all affected PHT staff implementing and processing organization determinations and plan reconsiderations. Monitoring and audit of the effectiveness of the PHTs compliance in this area is as follows:

Existing Authorization Facilitators are reviewing the status of authorization determination requests as those requests are received. All authorization determination requests marked urgent or any equivalent term will have a determination performed within 72 hours of receipt. Appeals of adverse determinations marked as urgent or emergent and requested as expedited will be forwarded to the Grievance and Appeals Coordinator, Inez Abreu, upon receipt. The Grievance and Appeals Coordinator will review the appeal for redetermination and send a determination notice to the member and the provider within 72 hours of receipt. PHT will ensure that it complies with pre-service determinations and plan reconsiderations by generating a daily pre-service aging report which identifies all determination and reconsideration requests as well as tracking timeliness of completion and resolution.

Timeline: The “daily pre-service aging report” and the “weekly detailed report” (mentioned below in Prevention Recurrence) is currently under development by the Information System’s staff and will be ready for first draft review by 5:00 PM tomorrow, December 4th, 2012. The final report form will be completed by the next day Wednesday, December 5th, 2012 At that time the PHT will be in full compliance with this corrective action plan.

Prevention Recurrence: The Acting Compliance Manager will generate and analyze a weekly detailed report of all open and completed determinations to review, track and report achievement of the required adjudication timeframes.

Immediate Corrective Action Request – Deficiency #2: PHT failed to process cases as expedited despite a physician’s request to expedite a coverage decision in violation of 42 CFR 422.570(c) (2) (ii) and 422.584(c) (2) (ii). Also see 42 CFR 422.570(c) (2) (ii) and 422.590(c) (2) (ii). Immediate Corrective Action Required: PHT must process an OD or appeal as expedited, if a physician has made or supported a request for a coverage decision (OD or reconsideration) and has indicated that the request is urgent (or any equivalent term).

Response: PHT agrees with the findings and will be in complete compliance with this requirement by no later than this Wednesday by 5:00 PM December 5th, 2012. PHT is taking the following action: PHT is now processing organization determinations or appeals identified as expedited. Procedures have been implemented to monitor and audit the effectiveness of the PHTs compliance in this area as follows:

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Authorization Facilitator will review status of authorization determination requested by provider. All authorization determination requests marked urgent or any equivalent term will have a determination performed within 72 hours of receipt. Appeals of adverse determinations requested as urgent or any equivalent term will be forwarded to the Grievance and Appeals Coordinator upon receipt. Grievance and Appeals Coordinator will review appeals for redetermination with Medical Director to assess for expedited status. A determination notice will be communicated to the member and the provider within 72 hours of receipt.

Timeline: The “weekly detailed report” (mentioned below in Prevention Recurrence) is currently under development by the Information System’s staff and will be ready for first draft review by 5:00 PM tomorrow, December 4th, 2012. The final report form will be completed by the next day Wednesday, December 5th, 2012. At that time, the PHT will be in full compliance with this corrective action plan.

Prevention Recurrence: The Acting Compliance Manager will generate and analyze a weekly detailed report of all open and completed expedited organization determinations and appeals to review, track and report achievement of the requirements specified in 42 CFR 422.570(c)(2)(ii) and 422.584(c)(2)(ii) and 422.590(c)(2)(ii).

Immediate Corrective Action Request – Deficiency#3: PHT did not prepare a written explanation and send the case file to the independent entity contracted by CMS, within 60 calendar days from the date it received the request for a standard reconsideration, when it made a determination that affirms, in whole or in part, its adverse organization determination in violation of 42 CFR §422.590(b)(2). Immediate Corrective Action Required: PHT must prepare a written explanation and send the case file to the independent entity contracted by CMS within 60 days from the date it received the request for a standard reconsideration when it has affirmed, in whole or in part, its adverse organization determination.

Response: PHT agrees with the findings and is now in compliance with this requirement by having taken the following action: The Grievance and Appeals Coordinator provided training via email and confirmed verbally to the Claims Appeals Coordinator the process for identifying and forwarding adverse determinations to Maximus/Independent Review Entity (IRE).

Prevention Recurrence: The Acting Compliance Manager will generate a weekly report of all adverse organization determinations and verify forwarding to Maximus/IRE. The report will be reviewed and analyzed by the Compliance Officer to confirm achievement of the requirements specified in 42 CFR §422.590(b) (2). Immediate Corrective Action Request – Deficiency#4: PHT is routinely processing requests from enrollees as inquiries or grievances, instead of ODs or appeals in violation of 42 CFR 422.566(c) and 422.578, delaying access to care, exposing enrollees to potential financial liability and/or denying enrollees access to the appeals process. Required Corrective Action: * PHT must immediately implement procedures to properly identify and process requests from enrollees for ODs and appeals. * PHT must review all grievances received by PHT within the last 6 months. Any grievances determined to be a request for an organization determination or appeal must be reprocessed accordingly and the enrollee immediately notified.

Response: PHT agrees with the findings and will be in compliance with this requirement by taking the following action: PHT has determined that it has a policy that adequately describes the process to distinguish and determine grievances and appeals. PHT will implement ongoing training and oversight to staff. The Acting Compliance Manager has produced a report of all grievances logged in our system for the past 6 months. The grievances are

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currently being reviewed by the Acting Compliance Manager and Member Services Supervisor for reclassification as necessary.

Timeline: PHT will review and determine reclassification of the past 6 months of grievances by no later than December 14th, 2012. Enrollee notification will be processed and sent as each case is identified and will be completed by no later than December 14th, 2012. The identified policies, procedures and training materials will be reviewed, updated and approved for use by no later than Friday, December 14th 2012. Training of all staff will be implemented immediately thereafter and be completed by December 31st, 2012.

Prevention Recurrence: Tracking and monitoring of this requirement is an ongoing responsibility of the Compliance Officer and shall be included in weekly reports to PHT management. Any identified discrepancies will be dealt with immediately.

Immediate Corrective Action Request – Deficiency#5: PHT does not notify the enrollee of its determination expeditiously as the members health condition warrants or no later than no later than 14 calendar days after the date the plan received the request in violation of 42 CFR § 422.568(a) and The Medicare Managed Care Manual, Chapter 13, Section 40.1. Immediate Corrective Action Required: PHT must immediately begin notifying enrollees of their determination with the appropriate timeframes.

Response: PHT agrees with the findings and will be in full compliance with this requirement by Monday, December 10th, 2012 by taking the following action: PHT has determined that ikaSystems initiated procedures were not being followed as a result of staff training deficiencies. PHT has implemented verbal training to staff on the adverse determination notification processes PHT will monitor the above process by running authorizations report and notification log on a weekly basis beginning Monday December 10th, 2012 to ensure current notifications were mailed.

Timeline: The “weekly authorization report” (mentioned above) is currently under development by the Information System’s staff and will be ready for first draft review by 5:00 PM tomorrow, December 4th, 2012. The final report form will be completed by Wednesday, December 5th, 2012. At that time, the PHT will be in full compliance with this corrective action plan. Formal training of all staff will be implemented by December 14th, 2012and completed by December 31st, 2012.

Prevention Recurrence: Tracking and monitoring of this requirement is an ongoing responsibility of the Interim Health Services Manager, Barbara Koslow, and shall be included in weekly reports to PHT management. Any identified discrepancies will be dealt with immediately. The Compliance Officer will be responsible to do spot check audits to confirm compliance with this requirement. Immediate Corrective Action Request – Deficiency#6: PHT’s notice of any denial does not state the specific reasons for the denial with enough information for the enrollee to understand the reason the request was denied in violation of 42 CFR § 422.568(e)(2) and The Medicare Managed Care Manual, Chapter 13, Section 40.2.2 Immediate Corrective Action Required: PHT must immediately correct their denial notices to clearly include the reasons for denial with enough information that the member can understand the reason the request was denied.

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Response: PHT agrees with the findings and will be in compliance with this requirement by taking the following action: PHT is implementing training and oversight to staff on modifying the letter of notification to include an editable text field to allow for a broader descriptive narrative for the specific reasons for the denial.

Timeline: Modification of the template letter has been completed. Timeline: Initial verbal instruction to the staff has already taken place. More formal training will be completed by Monday December 10th, 2012 and will be ongoing for future staff and be part of their individual annual performance evaluation review. The Interim Health Services Manager will do spot review of denials in process to insure the updated notification content is consistently complete. Quarterly analysis of the process will begin at the end of the first quarter of 2013.

Prevention Recurrence: Tracking and monitoring of this requirement is an ongoing responsibility of the Interim Health Services Manager. Any identified discrepancies will be dealt with immediately by the Interim Health Services Manager especially as it relates to comprehensiveness of the explanation as well as being at a reading level the member can understand. The Compliance Officer will monitor the letters on monthly basis to determine and report on follow through.

Immediate Corrective Action Request – Deficiency#7: PHT imposes authorization restrictions for emergency medical services and the resulting admission to the hospital in violation of the Medicare Managed Care Manual, Chapter 4, Section 20.3. Immediate Corrective Action Required: PHT must immediately stop imposing authorization restrictions for emergency medical services (ER room and Inpatient admissions through ER).

Response: PHT agrees with the findings has taken appropriate action to quickly enter and maintain compliance by the following action: Corrective Action implemented and completed on the day it was identified by the auditors while they were here at the PHT. The Medical Director has issued a notification to all staff involved in the pre-determination process that no authorization predeterminations are required for ER services. Areas notified include the pre-certification and Member Services. One-to-one face-to-face education of the precertification staff was performed by the Medical Director. Face to face education of Member Services staff was performed by the Member Service Supervisor. Long term re-education will be performed for new staff by the Precertification Team Leader and Member Services Supervisor.

Timeline: this Corrective Action has been completed. Training of the staff has been completed and will be ongoing for future staff and be part of their individual annual performance evaluation review.

Prevention Recurrence: Tracking and monitoring of this requirement is an ongoing responsibility of the Interim Health Services Manager who will generate and review a weekly “Authorization by Authorization Type Report” to ensure that no ER authorizations are present. The results of this monitoring will be reported monthly to the Quality Improvement Committee (QIC) in their oversight role.

Immediate Corrective Action Request – Deficiency#8: PHT does not use Medicare criteria (including regulatory and manual guidance or national and local coverage determinations) when making the organization determination for pre‐service authorization in violation of 42 CFR §422.101(b)(1). Immediate Corrective Action Required: PHT must begin ensuring that appropriate Medicare criteria (including regulatory and manual guidance as well as national or

local coverage determinations) are properly utilized when making pre‐service organization determinations.

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Response: PHT agrees with the findings and will be in compliance with this requirement by no later than Friday, December 7th, 2012. PHT is taking the following action: PHT is in the process of re-subscribing to McKesson’s Interqual criteria software as the source for our medical determinations. PHT has reinforced to the staff the use of the CMS vendor for local coverage determinations (“LCD”) which is First Coast CMS. Re-training of both systems, McKesson and First Coast CMS, is ongoing by both the Medical Director and the Interim Health Services Manager especially as it relates to documenting the source of the criteria of the determination into the pre-certification screens/system in the ikaSystems System.

Timeline: Training of the staff will be completed by Thursday, December 20th and will be ongoing for future staff and be part of their individual annual performance evaluation review.

Prevention Recurrence: Tracking and monitoring of this requirement is an ongoing responsibility of the Medical Director who will review the use of the Interqual and First Coast CMS sites during live production by each concurrent reviewer. Spot checks will be done bi-weekly.

Immediate Corrective Action Request – Deficiency#9: PHT failed to provide notification of the denial to the provider who submitted the request on behalf of the beneficiary in violation of The Medicare Managed Care Manual, Chapter 13, Section 40.2.1. Immediate Corrective Action Required: PHT must immediately begin providing notices of denial to the providers who submit requests on behalf of the beneficiary.

Response: PHT agrees with the findings and will be in full compliance with this requirement by no later than Friday, December 7th, 2012 by having taken the following action: PHT has implemented the process of denials being sent to both the provider and the member. This has been accomplished by verbal training to the staff to include copies of the letter to both parties. Formal training will be completed by the end of this week, December 7th, 2012, and training will be ongoing for future staff and be part of their individual annual performance evaluation review.

Timeline: this Corrective Action will be completed by no later than Friday December 7th, 2012.

Prevention Recurrence: Tracking and monitoring of this requirement is an ongoing responsibility of the Interim Health Services Manager who will review and monitor the above process on a bi-weekly basis by spot check review of the actual production, and mailing of the letters as well as looking up individual member files for denial letter copies being uploaded to the system.

Immediate Corrective Action Request – Deficiency#10: PHTs notice of any denial failed to inform non‐contracted providers of their right to reconsideration in violation of The Medicare Managed Care Manual, Chapter 13, Section 40.2.3. Immediate Corrective Action Required: PHT must immediately begin providing non‐contracted providers with appropriate appeal rights when they deny organization

determinations.

Response: PHT agrees with the findings and is working on compliance with this requirement by taking the following action: PHT is working with the ikaSystems vendor to revise the system generated Explanation of Payment (EOP) to include appeal rights to non-contracted providers. In the interim, PHT will do the following: effective, Tuesday, December 4th, 2012, the PHT will run a daily report from the previous 24 hours of activity in the ikaSystems to identify any denials rendered to non-contracted providers. From the report the PHT will produce and

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mail the notice to the Non-contracted provider of their appeal rights as well as generating a copy of the letter and load it to the Provider’s profile in ikaSystems.

Timeline: The interim solution described above will be implemented as of Tuesday, December 4th, 2012. ikaSystems has yet as to commit to how long it will take for a definitive timeframe for completion of the changes to be made to the EOP. PHT anticipates the system change to the EOP to be no longer than 30 days or January 2nd, 2013.

Prevention Recurrence: Tracking and monitoring of this requirement is an ongoing responsibility of the Acting Compliance Manager who will review and monitor the above process by running the daily report to ensure current appeal right notifications are being mailed.

Grievances Immediate Corrective Action Request – Deficiency#1: PHT failed to implement a meaningful process for grievances that include resolving the grievance to the members satisfaction in violation of 42 C.F.R. § 422.564(a) and The Medicare Managed Care Manual, Chapter 13, Section 20.3 Immediate Corrective Action Required: PHT must develop and implement a process for grievances that include appropriate resolution.

Response: PHT agrees with the findings and will be in compliance with this requirement by taking the following action: PHT has identified existing policies, procedure and training materials which need to be reviewed, updated and approved for use. The updated materials will be used to perform re-education of all staff on the grievance process and appropriate resolution.

Timeline: The identified policies, procedures and training materials will be reviewed, updated and approved for use by no later than Friday, December 14th 2012. Training of all staff will be implemented immediately thereafter and be completed by December 31st, 2012.

Prevention Recurrence: Tracking and monitoring of this requirement is an ongoing responsibility of the Acting Compliance Manager who will review and monitor the above process by running a weekly “Call Log” report that captures all complaints and grievances filed by members. The data will be analyzed by the Acting Compliance Manager to ensure the process is being performed correctly.

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Immediate Corrective Action Request – Deficiency #2 PHT routinely failed to provide enrollees with a written response that included a description of their right to file a complaint with the Quality Improvement Organization in response to quality of care grievances in violation of 42 CFR 422.564(e)(3)(iii). Immediate Corrective Action Required PHT must immediately begin providing a written response to all quality of care complaints that include a description of the enrollee’s right to file a written complaint with the QIO. Response: PHT agrees with the findings and will be in compliance with this requirement by taking the following action: PHT has identified existing policies, procedure and training materials which need to be reviewed , updated and approved for use. The updated materials will be used to perform re-education of all staff on how to properly identify quality of care complaints. The PHT will investigate and resolve these types of complaints and respond with the appropriate letter notifying the member of their right to appeal as well as their right to file a complaint with the QIO which currently is Florida Medical Quality Assurance, Inc. (FMQAI). Timeline: The identified policies, procedures and training materials will be reviewed, updated and approved for use by no later than Friday, December 14th 2012. Training of all staff will be implemented immediately thereafter and be completed by December 31st, 2012.

Prevention Recurrence: Tracking and monitoring of this requirement is an ongoing responsibility of the Interim Health Services Manager with the assistance of the Acting Compliance Manager. The Acting Compliance Manager will review and monitor the above process by running a weekly “Call Log” report that captures all complaints and grievances filed by members. If any discrepancies are identified an acknowledgement letter will be sent by the Acting Compliance Manager to the member notifying them of their rights to file a written complaint with the QIO. The Acting Compliance Manager will report any such discrepancies to the Interim Health Services Manager for investigation and resolution. The Interim Compliance Officer will be responsible for spot checking the performance of the Acting Compliance Manager in this regard.

CONCLUSION: In closing, the PHT remains steadfast in its commitment to Beneficiary safety and well-being, as well as operating a high-performing Medicare Advantage program. The PHT is appreciative for the opportunity to remediate the identified deficiencies and looks forward to a collaborative relationship with CMS in ensuring all audit findings are resolved satisfactorily.

FISCAL COMMITTEE


Fiscal Committee Joe Arriola, Chairperson Darryl K. Sharpton, Vice Chairperson Michael Bileca Joaquin del Cueto Mojdeh L. Khaghan Marcos Jose Lapciuc Stephen S. Nuell

Date, Time and Location December 13, 2012 – To follow the Audit & Compliance Subcommittee meeting Ira C. Clark Diagnostic Treatment Center Conference Room 259

AGENDA

1. Approval of the Previous Meeting Minutes (Joe Arriola, Chairperson) (a) *Meeting Minutes as of November 15, 2012 2. Financial Statements as of November 2012 (Mark T. Knight, Executive Vice President and Chief Financial Officer, Jackson Health System)

3. Cost Accounting Update

(Brian Dean, Vice President, Finance Division, Jackson Health System) 4. *Accounts Receivable Aging Report – November 2012 (CarmenPla, Vice President, Patient Financial Services, Jackson Health System) 5. International Collections Update Presentation (Carmen Pla, Vice President, Patient Financial Services, Jackson Health System) 6. Contracts and Agreements

(a) *Resolution authorizing the President or his designee to approve and execute Renewal Agreements with the following Community Health Centers (Baker Act Match 2012-2013): 1. Citrus Health Network, Inc. 2. Citrus Health Network (CCSU), Inc. 3. Community Health of South Florida, Inc. 4. Miami Behavioral Health Center, Inc. 5. Jackson North Community Health Center 6. New Horizons CMHC, Inc. For the provision of mental health services in the total amount of $2,348,141 (John Repique, Sr. Vice President, Chief Administrative Officer and Chief Nursing Officer, Mental Health and Corrections Health Services, Jackson Health System)

Fiscal Committee Meeting Agenda December 13, 2012 Page 2

(b) *Resolution authorizing execution of a settlement agreement with and payment to the University of Miami, Department of Psychiatry in the amount of Two Hundred Twenty Five Thousand, One hundred Thirty Seven Dollars and Twenty-Six Cents ($225,137.26) as a full and final settlement for services provided by the University of Miami Department of Psychiatry at Jackson Mental Health Hospital (John Repique, Sr. Vice President, Chief Administrative Officer and Chief Nursing Officer, Mental Health and Corrections Health Services, Jackson Health System)

(c) *Resolution authorizing and approving the President of the Public Health Trust to

execute Memorandum of Understanding by and between Miami-Dade County and the Public Health Trust regarding the revolving line of credit facility to be provided by Wells Fargo Bank, N.A. in an amount not to exceed $75,000,000, subject to approval by the Board of County Commissioners by Ordinance (Brian Dean, Vice President, Finance Division, Jackson Health System)

(d) *Support document for agenda item 6 (c) (Memorandum of Understanding by and

between Miami-Dade County and the Public Health Trust)

(e) *Resolution authorizing payment to the University of Miami Department of Anesthesia in the amount of Five Hundred Seventy Six Thousand Dollars and Zero Cents ($576,000.00) as a full and final Settlement for services provided by the University of Miami Department of Anesthesia at Holtz Children’s Hospital (Steven Burghart, Sr. Vice President and Chief Administrative Officer, Holtz Children’s Hospital & Women’s Hospital Center, Jackson Health System)

(f) *Resolution authorizing payment to the University of Miami Department of Surgery

in the amount of Six Hundred Thirty Four Thousand Dollars and Zero Cents ($634,000.00) as a full and final Settlement for services provided by the University of Miami Department of Surgery at Holtz Children’s Hospital (Steven Burghart, Sr. Vice President and Chief Administrative Officer, Holtz Children’s Hospital & Women’s Hospital Center, Jackson Health System)

7. Pension Plan Subcommittee Report (Darryl K. Sharpton, Chairperson)

(1) Resolutions recommended to be approved

(a) *Resolution approving the Public Health Trust Defined Benefit Retirement

Plan Actuarial Report for the Plan Year Ending December 31, 2013 (Brian Dean, Vice President, Finance Division, Jackson Health System)

(b) *Resolution Approving the Public Health Trust Defined Benefit Retirement

Plan Amended Investment Policy Statement (Brian Dean, Vice President, Finance Division, Jackson Health System)

(c) *Resolution approving the Public Health Trust appointment of Peter L.

Bermont to the Pension Plan Subcommittee (Brian Dean, Vice President, Finance Division, Jackson Health System)

(d) Support document for agenda item 7 (1) (c) (CV for Peter L. Bermont)

Fiscal Committee Meeting Agenda December 13, 2012 Page 3 8. Facilities Subcommittee Report (Darryl K. Sharpton, Chairperson) (1) Resolution recommended to be approved

(a) *Resolution authorizing the President or his designee to enter into a new Lease Agreement with The Trustees of Columbia University in the City of New York, a New York Non-Profit Corporation for the rental of Two Hundred and Forty-Three (243) square feet of space in the Ambulatory Care Center East Building, Room CLU at 1611 NW 12 Avenue, Miami, Florida 33136 for a period of two (2) years and eight (8) months commencing January 1, 2013 and expiring on August 31, 2015, for an annual payment of Six Thousand Eight Hundred Four Dollars ($6,804) with an annual increase in base rent of one percent (1%) and common area maintenance (Madeline Valdes, Corporate Director, Property Management Division, Jackson Health System)

9. Purchasing Subcommittee Report

(Joaquin del Cueto, Chairperson) (1) *Review and recommended approval of the December 2012 Purchasing Report

(Mark T. Knight, Executive Vice President and Chief Financial Officer, Jackson Health System)

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD Fiscal Committee Joe Arriola, Chairperson Darryl K. Sharpton, Vice Chairperson Michael Bileca Joaquin del Cueto Mojdeh L. Khaghan Marcos Jose Lapciuc Stephen S. Nuell Date, Time and Place November 15, 2012 – Followed the Audit & Compliance Subcommittee meeting Ira C. Clark Diagnostic Treatment Center Conference Room 259

ATTENDANCE

Fiscal Committee Joaquin del Cueto Darryl K. Sharpton Stephen S. Nuell

Mojdeh L. Khaghan Marcos Jose Lapciuc Joe Arriola Excused Michael Bileca

Jackson Health System Carlos A. Migoya Mark T. Knight Brian Dean Jeffrey Crudele Carmen Pla Don S. Steigman Rosa Costanzo Kevin Andrews Alex Contreras

Miami-Dade County Attorneys

Jeffrey Poppel Eugene Shy, Jr.

Fiscal Committee Meeting November 15, 2012 Page 2 Meeting Call to Order With a quorum being present, the meeting of the Fiscal Committee was called to order at 8:49 a.m. by Joe Arriola, Chairperson, Fiscal Committee. 1. Approval of the Previous Meeting Minutes

(a) Meeting Minutes as of October 18, 2012 The meeting minutes of October 18, 2012 were approved as presented.

2. Financial Statements Report as of October 2012

With regards to the Financial Report for the month of October 2012, Mark T. Knight, Chief Financial Officer, Jackson Health System (JHS) distributed and reviewed financial statements ending October31, 2012 highlighting key financial information and overview of Overtime FTE’s Trend Report for pay period beginning 1/7/12 through 10/27/12. Mr. Sharpton questioned what is being done to better monitor and control overtime expenses. Don S. Steigman, Chief Operating Officer, Jackson Health System talked about agency utilization versus premium pay and the work that is being done to fill vacancies which would reduce premium pay. He stated that he is working with JHS Management Team and have developed and effectuating a plan to better monitor and further reduce overtime. With regards to payments for long term patient care, the Committee was engaged in detailed discussion particularly as it relates to payor mix, number of patients who qualify for Medicare and/or Medicaid, patient trend information, and cost for patient care and collections process. In an effort to be better informed, Mr. Migoya requested that in a month or two the Committee be provided with a Long Term Care presentation. JMH Health Plan Brian Dean, Interim Executive Director, JMH Health Plan (Health Plan) presented a financial statements report, as of October 2012. A copy of the report was distributed at the meeting. Mr. Dean highlighted information relative to the trailing indicators and overview of the Health Plan organizational chart. Mr. Dean introduced Paul Marineau, who has been appointed Executive Director of the Health Plan.

3. Cost Accounting Update Mr. Dean reported that Jackson North Medical Center and Jackson South Community Hospital are producing information and looking forward in late January of next year to implement the system at Jackson Memorial Hospital.

4. Accounts Receivable Aging Report as of October 2012

Carmen Pla, Vice President, Patient Financial Services, Jackson Health System, presented an Accounts Receivable Aging Report as of October 2012. Collections for the month were great due to retro payments from Medicaid rate buy back, POS cash exceeded goal and increased from the previous month, DNFB days decreased, potential Medicaid conversions continue to trend higher than goal, AR greater than 90 days increased by 3%, and credit balances remain at goal.

Fiscal Committee Meeting November 15, 2012 Page 3 5. Contracts and Agreements Recommended for Approval

(a) Resolution approving and authorizing Carlos A. Migoya, President of the Public Health

Trust, to execute (1) Buyout and Release Agreement by and among the Public Health Trust, Massmutual Asset Finance, LLC, Bal Energy Management, LLC and Johnson Controls, Inc., including execution of acceptance of the bill of sale; and (2) Termination of Service Agreement by and between the Public Health Trust and Johnson Controls, Inc., including execution of a new Service Agreement with Johnson Controls, Inc. (Mark T. Knight, Executive Vice President and Chief Financial Officer, Jackson Health System)

(b) Support Documents for Agenda Item 5 (a) Mr. Arriola requested a motion for the items. Ms. Khaghan moved approval; seconded by Mr. Sharpton, and carried without dissent.

(c) Resolution authorizing and approving a waiver of formal competition and retroactive agreements with Anthony D. Hall, CPA, PA: (1) in an amount not to exceed $12,500,000 for Cost Report Recovery Consulting Services for Cost Report Year 1992, in which Anthony D. Hall, CPA, PA has identified $28,000,000 in estimated reimbursement to JHS in which $7,000,000 is due upon execution of the agreement and JHS receipt of recovery, and (2) in an amount not to exceed $12,500,000 for Cost Report Recovery Consulting Services for Cost Report Year 2003 upon execution of the agreement and JHS receipt of recovery (Brian Dean, Vice President, Finance Division, Jackson Health System)

(d) Support Documents for Agenda Item 5 (c) Mr. Arriola requested a motion for the items. Mr. Sharpton moved approval; seconded by Mr. Nuell, and carried with one dissenting vote. Mr. del Cueto was the dissenting voter. 6. Facilities Subcommittee Report

Darryl K. Sharpton, Chairperson, Facilities Subcommittee reported that the Subcommittee met on November 15, 2012. He further reported that the Subcommittee approved and forwarded to the Fiscal Committee for approval the following resolutions: (1) Add-on resolution, (2) item 6 (a), and (3) item 6 (b) as a substitute item. Add-on agenda item

Resolution approving the renaming of Jackson Mental Health Hospital Center as “Jackson Behavioral Health Hospital” and authorizing the President of the Public Health Trust to obtain approval of the Board of County Commissioners (Madeline Valdes, Corporate Director, Property Management Division, Jackson Health System)

Fiscal Committee Meeting November 15, 2012 Page 4

(a) Resolution providing for the delegation of authority from the Financial Recovery Board of the Public Health Trust to the President or his designee to negotiate and execute Revocable License Agreements for the time share space with qualified community physicians for an initial term of at least one (1) year, revocable at will by either party, and at a fair market value (Madeline Valdes, Corporate Director, Property Management, Jackson Health System)

(b) SUBSTITUTE Resolution authorizing the President or his designee to move forward with

developing the design, permitting, and construction of a new Level II Trauma Center at Jackson North Medical Center in an amount not to exceed One Million Dollars ($1,000,000) from capital contributions budget for year 2013 (Madeline Valdes, Corporate Director, Property Management, Jackson Health System)

Mr. Arriola requested a motion for the add-on agenda item, agenda item 6 (a) and substitute agenda item 6 (b). Mr. del Cueto moved approval seconded by Mr. Sharpton, and carried without dissent.


Joaquin del Cueto, Chairperson, Purchasing Subcommittee reported that the Subcommittee met on November 15, 2010. The Subcommittee was presented with routine monthly reports and reviewed for approval the November 2012 Purchasing Report. The Subcommittee members present reviewed in detail the November 2012 Purchasing Report and approved to forward the Purchasing Report to the Fiscal Committee without a recommendation for item 3 of the Purchasing Report. Mr. Arriola requested a motion for items 1 and 2 of the November 2012 Purchasing Report. Mr. Nuell moved approval; seconded by Mr. Lapciuc, and carried without dissent. Section V. Awards Under A Waiver Of Formal Competition E. Miscellaneous Bid Waiver

3. (425013-MR) The Executive Office requests additional funding to the Agreement with Maxor National Pharmacy Services Corp. (“Maxor”) for the operation of the Specialty Pharmacy (ongoing purchase).

Maxor National Pharmacy Cervices Corp. Previously Approved Amount: $ 6,608,211 This request for funding: $ 4,562,154 Total approved funding: $11,170,365

Fiscal Committee Meeting November 15, 2012 Page 5

With regards to item 3 of the Purchasing Report, the Committee was engaged in specific discussion having to do with outsourcing pharmacy services versus utilization of staff, as well as the cost to outsource the services over a four year period of time versus utilizing staff for a savings over a two year period of time, advertise an RFP for purposes of possibly getting the service done for less, JHS questionable bench strength to successfully get the services done, review of the contract, billing and services to provide beyond the agreed staff to operate pharmacy services. Martha Baker, RN, President, SEIU Local 1991 spoke about the savings involved when using JHS staff to operate the pharmacy services and encouraged the utilization of JHS staff. After the discussion, Mr. Arriola requested a roll call vote. Darryl K. Sharpton Yes Mojdeh L. Khaghan Yes Marcos Jose Lapciuc Yes Stephen S. Nuell Yes Joe Arriola No Joaquin del Cueto No At the conclusion of the roll call vote there was a 4 to 2 vote in favor of item 3 of the November 2012 Purchasing Report. In an effort to avoid lengthy debates regarding a purchasing item, Mr. Arriola requested that the PHT FRB be fully vetted (from both sides of an issue) before going forward and recommending it for approval.

Meeting Call to Adjourn The meeting of the Fiscal Committee adjourned at 11:09 a.m. Transcribed by Ivenette Cobb Executive Assistant Public Health Trust Financial Recovery Board

2. Financial Statements as of November 2012

3. Cost Accounting Update

Jackson Health System Aged Trial Balance

Accounts Receivables All Hospitals

November 2012

1

Revenue Cycle KPI’s

• POS increase by an additional 1% this would be approximately $5.5M increase • Increased Potential Medicaid Conversion factor by additional 5% and sustain • AR Greater than 90 days is an aggressive goal and already exceeds industry best practice • Reduction of Denials would be an impact of approximately $3M (note that denial % will fluctuate as denials are

appealed and final determination is obtained. Denial % is being measured on Fiscal Year to Date basis) • Reduction of late charges would impact productivity and ensure timely revenue cycle processes

KPI Best Practice /Benchmark Goal Actual Prior Month

POS 2% of net collections $ 1.8M $1.8M $1.8M

Potential Medicaid Conversion

% of approvals compared to referrals for the prior 90 days. 90% 89% 91%

AR Greater than 90 Days

Less than 25% of discharged AR 25% 30% 30%

Denial Reduce denial write-offs FYTD (FY12=2.6%) 2.3% 1.6% 1.7%

Revenue Integrity Reduce late charge (# of charges) greater than 5 days (FY12=2.4%) 1.5% 2.4% 1.4%

Cash Collections Goal Actual

November 2012 $90.6M $ 90.2M

Benchmarks obtained by: HARA & Advisory Board ** Internal Target. No industry benchmark available

2

Source: Dania Trasobares-Llópiz Director of Treasury Management (updated 11/06/12)

JHS CBO Cash Collections Month FY-12 Cash FY-13 Cash October $ 90,249,736 $ 93,035,086 November 83,841,693 $ 90,228,516 December 88,954,472 January 76,200,810 February 79,062,126 March 96,923,009 April 85,893,916 May 95,658,525 June 85,636,129 July 88,697,935 August 85,818,756 September 79,204,218 Total $ 1,036,141,325 $ 183,263,603

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International Services December 2012

1

Volumes & Dollars

VOLUMES / GROSS CHARGES Count Charges Count Charges Count Charges Count ChargesInpatient 726 66,006,213.76$ 880 85,068,660.79$ (154) (19,062,447) -18% -22%Outpatient 948 3,488,987.14$ 1156 7,483,068.23$ (208) (3,994,081) -18% -53%Total New Encounters 1674 69,495,200.90$ 2036 92,551,729.02$ (362) (23,056,528) -18% -25%

PAYMENTS Count Payments Count Payments Count Payment Count Net RevenueInpatient 918 (45,047,683.56) 777 (39,749,531.65) 141 5,298,152 18% 13%Outpatient 930 (2,011,935.28) 1157 (2,510,775.11) (227) (498,840) -20% -20%Total Completed Encounters 1848 (47,059,618.84) 1934 (42,260,306.76) (86) 4,799,312 -4% 11%

FY2012 FY2011 Change Year over YearSeptember 2012 YTD Total September 2011 YTD Total Absolute Percentage

September 2012 YTD Total September 2011 YTD Total Absolute PercentageFY2012 FY2011 Change Year over Year

2

Accomplishments

Reduced staff by 14 FTEs Expense Reduction (Down 33% from PY or $1,711,809 )

Brought in collections of international patients resulting on a savings of $1 million (UM fee)

Structured the outpatient appointment resulting in increased patient retention for and referrals to JMC providers.

Initiated revenue cycle meetings to increase collection rates, which resulted in a AR Clean-up / Net Revenue Increase

Creation of fee-for-service quotes Restructured scheduling to include JMG providers FYTD through September is a $6.5 million benefit

vs. PY same time period (increase revenue less expenses)

3

OVAG International Overview

4

• OVAG International is an international receivables Management company resolving exclusively cross border cases with focus on providing recovery solutions for collection of disputed and undisputed receivables. Working from their headquarters in Switzerland they utilize their own resources of multicultural, multilingual recovery specialists to offer you world-class service. • Why use them?

– Only used when internal collections efforts are exhausted.

– Contract is on a contingency fee basis, no payment = no fees.

– Their experience enables them to be the only international receivables management company that works exclusively on cross border cases. This specialization means that they have a unique combination of skills and knowledge that will be applied to our accounts.

Awarded through a competitive RFP Process

Placements & Collections

Note: • Placement of accounts are reviewed by CBO

leadership on a case by case basis. • Fees vary due to contracted fee caps.

Collections Fee Fee %FY # $ $ $ %

2008 159 14,789,855 3,302,425 342,725 10.38%2009 243 13,592,595 4,125,971 363,639 8.81%2010 161 2,889,047 1,219,773 121,042 9.92%2011 851 10,354,675 1,935,275 196,168 10.14%2012 307 5,851,101 3,287,149 360,989 10.98%Total 1,721 47,477,273 13,870,594 1,384,562 9.98%

OVAG AGENCYPlacements

5

6. Contract and Agreements

Agenda Item 6 (a) Fiscal Committee December 13, 2012


Resolution authorizing the President or his designee to approve and execute Renewal Agreements with the following Community Health Centers (Baker Act Match 2012-2013): 1. Citrus Health Network, Inc. 2. Citrus Health Network (CCSU), Inc. 3. Community Health of South Florida, Inc. 4. Miami Behavioral Health Center, Inc. 5. Jackson North Community Health Center 6. New Horizons CMHC, Inc. For the provision of mental health services in the total amount of $2,348,141 (John Repique, Sr. Vice President, Chief Administrative Officer and Chief Nursing Officer, Mental Health and Corrections Health Services, Jackson Health System)

WHEREAS, Jackson Memorial Hospital and all Community Mental Health Centers (CMHCs) located in

Miami-Dade County are designated receiving facilities for Baker Act (psychiatric) patients; and

WHEREAS, these CMHCs receive funding from the State of Florida, Department of Children and Families

which funding requires a 25% local matching funds contribution, which since the origin of this program have been

paid by the Public Health Trust; and

WHEREAS, as explained in the attached memorandum, staff recommends continuing this funding through

a contractual relationship from October 1, 2012, through September 30, 2013; and

WHEREAS, the Public Health Trust contribution of the 25% local match funding for each CMHC would

amount to: $488,878.00 to Citrus Health Network Community Mental Health Center, $489,739.00 to Citrus Health

Network (CCSU) Community Mental Health Center, $348,910.00 to Community Health of South Florida

Community Mental Health Center, $345,647.00 to Miami Behavioral Health Center, Inc. $335,957.00 to Jackson

North Community Mental Health Center, and $339,010.00 to New Horizons Community Mental Health Center, for

a total Public Health Trust contribution of $2,348,141.00 payable in twelve equal monthly installments; and

WHEREAS, the President and the Fiscal Committee recommend approval.

NOW, THEREFORE, BE IT RESOLVED BY THE FINANCIAL RECOVERY BOARD OF THE


President or his designee to approve and execute renewal agreements with the following Community Mental Health

Centers: Citrus Health Network, Inc., Citrus Health Network (CCSU) Inc., Community Health of South Florida,

Inc., Jackson North Community Mental Health Center, Miami Behavioral Health Center, Inc., and New Horizons

CMHC, Inc., for the provision of mental health services in the total amount of$2,348,141.

TO: The Financial Recovery Board of the Public Health Trust of Miami Dade FROM: John Repique, VP/Chief Administrative Officer Jackson Mental Health Hospital DATE: December 4, 2012 SUBJECT: Renewal of Baker Act Match Contracts for Mental Health RECOMMENDATION The President and CEO recommends that the Board hereby authorizes the renewal of Baker Act match contracts with all Community Mental Health Centers (CMHCs) located in Miami-Dade County designated by the Department of Children and Families for the provision of mental health services in District 11 (Miami-Dade and Monroe Counties), which by law (Fla. Stat. 394.76) mandates local participation on a 75-to-25 state-to-local ratio. Under this ratio, the applicable local participation for fiscal year October 1, 2012, to September 30, 2013, to be paid in 12 monthly installments, is as follows:

Community Mental Health Centers Annual 25% Match Funding

1 Citrus Health Network Community Mental Health Center $488,878.00

2 Citrus Health Network (CCSU) Community Mental Health $489,739.00

3 Community Health of South Florida Community Mental Health Center

$348,910.00

4 Miami Behavioral Health Center, Inc. $345,647.00

5 Jackson North Community Mental Health Center . $335,957.00

6 New Horizons Community Mental Health Center $339,010.00

TOTAL $2,348,141.00

BACKGROUND The Baker Act is the law governing involuntary hospitalization for psychiatric patients in Florida. Funding for designated Baker Act Receiving Facilities, which treat primarily indigent patients covered under this law (all CMHCs are such facilities), is provided under the state budget through the Department of Children and Families. Each county is required to match the state funds designated for these centers on a 75/25 ratio. In the mid 1980s, this obligation for Miami-Dade County was assumed by the Public

Health Trust. This year Baker Act contracts were finalized after the start of the current fiscal year due to state funding cycle necessities.

FY 2012-2013 BAKER ACT MATCH PAYMENT AGREEMENTS BETWEEN PUBLIC HEALTH TRUST AND

COMMUNITY MENTAL HEALTH CENTERS (CMHCs) REQUEST Staff requests renewal of Baker Act match contracts with all Community Mental Health Centers

(CMHCs) located in Miami-Dade County designated by the Department of Children and Families for the

provision of mental health services in District 11 (Miami-Dade and Monroe Counties), which by law (Fla.

Stat. 394.76) mandates local participation on a 75-to-25 state-to-local ratio. Under this ratio, the

applicable local participation for fiscal year October 1, 2012, to September 30, 2013, to be paid in 12

monthly installments, is as follows:


1 Citrus Health Network Community Mental Health Center $488,878.00 2 Citrus Health Network (CCSU) Community Mental Health $489,739.00 3 Community Health of South Florida Community Mental Health

Center $348,910.00

4 Miami Behavioral Health Center, Inc. $345,647.00 5 Jackson North Community Mental Health Center . $335,957.00 6 New Horizons Community Mental Health Center $339,010.00 TOTAL $2,348,141.00.00

BACKGROUND The Baker Act is the law governing involuntary hospitalization for psychiatric patients in Florida.

Funding for designated Baker Act Receiving Facilities, which treat primarily indigent patients covered

under this law (all CMHCs are such facilities), is provided under the state budget through the Department

of Children and Families. Each county is required to match the state funds designated for these centers on

a 75/25 ratio. In the mid 1980s this obligation for Miami-Dade County was assumed by the Public

Health Trust. This year Baker Act contracts were finalized after the start of the current fiscal year due to

state funding cycle necessities.

Agenda Item 6 (b) Fiscal Committee December 13, 2012

PHT RESOLUTION NO. 12/12 –

RESOLUTION AUTHORIZING EXECUTION OF A SETTLEMENT AGREEMENT WITH AND PYMENT TO THE UNIVERSITY OF MIAMI DEPARTMENT OF PSYCHIATRY IN THE AMOUNT OF TWO HUNDRED TWENTY FIVE THOUSAND, ONE HUNDRED THIRTY SEVEN DOLLARS AND TWENTY SIX CENTS ($225,137.26) AS A FULL AND FINAL SETTLEMENT FOR SERVICES PROVIDED BY THE UNIVERSITY OF MIAMI DEPARTMENT OF PSYCHIATRY AT JACKSON MENTAL HEALTH HOSPITAL

(John Repique, Sr. Vice President, Chief Administrative Officer and Chief Nursing Officer, Mental Health and Corrections Health Services, Jackson Health System)

WHEREAS, the Public Health Trust operates the Jackson Mental Health Hospital (“JMHH”)

which includes providing mental health crisis emergency department services daily; and

WHEREAS, in 2011, the Chief Administrative Officer of the JMHH arranged for staffing of the

Emergency Department by the University of Miami Department of Psychiatry (“Department”); and

WHEREAS, the Department agreed to provide physician coverage for the JMHH Emergency

Department with the expectation the services would be compensated through the Annual Operating

Agreement between the Public Health Trust and University of Miami; and

WHEREAS, the Department staffed the JMHH Crisis ER with psychiatrists during the period of

October 1, 2011 through May 31, 2012; and

WHEREAS, the JMHH received the services beginning October 1, 2011 but did not compensate

the Department through the Annual Operating Agreement for those services; and

WHEREAS, the parties have mutually agreed to a Settlement Agreement, in substantially the form

attached hereto, which provides payment for the provided services; and

WHEREAS, the administration recommends authorizing the Settlement Agreement and payment

of $225,137.26 as being in the best interest of the Public Health Trust in order to avoid the expense of

uncertainty of litigation.

Agenda Item 6 (b) Fiscal Committee December 13, 2012

-Page 2-

NOW, THEREFORE, BE IT RESOLVED BY THE FINANCIAL RECOVERY BOARD OF

THE PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby

authorizes the Public Health Trust President and Chief Executive Officer or his designee to execute a

Settlement Agreement with and to pay the University of Miami Department of Psychiatry in the amount of

Two Hundred Twenty Five Thousand, One Hundred Thirty Seven Dollars and Twenty Six Cents

($225,173.26) as settlement in full for Jackson Mental Health Hospital Crisis ER coverage during the

period of October 1, 2011 through May 31, 2012 provided by the University of Miami Department of

Psychiatry Department at Jackson Mental Health Hospital.

To: Financial Recovery Board Public Health Trust From: John Repique VP/Chief Administrative Officer Jackson Mental Health Hospital Date: December 6, 2012 Subject: Settlement Agreement for Psychiatric Services between the Public Health Trust

of Miami-Dade County and the University of Miami Department of Psychiatry REQUEST: Approval of payment in the amount of $225,137.26 to the University of Miami Department of Psychiatry (“Department”) as part of a settlement agreement (and execution of said agreement) resolving a payment dispute for services provided by the Department at Jackson Mental Health Hospital (“JMHH”). BACKGROUND: In October of 2011, Ms. Melida Akiti (Former JMHH Vice President/CAO) discussed modifying the JMHH relationship with the Department, intending to reallocate the money paid to the Department through the Annual Operating Agreement (“AOA”). The proposed changes consisted of removing Recruitment payments and adding Crisis ER physician coverage as a purchased services line item to the AOA. Although a written agreement was never generated from this verbal discussion to note the changes officially the Department provided the discussed coverage in good faith. In an effort to resolve this earned-but-unpaid-compensation matter expeditiously and amicably, the parties have agreed to settle any potential dispute regarding payment for services rendered through a settlement agreement. The parties have agreed that payment shall be in the amount of two hundred twenty five thousand, one hundred thirty seven dollars and twenty six cents ($225,137.26) for Crisis ER physician coverage services rendered by the Department from October 1, 2011 to May 31, 2012. This amount is calculated by using $160.000 as base salary for the psychiatrists, which is within the recommended range of the AAMC salary survey and including adjustments made to offset collections The Jackson Mental Health Hospital and the University of Miami/Department of Psychiatry agree that this amount represents full and correct payment for the services provided. These dollars are budgeted and included in the approved FY 11-12 operating budget for JMHH, and expenses have been accrued for the period of time services were provided by the Department at JMHH. RECOMMENDATION: That the Financial Recovery Board of the Public Health Trust approves payment in the amount of two hundred twenty five thousand, one hundred thirty seven dollars and twenty six cents ($225,137.26) to the University of Miami Department of Psychiatry for physician services provided by the Department at JMHH Crisis ER unit during October 2011 to May 2012.

November 2, 2012 Attention: Jared Abramson, Vice Chairman for Administration Miami, Fl - 33136 Re: Settlement Agreement for Psychiatric Emergency Services between the Public Health Trust of Miami-Dade County and the University of Miami Department of Psychiatry and Behavioral Sciences Dear Mr. Abramson: The Public Health Trust has been in negotiation with the Department of Psychiatry and Behavioral Sciences at the University of Miami (“UM”) since October 1st, 2011, to finalize the terms and conditions of the Psychiatric Emergency Services Contract at Jackson Mental Health Hospital. Despite extensive negotiations, the parties have not yet executed said contract. The parties agree that the Department of Psychiatry and Behavioral Sciences at the University of Miami has provided Psychiatry attending services in the Crisis Emergency Room in good faith at Jackson Mental Health Hospital for the months October 1st, 2011through May 31st, 2012. The services were rendered based on the understanding that the Department of Psychiatry and Behavioral Sciences would get reimbursed based on mutually agreed upon conditions: (1) the University of Miami would provide up to 5 physician FTEs at an annual total compensation of $160,000 each; (2) University of Miami would provide up to 500 hours of moonlighting services reimbursed at $90/hr; (3) The Trust will net the collections for each active physician assigned to Crisis against their total compensation; (4) The Trust would reimburse the University of Miami 8.5% of collections for billing of the physician charges. UM has not received the anticipated compensation, although the parties acknowledge the services were provided to the Trust. At this time, to avoid the expense and uncertainty of litigation and to resolve this matter expeditiously and amicably, the parties have agreed to settle any potential dispute regarding payment for the services rendered. Both parties have agreed to the total amount of two hundred twenty five thousand, one hundred thirty seven dollars and twenty six cents ($225,137.26), payable within 60 days of the execution of this letter of settlement agreement, as the settlement payment amount to resolve this dispute. This document serves as a settlement agreement for the payments to be made by the Public Health Trust to the University of Miami Department of Psychiatry and Behavioral Sciences for providing Psychiatry attending services in Crisis during the period October 1st, 2011 to May 31st, 2012. This settlement agreement is a resolution of disputed sums and shall not be deemed an admission of liability by any party.

Subject to the noted payment for services rendered, the University and Department of Psychiatry and Behavioral Sciences hereby release, waive and forever discharge the Trust with respect to any and all claims, causes of action, lawsuits, arbitrations, debts, sums of money, demands, liabilities, damages or losses of every kind and character, whether asserted or unasserted, whether known or unknown, suspected or unsuspected, in law or in equity, in connection with the Public Health Trust’s payment for the Psychiatry attending services identified above. This release does not release the Public Health Trust from any medical malpractice claims arising out of the medical services provided by the Psychiatry attending services to patients of the Trust. The parties agree, as expressed in the Annual Operating Agreement, that the Psychiatry attending services were serving as agents of the Trust when providing the referenced services and treating Trust patients. Thus, the Trust believes sovereign immunity should address said medical malpractice claims. To the extent you desire to agree with the terms specified in the above paragraphs of this Agreement, please indicate your acceptance of the Public Health Trust’s offer by signing this letter and returning an executed copy to the Administrative Offices of Jackson Mental Health Hospital, Miami, Florida 33136. The copy of such letter, as executed by you on behalf of the University of Miami Department of Psychiatry and Behavioral Sciences, shall serve as the mutual written agreement and will also serve as an evidence of the existing relationship between the parties. Should you have any questions, please feel free to contact R. John Repique, Vice President and Chief Administrative Office, at (305) 355-8234.

Sincerely,

THE PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA

____________________________________

Carlos Migoya, MBA President and Chief Executive Officer ACCEPTED AND ACKNOWLEDGEMENT, ____________________________________ Charles B. Nemeroff, MD, PhD

Leonard M. Miller Professor and Chair Department of Psychiatry and Behavioral Sciences University of Miami Miller School of Medicine Clinical Service Chief, Jackson Memorial Hospital

Agenda Item 6 (c) Fiscal Committee

December 13, 2012


RESOLUTION AUTHORIZING AND APPROVING THE PRESIDENT OF THE PUBLIC HEALTH TRUST TO EXECUTE MEMORANDUM OF UNDERSTANDING BY AND BETWEEN MIAMI-DADE COUNTY AND THE PUBLIC HEALTH TRUST REGARDING THE REVOLVING LINE OF CREDIT FACILITY TO BE PROVIDED BY WELLS FARGO BANK, N.A. IN AN AMOUNT NOT TO EXCEED $75,000,000, SUBJECT TO APPROVAL BY THE BOARD OF COUNTY COMMISSIONERS BY ORDINANCE

(Brian Dean, Vice President, Finance Division, Jackson Health System) WHEREAS, in October 2012, the Financial Recovery Board approved Resolution No. PHT 10/12-

074 requesting and recommending that the Board of County Commissioners (the “Commission”) authorize

and approve the establishment of a revolving line of credit in an amount not to exceed $75,000,000 with

Wells Fargo Bank, N.A. for the benefit of the Public Health Trust (the “Trust”); and

WHEREAS, based upon such request, on December 4, 2012, the Commission adopted an

Ordinance on first reading to approve issuance and terms of the Wells Fargo Bank, N.A. revolving line of

credit facility on behalf of the Trust in an amount not to exceed $75,000,000; and

WHEREAS, because Miami-Dade County is securing the credit facility with its credit on behalf of

the Trust, it is necessary that the Miami-Dade County and the Trust enter into the attached Memorandum of

Understanding for the purposes of governing the Trust’s repayment obligation to Miami-Dade County and

other obligations relating to the revolving line of credit; and

WHEREAS, the President and Fiscal Committee recommend authorizing and approving the

President’s execution of the Memorandum of Understanding by and between Miami-Dade County and the

Trust, subject to the Commission’s passing and adopting the Ordinance regarding the Wells Fargo Bank,

N.A. revolving line of credit facility.



authorizes the President to execute the attached Memorandum of Understanding by and between Miami-

Dade County and the Public Health Trust regarding the revolving line of credit facility to be provided by

Wells Fargo Bank, N.A. in an amount not to exceed $75,000,000, subject to approval by the Board of

County Commissioners by Ordinance.

Agenda Item 6 (f) Fiscal Committee December 13, 2012


RESOLUTION AUTHORIZING PAYMENT TO THE UNIVERSITY OF MIAMI DEPARTMENT OF SURGERY IN THE AMOUNT OF SIX HUNDRED THIRTY FOUR THOUSAND DOLLARS AND ZERO CENTS ($634,000.00) AS A FULL AND FINAL SETTLEMENT FOR SERVICES PROVIDED BY THE UNIVERSITY OF MIAMI DEPARTMENT OF SURGERY AT HOLTZ CHILDREN’S HOSPITAL

(Steven Burghart, Sr. Vice President and Chief Administrative Officer, Holtz Children’s Hospital & Women’s Hospital Center, Jackson Health System)

WHEREAS, the Public Health Trust operates the Holtz Children’s Hospital (“HCH”) which

includes providing pediatric cardio thoracic surgery services daily; and

WHEREAS, in October 2009, the Chief Administrative Officer of the HCH arranged for pediatric

cardio thoracic surgeries to be provided from the University of Miami Department of Surgery

(“Department”); and

WHEREAS, the Department agreed to provide pediatric cardio thoracic surgery physician

coverage to the HCH for pediatric cardio thoracic surgeries with the expectation the services would be

compensated through the Annual Operating Agreement between the Trust and the University of Miami;

and

WHEREAS, the Department staffed the HCH pediatric cardio thoracic surgeries with pediatric

cardio thoracic surgeons during the period of October 1, 2009 through May 31, 2012; and

WHEREAS, the HCH received the services beginning October 1, 2009 but did not compensate the

Department through the Annual Operating Agreement for those services; and

WHEREAS, the parties have mutually agreed to a Settlement Agreement which provides payment

for the provided service; and

Agenda Item 6 (f) Fiscal Committee December 13, 2012

-Page 2-

WHEREAS the administration recommends authorizing the Settlement Agreement and payment

of $634,000.00 as being in the best interest of the Trust in order to avoid the expense and uncertainty of

litigation.


PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that authorization is hereby given

to pay the University of Miami Department of Surgery in the amount of six hundred thirty four thousand

and zero cents ($634,000.00) as settlement in full for Holtz Children’s Hospital pediatric cardio thoracic

surgery coverage during October 1, 2009 through May 31, 2012 provided by the University of Miami

Department of Surgery at Holtz Children’s Hospital.

To: Fiscal Affairs, Financial Recovery Board Public Health Trust From: Steven Burghart Chief Administrative Officer Holtz Children’s Hospital and Jackson Women’s Hospital Center Date: Settlement Agreement for Pediatric Cardio Thoracic Surgery Services between the Public

Health Trust of Miami-Dade County and the University of Miami Department of Surgery REQUEST: Approval of payment in the amount of $634,000.00 to the University of Miami Department of Surgery (“Department”) as a settlement agreement for services provided by the Department at Holtz Children’s Hospital (“HCH”). These dollars are budgeted and included in the approved FY 10-12 operating budgets for HCH, and expenses have been accrued for the period of time services were provided by the Department at HCH. BACKGROUND: In October 2009 HCH discussed an agreement with the Department, to have the Department provide pediatric cardio thoracic surgeons for pediatric thoracic surgeries on a go forward basis. These services were intended to become part of the AOA agreement but were never executed officially, while the Department provided the pediatric cardio thoracic surgeon coverage in good faith. In an effort to resolve this earned-but-unpaid-compensation matter expeditiously and amicably, the parties have agreed to settle any potential dispute regarding payment for services rendered through a settlement agreement, The parties have agreed that payment shall be in the amount of six hundred thirty four thousand dollars and zero cents ($634,000.00) for pediatric cardio thoracic surgery services rendered by the Department from October 1, 2009 to May 31, 2012. The Holtz Children’s Hospital and the University of Miami/Department of Surgery agree that this amount represents full and correct payment for the services provided. RECOMMENDATION: That the Financial Recovery Board of the Public Health Trust approves payment in the amount of six hundred thirty four thousand dollars and zero cents ($634,000.00) to the University of Miami Department of Surgery for physician services provided by the Department at HCH during October 2009 to May 2012.

November 20, 2012 Attention: Alan Livingstone, MD Miami, Fl - 33136 Re: Settlement Agreement for Pediatric Cardio-Thoracic Surgery between the Public Health Trust of Miami-Dade County and the University of Miami Department of Surgery. Dear Dr. Livingstone: The Public Health Trust has been in negotiation with the Department of Surgery at the University of Miami (“UM”) since October 2009, to finalize the terms and conditions of the Pediatric Cardio-Thoracic Surgery Services Contract at Holtz Children’s Hospital. UM maintains that based on representations from the Chief Executive Officer of the Jackson Health System, UM employed Drs. Eliot Rosenkranz and Marco Ricci and provided Cardio Thoracic Surgery services in reliance on Jackson Health System’s agreement to reimburse the Department of Surgery. The parties agree that the Department of Surgery at the University of Miami has provided Cardio Thoracic Surgery services in good faith at Holtz Children’s Hospital for the months October 2009 through May 2012. UM maintains that the services were rendered based on the understanding that the Department of Surgery would get reimbursed at fair market value for this provision of purchased services based on the terms of the applicable Basic Affiliation Agreement and Annual Operating Agreements. At this time, to avoid the expense and uncertainty of litigation and to resolve this matter expeditiously and amicably, the parties have agreed to settle any potential dispute regarding payment for the services rendered. This document serves as a settlement agreement for the payments to be made by the Public Health Trust to the University of Miami Surgery Department for providing Cardio Thoracic Surgery services for the period October 2009 through May 2012. This settlement agreement is a resolution of disputed sums and shall not be deemed an admission of liability by any party. Subject to the noted payment for services rendered, the University and Department of Surgery hereby release, waive and forever discharge the Trust with respect to any and all claims, causes of action, lawsuits, arbitrations, debts, sums of money, demands, liabilities, damages or losses of every kind and character, whether asserted or unasserted, whether known or unknown, suspected or unsuspected, in law or in equity, in connection with the Public Health Trust’s payment of $634,000 representing the outstanding balance for the Cardio Thoracic Surgery services as identified above. This release does not release the Public Health Trust from any medical malpractice claims arising out of the medical services provided by Drs. Rosenkranz or Ricci to patients of the Trust. The parties agree, as expressed in the Annual Operating Agreement, that Drs. Rosenkranz or Ricci were serving as agents of the Trust when providing the referenced services and treating Trust patients. Thus, the Trust believes sovereign immunity should address said medical malpractice claims.

To the extent you desire to agree with the terms specified in the above paragraphs of this Agreement, please indicate your acceptance of the Public Health Trust’s offer by signing this letter and returning an executed copy to the Administrative Offices of the JHS Department of Physician Services, Miami, Florida 33136. The copy of such letter, as executed by you on behalf of the University of Miami Department of Surgery, shall serve as the mutual written agreement and will also serve as an evidence of the existing relationship between the parties. Should you have any questions, please feel free to contact Mitchell Wallace, Director of Finance, Holtz Children’s Hospital and the Women’s Center at Jackson Health System, at (305) 585-7911. Sincerely, THE PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA ____________________________________ Carlos A. Migoya President and Chief Executive Officer ACCEPTED AND ACKNOWLEDGEMENT, ____________________________________ Alan Livingstone, MD Professor and Chair Department of Surgery University of Miami Miller School of Medicine Clinical Service Chief, Jackson Memorial Hospital ____________________________________ Humberto Speziani Assistant Vice President of Business Services University of Miami

7. Pension Plan Subcommittee Report

7 (1) Resolutions recommended to be approved

Agenda Item 7 (1) (a) Fiscal Committee December 13, 2012


RESOLUTION APPROVING THE PUBLIC HEALTH TRUST DEFINED BENEFIT RETIREMENT PLAN ACTUARIAL REPORT FOR THE PLAN YEAR ENDING DECEMBER 31, 2013

(Brian Dean, Vice President, Finance Division, Jackson Health System)

WHEREAS, the Public Health Trust Defined Benefit Retirement Plan (“Plan”) as required under Part VII,

Chapter 112, Florida Statutes requiring Actuarial Valuations on the Plan’s condition; and

WHEREAS, this Actuarial Report is presenting to management the contribution requirements for the 2013

Plan Year and also the current funding of Plan Accumulated Benefits; and

NOW, THEREFORE, BE IT RESOLVED BY THE FINANCIL RECOVERY BOARD OF THE PUBLIC

HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby approves the Public Health

Trust Defined Retirement Plan Actuarial Report for the Plan Year ending December 31, 2013.

Agenda Item 7 (1) (b) Fiscal Committee December 13, 2012


RESOLUTION APPROVING THE PUBLIC HEALTH TRUST DEFINED BENEFIT RETIREMENT PLAN AMENDED INVESTMENT POLICY STATEMENT


WHEREAS, this Board seeks to accomplish certain investment objectives for the Defined Benefit

Retirement Plan; and

WHEREAS, this Amended Investment Policy Statement establishes the policy by which investment

activities are to be in conducted; and

WHEREAS, the Pension Plan Subcommittee and Fiscal Committee recommend approval.


PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby approves the

Amended Investment Policy Statement.

Agenda Item 7 (1) (c) Fiscal Committee December 13, 2012


RESOLUTION APPROVING THE PUBLIC HEALTH TRUST APPOINTMENT OF PETER L. BERMONT TO THE PENSION PLAN SUBCOMMITTEE


WHEREAS, this Board seeks to add an at-large member from the community to the Pension Plan

Subcommittee; and



PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby approves the addition

of Peter L. Bermont to the Pension Plan Subcommittee as the at-large member, as more fully set forth in the

memorandum attached hereto and incorporated herein.


1611 N.W. 12th Avenue

West Wing – Rm 108

Miami, Fla 33136

Telephone: 305-585-6778

MEMORANDUM

TO: Financial Recovery Board Public Health Trust FROM: Brian Dean, Vice President, Finance DATE: 12/13/2012 SUBJECT: Pension Plan Subcommittee At-Large Member Recommendation

Recommendation That this Board hereby approves the appointment of Mr. Peter L. Bermont to the Pension Plan Subcommittee. Background The Investment Policy Statement (“IPS”) adopted by the FRB specified the addition of an At-Large member to the Pension Plan Committee as its seventh member. The At-Large member must meet certain experience and background requirements as outlined in section 1 of the IPS. Attached to this memorandum is the CV for Mr. Peter L. Bermont. Mr. Bermont’s vast experience in institutional asset management as well as the nuances of defined benefit plans provides support for his candidacy for the At-Large Pension Plan Committee Member.

8. Facilities Subcommittee Report

8 (1) Resolution recommended to be approved

Agenda Item 8 (1) (a) Fiscal Subcommittee December 13, 2012

RESOLUTION NO. PHT 12/12–
















REQUEST




December 13, 2012





(for 3 years)




Background















Recommendation








(for 6 years)












Recommendation








(for 5 years)


Background








Urine Immunotyping

Hemoglobinopathy

Thalassemia testing









No items to report.



JOINT CONFERENCE AND EFFICIENCIES COMMITTEE


Joint Conference & Efficiencies Committee Stephen S. Nuell, Chairperson Joe Arriola, Vice Chairperson Michael Bileca Joaquin del Cueto Mojdeh L. Khaghan Marcos Jose Lapciuc Darryl K. Sharpton

Date, Time and Location December 13, 2012 – To follow the Fiscal Committee meeting Ira C. Clark Diagnostic Treatment Center Conference Room 259

AGENDA


(Stephen S. Nuell, Chairperson)

(a) *Meeting Minutes as of November 15, 2012

2. Chief Medical Officer Report (Michael Butler, MD, Executive Vice President, Chief Medical Officer, Jackson Health System)

3. President of the Executive Medical Committee of the Medical Staff Report (Joshua Lenchus, DO, RPh, FACP, SFHM, President, Executive Medical Committee of the Medical Staff, Jackson Health System)

4. Review of the Credentials Committee Decisions

(Joshua Lenchus, DO, RPh, FACP, SFHM, President, Executive Medical Committee of the Medical Staff, Jackson Health System)

(a) Review and Recommend Approval of the Credentials Activity Report – December 2012

(Support document will be distributed at the meeting.)

(b) Resolutions recommended to be approved

(1) *Resolution approving and adopting a Jackson Health System Surgical Assistant (SA) delineation of privileges of the Medical Staff – December 2012 (Kevin Andrews, Vice President, Quality and Patient Safety Division, Jackson Health System)

(2) *Support document for agenda item 4 (b) (1)

(3) *Resolution approving and adopting a Jackson Health System

Optometrist delineation of privileges of the Medical Staff – December 2012 (Kevin Andrews, Vice President, Quality and Patient Safety Division, Jackson Health System)

(4) *Support document for agenda item 4 (b) (3)

5. Standing Reports

(a) *Service Excellence Update Presentation (Anne Prendergast, Assistant Director, Leadership and Organizational Development, Human Resources Capital Management, Jackson Health System)

(b) Scorecard and Bridges to Quality Report

(Kevin Andrews, Vice President, Quality and Patient Safety Division, Jackson Health System)

Agenda items noted with an asterisk (*) indicates that the supporting documents are attached.


Joint Conference & Efficiencies Committee Stephen S. Nuell, Chairperson Joe Arriola, Vice Chairperson Michael Bileca Joaquin del Cueto

Mojdeh L. Khaghan Marcos Jose Lapciuc

Darryl K. Sharpton

Date, Time and Place November 15, 2012 – Immediately followed the Fiscal Committee meeting Ira C. Clark Diagnostic Treatment Center Conference Room 259

ATTENDANCE

Joint Conference & Efficiencies Committee Stephen S. Nuell Joe Arriola Joaquin del Cueto Mojdeh L. Khaghan Marcos Jose Lapciuc Darryl K. Sharpton Excused Michael Bileca Jackson Health System Kevin Andrews Carlos A. Migoya Michael Butler, MD Joshua Lenchus, DO Don S. Steigman Matthew Pinzur Ed O’Dell Jeffrey Crudele Rosa Costanzo Miami-Dade County Attorney Christopher Kokoruda

Joint Conference & Efficiencies Committee Meeting November 15, 2012 Page 2 of 4 CALL TO ORDER With a quorum being present, the Joint Conference & Efficiencies Committee meeting was called to order by Stephen S. Nuell, Chairperson at 11:30 a.m. Mr. Nuell announced that items 5b, the Corrections Health Service Department of Justice Report and 5c, the Resolution authorizing execution of consent agreement and authorizing and directing actions as are necessary to implement said consent agreement with the U.S. Department of Justice (“DOJ”) regarding alleged violations in DOJ findings letter dated August 24, 2011, were removed from the agenda. 1. APPROVAL OF THE PREVIOUS MEETING MINUTES

(a) Meeting Minutes as of October 18, 2012

Mr. Nuell requested approval of the October 18, 2012 meeting minutes.

The meeting minutes of October 18, 2012, was approved as presented.

2. CHIEF MEDICAL OFFICER REPORT

Michael Butler, MD, Chief Medical Officer, Jackson Health System reported the following:

• Building infrastructures that ensure each patient’s chart includes accurate documentation of the Attending’s presence and of appropriate supervision, as well as improve the process for orders.

• Clinical Champions had a meeting to look at optimizing EHR/MHR and other related clinical software. • Continuing to look at methods to further drive down the Length of Stay during the new budget year to be

competitive. • A LIP Grant of approximately $3.5 million has been awarded to Jackson Health System to support the sustainability

model, to transform the Primary Care Delivery Model and the Health Information Exchange.

• Continuing to work with Credentialing to get the application process within 45- 60 days. 3. PRESIDENT OF THE MEDICAL STAFF REPORT

Joshua Lenchus, DO, Chairman of the Medical Staff reported the following: • The Level 2 Trauma initiative at Jackson North Medical Center is ongoing and the construction is underway at

Jackson South Community Hospital.

4. REVIEW OF THE CREDENTIALS COMMITTEE DECISIONS

(a) The Committee reviewed for approval the Credentials Committee Activity Report for the month of November 2012. (See attached summary report.)

Mr. Nuell requested a motion for the item.

Mr. Arriola moved approval; seconded by Mr. del Cueto and

carried without dissent. The Committee was provided with a copy of the November 2012 Credentialing Report.

Conference & Efficiencies Committee Meeting November 15, 2012 Page 3 of 4 5. STANDING REPORTS

a. LIP and HEN Project Update Kevin Andrews, Vice President of Quality & Patient Safety provided a brief update regarding the LIP and HEN Projects and how projects of multiple areas have crossed over in an effort to reach the goal of funding and managing patient care more globally. To do this, teams are being developed to look at key indicators systematically. He reviewed with the Committee that this project began over 1-1/2 years ago which included utilizing the vendor, Independent Living Systems (ILS), to provide at home patient management pilot and demonstrated a reduction in readmission. There is no magic bullet to reduce re-admissions, it is multi-factorial, primary care and management of populations at home. The Committee was provided with copies of supportive documentation.

b. Corrections Health Service Department of Justice Report

This item was deleted from the agenda.

c. Resolution This item was deleted from the agenda.

d. Scorecard and Bridges to Quality Report Kevin Andrews, Vice President of Quality & Patient Safety presented regarding the balanced scorecard and how there continues to be room for improvement. In coming months there will be more yellow and green due to team development and engaging the right people.

Reviewing trend scores showed that Jackson South Community Hospital is doing great, Jackson North Medical Center is showing significant improvement and that Jackson Memorial Hospital Main Campus has plateaued. Mr. Andrews explained that culture is difficult to change, but next month Service Excellence will present to the Committee regarding attitude and service issues with employees.

ADJOURNMENT

The Joint Conference & Efficiencies Committee meeting adjourned at 12:39 p.m. Transcribed by Kimberly A. Calhoun, Executive Assistant Quality and Patient Safety Division Jackson Health System

CREDENTIALS COMMITTEE MONTHLY ACTIVITY REPORT

NOVEMBER 2012

Medical Staff

Health Professional

Affiliate Initial Applicant(s) ( 14 ) – Community Physician(s) ( 12 ) – Academic Physician(s) 26 7 Provisional Annual Evaluations 18 1 Reappointments(s) 114 15 Reappointments(s) Reinstatements 2 0 Termination 0 0 Notification of Site(s) of Practice a. Correction of Clinical Privileges 0 0 b. Request for Additional Privileges 9 0 c. Change of Membership Category 4 0 d. Additional/Change Sponsor 0 3 e. Additional Service 0 0

f. Request for Change of Service/Clinical Privileges 0 0

g. Delete Sponsor/Privileges 0 0 h. Denial of Clinical Privileges – Modified 0 0 i. Relinquish Clinical Privileges/Facility 6 0 j. Request for reduction of clinical privileges 0 0 k. Deceased 0 0 l. Request for Leave of Absence 0 0 Resignation(s) 10 7 Voluntary Withdrawal and Voluntary Relinquishment of Membership and Privileges: a. Incomplete Reappointment(s) 0 1 b. Reappointment Application Not Returned 1 1 c. Lack of Utilization 0 0

2. Chief Medical Officer Report

3. President of the Executive Medical Committee of the Medical Staff Report

4. Review of the Credentials Committee Decisions

4 (a) Review and Recommend Approval of the Credentials Activity Report – December 2012

4 (b) Resolutions recommended to be approved

Agenda Item 4 (b) (1) Joint Conference & Efficiencies Committee December 13, 2012


RESOLUTION APPROVING AND ADOPTING A JACKSON HEALTH SYSTEM SURGICAL ASSISTANT (SA) DELINEATION OF PRIVILEGES OF THE MEDICAL STAFF – DECEMBER 2012


WHEREAS, the Medical Staff Surgical Assistant delineation of privileges (“SA DOP”) was revised so as

to be in compliance with the Joint Commission on Accreditation of Health Care Organization standards, statutory

requirements, and the current practice of the Medical Staff; and

WHEREAS, the Medical Executive Committee of the Medical Staff reviewed and approved the changes to

the SA DOP on November 13, 2012; and

WHEREAS, the recommended revisions were provided to the Joint Conference & Efficiencies Committee

on

December 13, 2012; and

WHEREAS, a copy of the SA DOP, as amended, has been attached hereto and incorporated herein by reference.


PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that it hereby adopts the attached

comprehensive amendment to the Public Health Trust Surgical Assistant delineation of privileges of the Medical Staff; and that this

resolution shall be effective upon its passage.

NAME: _______________________________________________

Jackson Health System - Delineation Of Privileges - SURGICAL ASSISTANT JMH JNMC JSCH Requested Approved Condition

ALL

QUALIFICATIONS: Current demonstrated competence and an adequate volume of current experience with acceptable results and certification by, or formal active participation in the examination process leading to certification by the American Board and Surgical Assistants (ABSA) and/or National Board of Surgical Technology and SUrgical Assisting (NBSTSA). ______ ______ ______

Physician (U.S. or Foreign trained must provide evidence of Florida licensed MD or DO

or

Medical School graduate (ACGME approved) possessing an MD or DO degree and a Florida training license.or

Graduate of a Foreign Medical School and possesion of an ECFMG or qualified to sit for the ECFMG exam.and

A minimum of two years primary or advance surgical experience.

and

Provide evidence of having first assisted on at least 400 clinical surgical cases or 1500 clinical surgical hours at a Joint Commission (JC) accredited facility or in a U.S. approved program, during the past two years, where applicant is listed as the first assistant on the operative record. (Case log or computer print out required).

Florida licensed Nurses (RN's), Florida Licensed Practical Nurses (LPN's) or Certified Surgical Technologists (CST's) must provide evidence of completion of an American Board of Surgical Assistants (ABSA) aprpoved or Commission on Accreditation of Allied Health Education Programs (CAAHEP) approved formal surgical assistant training program and evidence of active participation in the certification exam process.

Physician Assistants and Nurse practitioners must provide evidence of current Florida licensure and documentation of having first assisted on at least 400 clinical surgical cases or 1500 clinical surgical hours at a JC accredited facility during the last two years where the applicant was listed as the surgical assistant on the record.

ACLS Certification required. (Note: BLS has been removed not a JHS Requirement)

MEDICAL RECORDS JMH JNMC JSCH

Dictate/Write History and Physical (to be countersigned by physician within 24 hours).______ ______ ______

Dictate/Write Progress Notes (to be countersigned by physician within 24 hours). ______ ______ ______ Dictate Discharge Summaries (to be countersigned by physician within 24 hours). ______ ______ ______

MEDICAL HISTORY AND PHYSICAL

Interview patient for medical history. ______ ______ ______ Perform general screening physical exam (as approved by physician employer). ______ ______ ______

PERFORM SPECIALTY PHYSICAL EXAM AND EVALUATION, SUCH AS:

Respiratory ______ ______ ______ Cardiovascular ______ ______ ______ Gastrointestinal ______ ______ ______ ENT ______ ______ ______ Neurological ______ ______ ______ Skeletal ______ ______ ______ Gynecology ______ ______ ______ Genito-Urinary ______ ______ ______

ROUTINE THERAPEUTIC DUTIES JMH JNMC JSCH

Cleanse and dress wounds.______ ______ ______

Suture minor wounds and lacerations (in the presence of physician employer).______ ______ ______

Remove sutures/staples.______ ______ ______

Perform nasogastric intubation.

______ ______ ______ Insert and change catheters.

______ ______ ______ Remove fecal impaction.

______ ______ ______ Assist with specifically requested by physician employer as follows:

______ ______ ______

PATIENT CONTACT DUTIES

Provide counseling on health habits, exercise, tobacco, alcohol. Supportive counseling.______ ______ ______

Provide discharge instructions as per physician employer's orders. ______ ______ _______________________________________________________________

DUTIES THAT MAY BE PERFORMED ONLY IN THE PHYSICAL PRESENCE OF THE

SPONSORING PHYSICIAN.

Assist in surgery. ______ ______ ______ Assist in management of injuries. ______ ______ ______ Assist in management of acute medical emergencies. ______ ______ ______ Assist in Critical Care Unit. ______ ______ ______ Emergency Tracheostomy. ______ ______ ______ Cut Down. ______ ______ ______Close Incisions. ______ ______ ______ Emergency Intubation.

______ ______ ______ Emergency Subclavian I.V. ______ ______ ______ Emergency Insert Chest Tubes. ______ ______ ______ Arterial Puncture. ______ ______ ______Clamp, ligate, and cut tissue per surgeon’s directive ______ ______ ______Harvest saphenous vein, including skin incision, per surgeon’s directive ______ ______ ______Dissect common femoral artery and bifurcate per surgeon’s directive

______ ______ ______Maintain integrity of sterile field

______ ______ ______Close all wound layers (facia, subcutaneous and skin) as per surgeon’s directive

______ ______ ______Insert drainage tubes per surgeon’s directive

______ ______ ______Select and apply wound dressings ______ ______ ______Assist with resuscitation of patient during cardiac arrest or other life-threatening events in the operating room ______ ______ ______Perform any other duties or procedures incident to the surgical procedure deemed necessary and as directed by the surgeon ______ ______ ______

Insertion laminaria in nonviable pregnancies ______ ______ ______Removal surgical staples/sutures ______ ______ ______Assist in External Version ______ ______ ______Wound dressing ______ ______ ______ (Note: This section reserved for use in describing conditional privileges by the

Governing Board).

Privilege/Procedure:______________________________________________ Condition:_____________________________________________________ ______ ______ ______


Acknowledgment of Practitioner:

I understand that: (a) I do not have admitting and/or discharge privileges. I fully understand that patients under my care must be admitted and discharged by my sponsoring physician(s) in accordance with the Medical Staff Bylaws of the Publilc Health Trust and Rules and Regulations of the Jackson Health System. (b) In exercising any clinical privileges granted, I am constrained by the Medical Staff Bylaws of the Public Health Trust, Rules and Regulations of the Jackson Health System, Site specific Rules and Regulations of each facility (where applicable), and any Hospital policies and procedures applicable generally and any applicable to the particular situation. (c) Any restriction on the clinical privileges granted to me is waived in an emergency situation and in such situation my actyions are governed by the applicable section of the Medical Staff Bylaws and hospital policies and procedures. (d) I have not requested to perform privileges for which I am not qualified and competent to perform. Furthermore, I have received sufficient training in my area of specialty to be considered competent and qualified for the privileges that I am requesting.

Applicant's Signature:__________________________Date:__________

Supervising (Sponsoring) Physician

(JMH):_____________________________________ Date:__________


(JNMC):____________________________________ Date:__________


(JSCH):____________________________________ Date:__________

Associate Chief of Service

(JNMC):____________________________________Date:___________

___ Delegated approved by Chief of Service


(JSCH):____________________________________Date:___________


Chief of Service:_____________________________ Date:__________

Agenda Item 4 (b) (3) Joint Conference & Efficiencies Committee December 13, 2012


RESOLUTION APPROVING AND ADOPTING A JACKSON HEALTH SYSTEM OPTOMETRIST DELINEATION OF PRIVILEGES OF THE MEDICAL STAFF – DECEMBER 2012


WHEREAS, the Medical Staff Optometrist delineation of privileges (“DOP”) was revised so as to

be in compliance with the Joint Commission on Accreditation of Health Care Organization standards,

statutory requirements, and the current practice of the Medical Staff; and

WHEREAS, the Executive Medical Committee of the Medical Staff reviewed and approved the

changes to the Optometrist DOP on December 10, 2012; and

WHEREAS, the recommended revisions were provided to the Joint Conference & Efficiencies

Committee on December 13, 2012; and

WHEREAS, a copy of the Optometrist DOP, as amended, has been attached hereto and incorporated herein

by reference.


THE PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that it hereby adopts the

attached comprehensive amendment to the Public Health Trust Optometrist delineation of privileges of the Medical

Staff; and that this resolution shall be effective upon its passage.

NAME: _______________________________________________

Jackson Health System - Delineation Of Privileges - OPTOMETRIST JMH JNMC JSCH Requested Approved Condition

ALL

QUALIFICATIONS: To be elegible to request clinical privileges in optometry, an applicant must meet the following minimum threshold criteria: ______ ______ ______ BASIC EDUCATION: Doctor of Optometry (OD)

MINIMUN FORMAL TRAINING: Applicants must be able to demonstrate successful completion of a professional optometric degree program leading to an OD. The program must be accredited by the ACOE.

IN ADDITION, AN OPTOMETRIST SHOULD MEET THE FOLLOWING

REQUIREMENTS:

A. Valid state license to practice optometry. B. Appropriate certification by a state board of optometry when applicable.C. Current evidence of competence and an adequate volume of clinical experience with accept able results in the privileges requested for patients of all applicable age groups. D. Successful completion of required specialty training or CME training in procedures that were not a part of the applicant’s optometry training program. E.

Employment by or agreement with a physician(s) currently appointed to the medical staff of the hospital to supervise the optometrist’s practice in the hospital. According to a

written agreement, the physician must • assume responsibility for supervision or monitoring of the optometrist’s practice as

stated in the appropriate hospital or medical staff policy governing optometrists • be continuously available or designate an alternate to provide consultation when requested and to intervene when necessary • assume total responsibility for the care of any patient when requested by the optometrist by this policy or in the interest of patient care • cosign all orders entered by the optometrist on the medical records of all patients seen or treated by the optometrist

REQUIRED PREVIOUS EXPERIENCE: Applicants must be able to demonstrate that they have successfully provided inpatient, outpatient, or consultative optometry services to at least 50 patients in the past 12 months.

REFERENCES: A letter of reference must come from the director of the applicant’s

optometry training program. Alternatively, a letter of reference regarding competence should come from the optometrist’s supervisor at the institution where the applicant most

recently practiced, or peer optometrist or ophthalmogist.

MEDICAL HISTORY AND PHYSICAL JMH JNMC JSCH

Interview patient for medical history. ______ ______ ______

CORE PRIVILEGES: Core privileges in optometry include but are not limited to the following:

1. Perform primary care examinations, including refraction ______ ______ ______2. Diagnose vision problems and eye diseases ______ ______ ______3. Test patients’ visual acuity, depth and color perception, and ability to focus and

coordinate their eyes ______ ______ ______4. Analyze test results and develop a treatment plan ______ ______ ______5. Provide pre- and postoperative care to cataract patients as well as those who have had laser vision correction or other eye surgery ______ ______ ______6. Provide emergency eye care services ______ ______ ______7. Diagnose conditions due to systemic diseases such as diabetes and high blood pressure, refer¬ring patients to other health practitioners as needed ______ ______ ______8. Administer drugs for diagnostic and therapeutic purposes ______ ______ ______

CLINICS OR LONG TERM CARE PRIVILEGES/ACTIVITIES LIST: JMH JNMC JSCH

9. Comprehensive medical eye examination, diagnosis, and treatment basis ______ ______ ______9a. Tonometry, ______ ______ ______9b. Biomicroscopy, ______ ______ ______9c. Retinoscopy. ______ ______ ______9d. Refractive error evaluation and eyeglass prescription. ______ ______ ______

10. Prescribes visual aids as necessary. ______ ______ ______11. Use of instruments and pharmaceutical aganets to treat the eye, adnexa, and related structures. ______ ______ ______12. Co-management and follow up care of pre-and post surgical patients; write patient treatment orders. ______ ______ ______13. Post documentation of the eye, adnexa, and related structures. ______ ______ ______14. Gonioscopy. ______ ______ ______15. Foreign body removal (cornea, lid, conjuctiva). ______ ______ ______16. Dilation of irritation of lacrimal system. ______ ______ ______17. Direct and indirect ophthalmoscopy ______ ______ ______18. Eye lash epilation. ______ ______ ______

SPECIAL REQUESTS IN OPTOMETRY JMH JNMC JSCH

For each special request, threshold criteria (e.g., additional training or completion of a recognized course and required experience) must be established. Special requests for optometry include but are not limited to the following procedure(s) if they were not a part of the applicant’s optometry training program:

19. Sensory motor evaluation ______ ______ ______20. Vision therapy/orthoptics ______ ______ ______21. Eikonometry ______ ______ ______22. Ocular photography ______ ______ ______23. Electrodiagnosis ______ ______ ______24. Ultrasonography ______ ______ ______25. Scanning laser polarimetry ______ ______ ______

(Note: This section reserved for use in describing conditional privileges by the

Governing Board).



REAPPOINTMENT:

• Reappointment should be based on unbiased, objective results of care according to the

organization’s existing quality-assurance mechanisms.

• Applicants must be able to demonstrate that they have maintained competence by

documenting that they have successfully provided inpatient, outpatient, or consultative optometry services to at least 50 patients annually during the reappointment cycle.

• In addition, continuing education related to optometry should be required.




Supervising (Sponsoring) Physician (JMH): Print

Name:________________________ Signature:_______________________

Date:___________

Supervising (Sponsoring) Physician (Clinic/Long Term Care) Print

Name:________________________ Signature:_______________________

Date:___________

Supervising (Sponsoring) Physician (JNMC): Print

Name:________________________ Signature:_______________________

Date:___________

Supervising (Sponsoring) Physician (JSCH) Print

Name:________________________ Signature:_______________________

Date:___________


(JNMC):____________________________________Date:___________



(JSCH):____________________________________Date:___________



5. Standing Reports

TO: Stephen S. Nuell, Chairman and Members, Financial Recovery Board Joint Conference & Efficiencies Committee FROM: Carlos A. Migoya President & Chief Executive Officer DATE: December 13, 2012 RE: Customer Service Steering Committee Report In 2011 we began to lay the foundation to create a culture of Service Excellence and an engaged workforce. These two topics were selected because studies have shown that an engaged workforce leads to increased patient satisfaction and improved likelihood to recommend. A conscious effort was made to engage specific departments using an incremental approach, which targeted areas that have a direct and immediate impact on patient satisfaction. A great number of initiatives were launched in order to prepare the workforce for the shift in culture and expectations. These included leader trainings on labor laws and performance management; management routines, such as monthly operating reviews and senior administrative team meetings; formal leader rounding with clinical areas and patients; targeted Service Excellence training and reinforcement. In order to formalize and hardwire the competencies and behaviors of staff, a Customer Service Steering Committee was formed. Launched at the beginning of FY 2010-11, the Customer Service Steering Committee is chartered to provide leadership, measurable standards and accountability through a Corporate Service Team Council. The formation of service teams at the corporate level provides an infrastructure of subject matter expertise for seven targeted service areas:

1. Employer of Choice 2. Physician Satisfaction 3. Inpatient/Outpatient Satisfaction 4. Service Recovery 5. Standards 6. Employee Engagement 7. Communication

Trust + Engagement = Exceptional Performance and Growth

Through FY 2011-12, incremental foundation was established through a continued pursuit of Service Excellence. 1. Formation of the Corporate Service Teams 2. Functional Service Team Council 3. Service Excellence as the gateway to employment

2012 Accomplishments 2013 Goals

1. Employer of Choice • Strategy of behavioral-based interviews

2. Physician Satisfaction • Selection of Avatar as provider of patient, physician

and employee satisfaction surveys 3. Inpatient/Outpatient Satisfaction

• Selection of Avatar as provider of patient, physician and employee satisfaction surveys

4. Service Recovery • Quantros standards • Targeted customer-service training program for

immediate customer-facing departments 5. Standards

• High-Medium-Low (HML) quarterly evaluation practice

• Leadership rounding program • Policy 313 - Appearance Standards

6. Employee Engagement • Selection of Avatar as provider of patient, physician

and employee satisfaction surveys • Quarterly town-hall meetings • My View emails from CEO • HML coaching

7. Communication • Retention of advertising agency • Brand positioning: Miracles Made Daily • New web site • Implementation of new marketing campaign

Service Team Performance • Begin to measure overall effectiveness and results

of the Customer Service Steering Committee teams and provide guidance to begin to measure metrics

• Conduct physician and employee satisfaction

surveys and develop measurable detail action plans for results

AAR/Accountability • Continue building a culture of accountability • Create detailed and measurable actions plans from

physician and employee satisfaction survey results Continuous Improvement • With a continuous focus on likelihood to

recommend, continue to monitor best practices, and use change management as a tool for leadership buy-in

Innovation • Online orientation • Dale Carnegie Training for leaders • Online leadership classes from Harvard On Line • Online applicant survey to measure for customer

service and position-specific skills and competencies.

In 2013 the Customer Service Steering Committee will focus on performance and continuous improvement with a sight line to the patient experience. As part of this transformational period, physician and employee satisfaction surveys will be conducted and detailed action plans will be created. By getting to the root of any employee and physician issues, our goal is to improve overall employee satisfaction and create a culture of accountability and service excellence.

Comment [MIPinz1]: AAR?

5 (b) Scorecard and Bridges to Quality Report

TRUST-FIU MEDICAL SCHOOL ANNUAL OPERATING AGREEMENT COMMITTEE


Trust/FIU Medical School Annual Operating Agreement Committee Stephen S. Nuell, Chairperson Joaquin del Cueto Marcos Jose Lapciuc

Date, Time and Location December 13, 2012 – To follow the Joint Conference & Efficiencies Committee meeting Ira C. Clark Diagnostic Treatment Center Conference Room 259

AGENDA 1. Approval of the Previous Meeting Minutes (a) *Meeting Minutes as of September 13, 2012 2. *Review of the Florida International University College of Medicine Annual Operating

Agreement, Fiscal Year 2012-2013 3. Recommend Approval of the Florida International University College of Medicine Annual

Operating Agreement, Fiscal Year 2012-2013

(a) *Resolution authorizing the President or his designee to negotiate and execute the fiscal year 2012-2013 Annual Operating Agreement with Florida International University College of Medicine, in the amount of $3,135,605 for the provision of physician services at Jackson North Medical Center (Sandy Sears, Senior Vice President and Chief Administrative Officer, Jackson North Medical Center )

(b) *Support documents for agenda item 3 (a) The items noted with an asterisk (*) indicates that the supporting documents are attached.


Trust/FIU Medical School Annual Operating Agreement Committee

Stephen S. Nuell, Chairperson Joaquin del Cueto Marcos Jose Lapciuc Date, Time and Location September 13, 2012 – Immediately followed the Fiscal Committee meeting Ira C. Clark Diagnostic Treatment Center Conference Room 259 1080 N. W. 19th Street Miami, FL 33128

ATTENDANCE Trust/FIU Medical School Annual Operating Agreement Committee Joaquin del Cueto Marcos Jose Lapciuc Stephen S. Nuell Financial Recovery Board Members Darryl Sharpton Michael Bileca Mojdeh L. Khaghan Jackson Health System Carlos A. Migoya Don S. Steigman Michael Butler, M.D. Kevin Andrews Sandy Sears Jeffrey Crudele Florida International University College of Medicine John Rock, M.D. Miami-Dade County Attorney’s Valda Christian Laura Llorente Christopher Kokoruda

Trust/FIU Medical School Annual Operating Agreement Committee Meeting September 13, 2012 Page 2 Meeting Call to Order With a quorum being present, the Trust/FIU Medical School Annual Operating Agreement Committee meeting was called to order by Stephen S. Nuell, Chairperson at 2:55 p.m. 1. Approval of the Previous Meeting Minutes (a) Meeting Minutes as of February 24, 2012 Mr. Nuell requested a motion approving the meeting minutes of February 24, 2012. Mr. Lapciuc moved approval; seconded by Mr. del Cueto, and carried without dissent. 2. Review of Florida International University College of Medicine Annual Operating

Agreement, Fiscal Year 2012-2013

Sandy Sears, Chief Administrative Officer, Jackson North Medical Center (JNMC) presented for approval the fiscal year 2012-2013 Florida International University College of Medicine Annual Operating Agreement (FIUCOM AOA). The FIUCOM AOA is provided for in the Basic Affiliation Agreement between the Public Health Trust (PHT) and FIUCOM for the period of January 2007 through 2017. The structure of the FIUCOM AOA is to retain clinical and administrative services of FIUCOM faculty members. In terms of how funds are allocated, there has been since 2010 a strategic planning process with FIUCOM which is used to determine opportunities for joint program development and service line expansion to meet community needs. Ms. Sears reminded everyone that last year PHT FRB approved $3.6 million for the FIUCOM AOA, this year the amount requested is $3.5 million which represents a 3% reduction. The funds will be used to support medical leadership and clinical services provided by the physicians at JNMC and support operations of the practices which are staffed by FIUCOM physicians. Out of the $3.5 million requested, $2.7 million is for medical leadership and clinical services at JNMC and approximately $755,000 will be used to support the operations of the clinics. Included was a breakdown and description of physician salaries by specialty, benchmark of the 50 percentile MGMA, revenue expense and volume assumptions, AOA per forma, and detailed budget action plan. John Rock, M.D., Dean, FIUCOM stated that through the year FIUCOM and PHT Management Teams have been working closely together and aligning the operations to the strategic initiatives. Dean Rock is of the opinion that both Management Teams have been successful and there is opportunity for growth. Moving forward the focus will be on the business of improving profitability of the practice at JNMC. Dean Rock thanked Ms. Sears for her support as FIUCOM develop its medicine and surgical rotations as JNMC which is important to the teaching process.

Trust/FIU Medical School Annual Operating Agreement Committee Meeting September 13, 2012 Page 3

Mr. Lapciuc stated that he requested from management a monthly report regarding FIUCOM practices to better understand how funds are being allocated. Mr. Steigman pointed out that each month as part of the operating reviews is the P&L statement that shows the breakdown between JNMC and physician practice. Following an explanation of the FIUCOM AOA variance and how the funds will be allocated, Mr. Lapciuc stated that he was unable to thoroughly review the agreement, requested to know what the strategic plan is with FIUCOM, future of the relationship, executive summary describing future plans for the relationship between PHT and FIUCOM. In reference to Mr. Lapciuc’s concern regarding FIUCOM strategic development, Dean Rock stated that meetings are scheduled regularly with FIUCOM and JHS Management Teams to strategically develop solutions in any way that are appropriate for JHS. He reminded everyone that FIUCOM is here for JHS. Following the discussion around concerns raised by Mr. Lapciuc and direction given by Miami-Dade County Attorney regarding the approval process, Mr. Nuell requested a motion to forward the item to the September 24, 2012 PHT Financial Recovery Board meeting without approval by the Committee. Mr. del Cueto moved approval; seconded by Mr. Lapciuc, and carried without dissent. The approval to forward the item to the full Board without approval by the Committee will provide additional time needed for review by the Committee of the FIUCOM AOA before final approval by the PHT Financial Recovery Board.

Adjournment The meeting of the Trust/FIU Medical School Annual Operating Agreement Committee adjourned at 3:14 p.m. Transcribed by Ivenette Cobb Executive Assistant Public Health Trust Financial Recovery Board

2. Review of the FIUCOM AOA, Fiscal Year 2012-2013

3. Recommend Approval of the FIUCOM AOA, Fiscal Year 2012-2013

Agenda Item 3 (a) Trust/FIU Medical School Annual Operating Agreement Committee December 13, 2012

RESOLUTION NO. PHT 12/12 – RESOLUTION AUTHORIZING THE PRESIDENT OR HIS DESIGNEE TO NEGOTIATE AND EXECUTE THE FISCAL YEAR 2012-2013 ANNUAL OPERATING AGREEMENT WITH FLORIDA INTERNATIONAL UNIVERSITY COLLEGE OF MEDICINE, IN THE AMOUNT OT $3,135,605 FOR THE PROVISION OF PHYSICIAN SERVICES AT JACKSON NORTH MEDICAL CENTER (Sandy Sears, Senior Vice President and Chief Administrative Officer, Jackson North Medical Center) WHEREAS, in July 2007, the Public Health Trust entered into a Basic Affiliation Agreement with

the Florida International University College of Medicine (“FIU”) to serve as the location for the training of

medical students; and

WHEREAS, the Trust and FIU have determined, as further set forth in the attached memorandum,

which is incorporated in this Resolution as if fully set forth herein, that it is in their mutual interests to

conduct a major part of FIU’s inpatient medical school training at Jackson North Medical Center

(“JNMC”); and

WHEREAS, FIU has recruited and will continue recruiting full-time and part-time faculty

members who will practice at JNMC, providing medical staff leadership, and clinical services; and

WHEREAS, the President finds that it is in the best interest of the Trust to pursue negotiations

with FIU for a 2012-2013 Annual Operating Agreement and recommends continued negotiations, contract

execution and approval of the proposed budget.


THE PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board finds it in he

best interest of the Public Health Trust to authorize the President, or his designee, to negotiate and execute

the Fiscal Year 2012-2013 Annual Operating Agreement with Florida International University College of

Medicine in the amount of $3,135,605 for the provision of physician services, including, but not limited to,

medical staff leadership and clinical services.

Attachment VII

JACKSON HEALTH SYSTEM HEALTH PLANS COMMITTEE

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD Jackson Health System Health Plans Committee Joe Arriola, Chairperson Joaquin del Cueto Stephen S. Nuell Date, Time and Location December 13, 2012 – To follow the Joint Conference & Efficiencies Committee meeting Ira C. Clark Diagnostic Treatment Center Conference Room 259

AGENDA 1. Approval of the Previous Meeting Minutes (a) *Meeting Minutes as of October 18, 2012 2. *JHSHP Revised Organizational Structure

(Brian Dean, Vice President, Finance, Jackson Health System)

3. Financial Statement Review as of November 2012 (Brian Dean, Vice President, Finance, Jackson Health System)

4. CMS Medicare Open Enrollment Results

(Paul Marineau, Executive Director, Jackson Health System Health Plans) 5. CMS Preliminary Audit

(Paul Marineau, Executive Director, Jackson Health System Health Plans & John Baar, Acting Compliance Officer)

6. Strategic Initiatives – Statewide CMS XXII and Statewide ITN Medicaid (Paul Marineau, Executive Director, Jackson Health System Health Plans)

The items noted with an asterisk (*) indicates that the supporting documents are attached.


Jackson Health System Health Plans Committee Joe Arriola, Chairperson Joaquin del Cueto Stephen S. Nuell

Date, Time and Place October 18, 2012 – Followed the Strategy & Growth Committee meeting Ira C. Clark Diagnostic Treatment Center Conference Room 259

ATTENDANCE

Jackson Health System Health Plans Committee Joaquin del Cueto Stephen S. Nuell Excused Joe Arriola Jackson Health System

Mark T. Knight Brian Dean Carlos A. Migoya Jeffrey Crudele Don S. Steigman

Miami-Dade County Attorney Laura Llorente Valda Christian

Jackson Health System Health Plans Committee Meeting October 18, 2012 Page 2 Meeting Call to Order

With a quorum being present, the meeting of the Jackson Health System Health Plans Committee was called to order at 2:02 p.m. by Marcos Jose Lapciuc, Chairperson, Public Health Trust Financial Recovery Board (PHT FRB). Opening Remarks Brian Dean, Interim Executive Director, JMH Health Plan, Jackson Health System introduced Paul Marineau, Director of Operations, JMH Health Plan and Jose E. Martinez, M.D., Medical Director, JMH Health Plan. Mr. Dean stated that as part of the governance structure the JMH Health Plan (Health Plan) is represented by individuals who specialize in the areas of fraud and abuse, grievance and appeals, and quality. The representatives of the Health Plan were prepared to provide informational reports regarding fraud and abuse and quality. The 2011 and 2012 Quality reports and Health Plan Claim Settlement Agreement are recommended for approval by the Committee. 2. JMH Health Plan Claim Settlement Agreement

(a) Resolution retroactively authorizing and approving: (1) the President of the Public Health Trust executing a Settlement Agreement with Miami Beach Healthcare Group d/b/a Aventura Hospital and Medical Center resolving the outstanding payment dispute between the Public Health Trust and Miami Beach Healthcare Group d/b/a Aventura Hospital and Medical Center and (2) Public Health Trust payment to Miami Beach Healthcare Group d/b/a Aventura Hospital and Medical Center in the amount of One Million Seven Hundred Thousand Dollars ($1,700,000) in settlements of said dispute (Brian Dean, Interim Executive Director, JMH Health Plan, Jackson Health System)

Mr. Lapciuc requested a motion for the item. Mr. Nuell moved approval; seconded by Mr. del Cueto, and carried without dissent. 3. Open Enrollment Update

Mr. Dean reported that the Health Plan has begun its open enrollment process for Medicare. The open enrollment process is from October 14, 2012 through December 7, 2012. The Committee and the PHT FRB will be kept informed as the open enrollment process continues.

Jackson Health System Health Plans Committee Meeting October 18, 2012 Page 3 5. JMH Health Plan Fraud and Abuse Plan Report

Paul Marineau, Director of Operations, JMH Health Plan, Jackson Health System presented the Committee with a Fraud and Abuse Plan (Plan) report that outlined its purpose, overview of the Plan and Plan activities, reporting process, review of sources of information, and summary of potential fraud and abuse investigations by the Health Plan from September 2010 to October 2012. A copy of the report was included with the agenda. Mr. Marineau introduced the following Health Plan representatives who are directly involved with quality assurance, compliance, and fraud and abuse activities: John Paul Baar, Acting Director of Government Programs and Fraud and Abuse Program, Barbara H. Koslow, MPH, Quality Manager, Inez B. Abreu, Acting Compliance Manager and Grievance and Complaint Coordinator. These Health Plan representatives by regulation and contract are required to have access to the PHT FRB and provide information regarding regulatory activities.

4. JMH Health Plan Quality Programs 2010 Quality Program Description 2011 Quality Program Description 2012 Quality Program Presentation 2012 Quality Program Description Review and Recommend Approval of the JMH Health Plan 2011 and 2012 Quality Programs

Jose E. Martinez, M.D., Medical Director, JMH Health Plan, Jackson Health System presented descriptions of the 2010, 2011 and 2012 JMH Health Plan Quality Programs (Quality Programs). A copy of the Quality Programs descriptions was included with the agenda. Dr. Martinez presented and reviewed the revised 2011 and 2012 Quality Programs. (See attached Quality Program update summary.) Following the review of the revisions to the 2011 and 2012 Quality Programs, Dr. Martinez requested an approval. Mr. Lapciuc requested a motion approving the revisions to the 2011 and 2012 Quality Programs. Mr. Nuell moved approval; seconded by Mr. del Cueto and carried without dissent.

1. Approval of the Previous Meeting Minutes (a) Meeting Minutes as of May 4, 2012 Mr. Lapciuc requested a motion for the meeting minutes as of May 4, 2012. Mr. Nuell moved approval; seconded by Mr. del Cueto, and carried without dissent. 6. JMH Health Plan Grievance and Appeals Summary Report

The JMH Health Plan Grievance and Appeals Summary Report was included as part of the JMH Health Plan Fraud and Abuse Plan Report (agenda item 5).

Jackson Health System Health Plans Committee Meeting October 18, 2012 Page 4 7. JMH Health Plan Financial Statements Review – August 2012

Mr. Brian stated that the JMH Health Plan Financial Statements for the month of August 2012 was reviewed at the Fiscal Committee meeting (10-18-12).

8. Medicaid Reform Update The item was deferred.

Adjournment The meeting of the Jackson Health System Health Plans Committee adjourned at 2:10 p.m. Transcribed by Ivenette Cobb Executive Assistant Public Health Trust Financial Recovery Board

JMHHP Quality Program Update Summary The JMHHP Quality program is presented to the PHT Board for review and approval. The last approved JMHHP Quality program was for the 2010 Calendar year. The revisions to the JMHHP Quality program for years 2011 and 2012 are being presented to the board for review and approval. The JMHHP mission remains unchanged. “JMH Health Plan will provide quality managed care health care services through a coordinated health delivery system.” The Quality improvement program role to supports the purpose of the JMH Health Plan is unchanged and its network providers are committed to the delivery of optimal and cost-effective health care to its enrollees. JMH Health Plan aims for continuous improvements in the quality of health care services and the health status of the population served. A comprehensive quality improvement (QI) program directs JMH Health Plan’s efforts. Operational and structural changes have occurred at the JMHHP from years 2010 to 2011 and 2012. Changes reflected in the Quality program descriptions from years 2010 to 2011 and 2012 reflect the operational and structural changes. No significant changes in the purpose, goals and objectives have occurred. Quality structure and governance remains unchanged with the program reporting to the Medical Director and governance maintained at the level of the PHT Board. The description of the Quality improvement of activities remains unchanged. The substantial changes and adjustments are associated with the organizational restructuring of the JMHHP. The adjustments are reflected in changes which have occurred in committee activities, membership and roles in committees. Specific to 2011 additional roles were added for the Director of Healthcare and the Quality Manger direct name of members removed. Two committees where removed from activity: Provider Advisory Committee and Member Affairs and Benefits. The process improvement (PIP) and preventive health (PHG) description combined in 2011. And a section added describing the Office of Medical Records Audits, see page 12. The scope and function of the active committees remained unchanged from 2012 to 2011. The Quality program description from 2011 to 2012 remains materially unchanged except for the removal of the (PHG) description section and the addition of a section describing the Special Needs program, see page 20. The committee structure remains the same with the elimination of the Pharmacy and Therapeutics Committee adjusting to changes in JMHHP lines of Business and the elimination of the Utilization Analysis Committee with Utilization management now reporting directly to the QA Manager. The QA program in 2012 continues to offer a focused approach to member care management that coordinates resources across the entire health care delivery system. The Primary Care Physicians (PCP) and specialists lead and coordinates the appropriate health services required by the member within the benefit structure of the JMH Health Plan and its Medical Director and healthcare delivery team.

Brian K. DeanSr. VP, Finance


Paul MarineauExecutive Director

Division of Managed Care & JMH Health Plan

Michael AlvarezMember Services

Ida DelgadoSales Manager

Gia BetancourtController

J.P. BaarInterim Compliance

Officer

Jose Martinez, MDMedical Director

Diana SalinasCorp. Compliance

Officer

Don SteigmanEVP, COO


Bob StarmanInterim Claims

Manager

Quality Improvement

Utilization Management

Network Services

Public Health TrustFinancial Recovery Board

Financial Recovery BoardHealth Plan Subcommittee

3. Financial Statement Review as of November 2012

4. CMS Medicare Open Enrollment Results

5. CMS Preliminary Audit

6. Strategic Initiatives - Statewide CMS XXII and Statewide ITN Medicaid

SPECIAL PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD


Ira C. Clark Diagnostic Treatment Center Conference Room 259 1080 N. W. 19th Street Miami, Florida 33128

SPECIAL MEETING

December 13, 2012 – To follow the Jackson Health System Health Plans Committee meeting

AGENDA – PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD MEETING 1. Special Meeting Call To Order (Marcos Jose Lapciuc, Chairperson, PHT Financial Recovery Board)

2. PHT Financial Recovery Board Bylaws Amendment Combining Purchasing and Facilities

Subcommittees

(a) *Resolution amending the Bylaws of the Financial Recovery Board of the Public Health Trust to combine the Purchasing Subcommittee and Facilities Subcommittee and renaming the combined committee the Purchasing and Facilities Subcommittee (Marcos Jose Lapciuc, Chairperson, PHT Financial Recovery Board)

3. PHT Financial Recovery Board Revised Committee Assignments

(a) *Resolution approving Public Health Trust Financial Recovery Board Committee Assignments, revised as of December 13, 2012

(b) *Support document for agenda item 3 (a) (PHT FRB Revised Committee

Assignment Roster)

4. Resolutions Recommended To Be Approved (The items were reviewed and approved at the December 13, 2012 PHT Financial Recovery Board One-Day Committee Meetings.)

(a) *Resolution authorizing the President or his designee to approve and execute

Renewal Agreements with the following Community Health Centers (Baker Act Match 2012-2013):

1. Citrus Health Network, Inc. 2. Citrus Health Network (CCSU), Inc. 3. Community Health of South Florida, Inc. 4. Miami Behavioral Health Center, Inc. 5. Jackson North Community Health Center 6. New Horizons CMHC, Inc.

For the provision of mental health services in the total amount of $2,348,141 (John Repique, Sr. Vice President, Chief Administrative Officer and Chief Nursing Officer, Mental Health and Corrections Health Services, Jackson Health System)

Special Public Health Trust Financial Recovery Board December 13, 2012 Page 2

(b) *Resolution authorizing execution of a settlement agreement with and payment to the University of Miami, Department of Psychiatry in the amount of Two Hundred Twenty Five Thousand, One hundred Thirty Seven Dollars and Twenty-Six Cents ($225,137.26) as a full and final settlement for services provided by the University of Miami Department of Psychiatry at Jackson Mental Health Hospital (John Repique, Sr. Vice President, Chief Administrative Officer and Chief Nursing Officer, Mental Health and Corrections Health Services, Jackson Health System)

(c) *Resolution authorizing and approving the President of the Public Health

Trust to execute Memorandum of Understanding by and between Miami-Dade County and the Public Health Trust regarding the revolving line of credit facility to be provided by Wells Fargo Bank, N.A. in an amount not to exceed $75,000,000, subject to approval by the Board of County Commissioners by Ordinance (Brian Dean, Vice President, Finance Division, Jackson Health System)

(d) *Support document for agenda item 4 (c) (Memorandum of Understanding

by and between Miami-Dade County and the Public Health Trust)

(e) *Resolution authorizing payment to the University of Miami Department of Anesthesia in the amount of Five Hundred Seventy Six Thousand Dollars and Zero Cents ($576,000.00) as a full and final Settlement for services provided by the University of Miami Department of Anesthesia at Holtz Children’s Hospital (Steven Burghart, Sr. Vice President and Chief Administrative Officer, Holtz Children’s Hospital & Women’s Hospital Center, Jackson Health System)

(f) *Resolution authorizing payment to the University of Miami Department of

Surgery in the amount of Six Hundred Thirty Four Thousand Dollars and Zero Cents ($634,000.00) as a full and final Settlement for services provided by the University of Miami Department of Surgery at Holtz Children’s Hospital (Steven Burghart, Sr. Vice President and Chief Administrative Officer, Holtz Children’s Hospital & Women’s Hospital Center, Jackson Health System)

(g) *Resolution approving the Public Health Trust Defined Benefit Retirement

Plan Actuarial Report for the Plan Year Ending December 31, 2013 (Brian Dean, Vice President, Finance Division, Jackson Health System)

(h) *Resolution Approving the Public Health Trust Defined Benefit Retirement

Plan Amended Investment Policy Statement (Brian Dean, Vice President, Finance Division, Jackson Health System)

(i) *Resolution approving the Public Health Trust appointment of Peter L.

Bermont to the Pension Plan Subcommittee (Brian Dean, Vice President, Finance Division, Jackson Health System)

(j) *Support document for agenda item 4 (i) (CV for Peter L. Bermont)

Special Public Health Trust Financial Recovery Board December 13, 2012 Page 3

(k) *Resolution authorizing the President or his designee to enter into a new Lease Agreement with The Trustees of Columbia University in the City of New York, a New York Non-Profit Corporation for the rental of Two Hundred and Forty-Three (243) square feet of space in the Ambulatory Care Center East Building, Room CLU at 1611 NW 12 Avenue, Miami, Florida 33136 for a period of two (2) years and eight (8) months commencing January 1, 2013 and expiring on August 31, 2015, for an annual payment of Six Thousand Eight Hundred Four Dollars ($6,804) with an annual increase in base rent of one percent (1%) and common area maintenance (Madeline Valdes, Corporate Director, Property Management Division, Jackson Health System)

(l) *Resolution authorizing and approving Award of Bids and Proposals,

Waiver of Bids, and other Purchasing Actions as recommended from the Fiscal Committee for December 2012, based on the Procurement Policy, Resolution No. PHT 12/05-231 (Mark T. Knight, Executive Vice President and Chief Financial Officer, Jackson Health System)

(m) *Resolution approving the Medical Staff and Health Professional Affiliate

Staff Membership and Clinical Privileges; approving Initial Appointments, Reappointments and Clinical Privileges and Activities; approving Modifications to Medical Staff Membership Category and Clinical Privileges; accepting Resignations and Leaves of Absence – November 2012 (Kevin Andrews, Vice President, Quality & Patient Safety Division, Jackson Health System)

(n) *Resolution approving and adopting a Jackson Health System Surgical

Assistant (SA) delineation of privileges of the Medical Staff – December 2012 (Kevin Andrews, Vice President, Quality and Patient Safety Division, Jackson Health System)

(o) *Support document for agenda item 4 (n) (Surgical Assistant delineation of

privileges)

(p) *Resolution approving and adopting a Jackson Health System Optometrist delineation of privileges of the Medical Staff – December 2012 (Kevin Andrews, Vice President, Quality and Patient Safety Division, Jackson Health System)

(q) *Support document for agenda item 4 (p) (Optometrist delineation of

privileges)

(r) *Resolution authorizing the President or his designee to negotiate and execute the fiscal year 2012-2013 Annual Operating Agreement with Florida International University College of Medicine, in the amount of $3,135,605 for the provision of physician services at Jackson North Medical Center (Sandy Sears, Senior Vice President and Chief Administrative Officer, Jackson North Medical Center )

(s) *Support documents for agenda item 4 (r)

5. Special Meeting Adjourned

(Marcos Jose Lapciuc, Chairperson, PHT Financial Recovery Board) Items noted with an asterisk (*) indicate that the supporting document is attached.

1. Special Meeting Call To Order

2. PHT Financial Recovery Board Bylaws Amendment Combining Purchasing and Facilities Subcommittees

Agenda Item 2 (a) Special PHT Financial Recovery Board December 13, 2012 RESOLUTION NO. PHT 12/12 -

RESOLUTION AMENDING THE BYLAWS OF THE FINANCIAL RECOVERY BOARD OF THE PUBLIC HEALTH TRUST TO COMBINE THE PURCHASING SUBCOMMITTEE AND FACILITIES SUBCOMMITTEE AND RENAMING THE COMBINED COMMITTEE THE PURCHASING AND FACILITIES SUBCOMMITTEE

(Marcos Jose Lapciuc, Chairperson, Public Health Trust, Financial Recovery Board)

WHEREAS, on July 21, 2011, the Financial Recovery Board (“FRB”) of the Public Health Trust adopted

its Bylaws pursuant to its passage of Resolution No. PHT 07/11-024; and

WHEREAS, on December 23, 2011, January 30, 2012, April 30, 2012 and May 31, 2012, the FRB adopted

amendments to the Bylaws; and

WHEREAS, the Financial Recovery Board presently seeks to amend its Bylaws to combine the

Purchasing Subcommittee and Facilities Subcommittee and renaming the combined committee the Purchasing and

Facilities Subcommittee.


PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby amends the Bylaws

of the Financial Recovery Board to combine the Purchasing Subcommittee and Facilities Subcommittee and

renaming the combined committee the Purchasing and Facilities Subcommittee as set forth in Attachment A

hereto.

ATTACHMENT A

Section 2. Standing Committees.

There shall be three (3) standing committees as follows: the Fiscal

Committee, Strategy and Growth Committee and Joint Conference

and Efficiencies Committee. Unless already provided for in these

Bylaws, the Chairperson is empowered, in his or her discretion, to

assign to standing committees the jurisdiction over matters

involving, but not limited to, philanthropy, human resources,

pension or other retirement programs, health plans, international

program, and other business units and service lines of the Trust and

other such areas of Trust business.

a. Fiscal Committee. There shall be a Fiscal Committee. The

Treasurer of the Board shall serve as committee

chairperson. The Fiscal Committee shall:

(1) Assist the Treasurer in performing the duties of his

or her office and shall advise and consult with staff

regarding the fiscal affairs of the Trust.

(2) Keep the Board fully advised as to the Trust's

compliance with the financial duties of the Trust as

set forth in the Trust Ordinance and applicable law.

In supervising the Trust's compliance with the Trust

Ordinance, the powers and duties of the committee

shall include but not be limited to the following:

(a) The preparation for the Board of an annual

Trust budget request which, subject to

approval of the Board, shall be submitted to

the Commission preceding each fiscal year

of the Trust. In its preparation of the annual

Trust budget request, (i) the >>Purchasing

and<< Facilities Subcommittee shall make

recommendations to the Fiscal Committee

regarding capital expenditures[[; (ii) the

Purchasing Subcommittee shall make

recommendations to the Fiscal Committee

regarding]] >>and<< expenditures in the

category of contractual and purchased

services; and >>(ii)<< [[(iii)]]the committee

of jurisdiction for the Trust’s International

Program shall make recommendations to the

Fiscal Committee regarding such program.

The Fiscal Committee shall consider the

recommendations of the >>Purchasing and

<< Facilities Subcommittee[[, Purchasing

Subcommittee]] and the committee of

jurisdiction for the International Program in

the preparation of the budget.

(b) The preparation for the Board of

supplemental budget requests to be

forwarded to the Commission subject to

Board approval.

(c) The development in conjunction with

County budget staff, of accounting,

budgeting, and financial management

systems which will enable Miami-Dade

County to provide the Trust with funding in

accordance with applicable law and

contractual arrangements.

(d) Through staff of the Trust, the preparation

for the Board of the financial reports and

accountings.

(e) The making of recommendations to the

Board and, through the Board, to the

Commission for the issuance of new bonds

and for the borrowing of money.

(f) The approval of and recommendation to the

Board of the facilities development budget

submitted by the >>Purchasing and<<

Facilities Subcommittee.

(3) Supervise the preparation of, examine and forward

to the Board all financial statements which the Trust

is required to make or which are necessary and

proper for carrying out the powers and duties of the

Trust.

(4) Study the rates and charges of the Trust Facilities

and make recommendations to the Board at least

annually with regards thereto.

(5) Within the framework of the operating agreement

between the Trust and Miami-Dade County, study

and make recommendations to the Trust/County

Committee regarding the determination by the

Commission of medical indigency status and health

care delivery policies in the designated facilities of

the Trust. The committee shall also make studies

and recommendations to the Board regarding the

establishment of policies for serving medically

indigent persons, extending credit and collecting

patient accounts payable.

(6) Subject to applicable requirements of law and the

Trust Ordinance, shall develop, and present to the

Board for approval, procedures for purchasing

supplies, equipment and services, and for managing

materials, and through the Purchasing >>and

Facilities<< Subcommittee shall supervise the

implementation of such procedures.

(7) At least quarterly, review and, as necessary, make

recommendations, to the Board concerning the

management and investment of all funds of the

Trust and to monitor compliance with Board

policies regarding investments as set forth in

Resolution No. PHT 11/96-181 as amended or

modified from time to time.

(8) The committee chairperson shall appoint an Audit

and Compliance Subcommittee. The subcommittee

shall be responsible for the oversight, guidance and

completion of the Trust’s external audit by its

external auditor, and oversight of internal audit and

internal control functions and regulatory

compliance programs.

(9) The committee chairperson shall appoint an

External Auditor Selection Subcommittee for the

purpose of recommending to the Fiscal Committee

an external auditor of the Trust. The External

Auditor Selection Subcommittee shall consist of a

minimum of three (3) Members, which shall include

the chairperson of the Audit and Compliance

Subcommittee. A three-fourths (3/4) vote of the

members present at a Fiscal Committee meeting is

required for a recommendation to the Trust waiving

the provisions of Article VI, Section (2)(a)(10) of

these Bylaws limiting the number of years that an

external auditor may serve.

(10) An external auditor hired by the Trust to provide an

audit of the Trust’s consolidated operations and a

management letter shall serve a maximum of five

(5) consecutive years unless the Board by a two-

thirds (2/3) vote of the members present waives this

requirement. If the Board waives the five (5) year

limitation on the external auditor’s term, the

managing partner in charge of the Trust’s audit shall

change.

3. Resolution Recommended To Be Approved

Special Meeting PHT Financial Recovery Board December 13, 2012

Agenda Item 3 (a) Special PHT Financial Recovery Board December 13, 2012


RESOLUTION APPROVING PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD COMMITTEE ASSIGNMENTS REVISED AS OF DECEMBER 13, 2012

(Marcus Jose Lapciuc, Chairperson, Public Health Trust Financial Recovery Board)

WHEREAS, in accordance with Section 25A-9 of the Code of Miami-Dade County, the

Public Health Trust Financial Recovery Board (“Financial Recovery Board”) has a committee

structure to assist in its work; and

WHEREAS, in accordance with the Bylaws of the Financial Recovery Board, the Chairperson

seeks to make the committee assignments as reflected in the attached Public Health Trust Financial

Recovery Board Committee Assignments (revised as of December 13, 2012) and recommends

approval.



approves the Public Health Trust Financial Recovery Board Committee Assignments (revised as of

December 13, 2012) as submitted by its Chairperson, a copy of which is attached hereto and

incorporated herein by reference. The committee assignments shall become effective immediately.

PHT FINANCIAL RECOVERY BOARD 2013 COMMITTEE ASSIGNMENTS

OVERSIGHT

PLANNING OVERSIGHT

QUALITY

OVERSIGHT

FINANCIAL OVERSIGHT

OPERATIONS OVERSIGHT

MANDATED BY

TRUST ORDINANCE

STANDING COMMITTEES (MEET MONTHLY)

STRATEGY & GROWTH Chairperson: Marcos J. Lapciuc Vice Chairperson: Joaquin del Cueto Members: Joe Arriola Michael Bileca Mojdeh L. Khaghan Stephen S. Nuell Darryl K. Sharpton

JOINT CONFERENCE & EFFICIENCIES Chairperson: Stephen S. Nuell Vice Chairperson: Joe Arriola Members: Michael Bileca Joaquin del Cueto Mojdeh L. Khaghan Marcos J. Lapciuc Darryl K. Sharpton

FISCAL Chairperson: Joe Arriola Vice Chairperson: Darryl K. Sharpton Members: Michael Bileca Joaquin del Cueto Mojdeh L. Khaghan Marcos J. Lapciuc Stephen S. Nuell

Chapter 25 A Committees

UM ANNUAL OPERATING AGREEMENT (meet as needed) Chairperson: Joe Arriola Members: Joaquin del Cueto Marcos J. Lapciuc FIU ANNUAL OPERATING AGREEMENT (meet as needed) Chairperson: Stephen S. Nuell Members: Joaquin del Cueto Marcos J. Lapciuc

SUBCOMMITTEES AD HOC & OTHER COMMITTEES

AUDIT & COMPLIANCE Chairperson: Mojdeh L. Khaghan Vice Chairperson: Michael Bileca Members: Marcos J. Lapciuc Joaquin del Cueto PURCHASING & FACILITIES Chairperson: Darryl K. Sharpton Vice Chairperson: Joaquin del Cueto Members: Joe Arriola Michael Bileca Mojdeh L. Khaghan Stephen S. Nuell EXTERNAL AUDITOR SELECTION Chairperson: Joe Arriola Members: Michael Bileca Joaquin del Cueto Mojdeh L. Khaghan Marcos J. Lapciuc PENSION PLAN Chairperson: Darryl K. Sharpton Members: Joaquin del Cueto Mojdeh L. Khaghan Carlos A. Migoya Mark T. Knight Duane J. Fitch Member at Large/TBD

JACKSON HEALTH SYSTEM HEALTH PLANS Chairperson: Joe Arriola Members: Joaquin del Cueto Stephen S. Nuell

PHILANTHROPY Chairperson: Stephen S. Nuell Members: Joe Arriola Darryl K. Sharpton

NOTE: Marcos José Lapciuc, Chairperson or in the Chairperson’s absence Darryl K. Sharpton Vice Chairperson, PHT Financial Recovery Board, is an ex-officio voting member on all board committees - Revised: December 13, 2012

4. Resolutions Recommended To Be Approved

Agenda Item 4 (a) Special PHT Financial Recovery Board December 13, 2012


Resolution authorizing the President or his designee to approve and execute Renewal Agreements with the following Community Health Centers (Baker Act Match 2012-2013): 1. Citrus Health Network, Inc. 2. Citrus Health Network (CCSU), Inc. 3. Community Health of South Florida, Inc. 4. Miami Behavioral Health Center, Inc. 5. Jackson North Community Health Center 6. New Horizons CMHC, Inc. For the provision of mental health services in the total amount of $2,348,141 (John Repique, Sr. Vice President, Chief Administrative Officer and Chief Nursing Officer, Mental Health and Corrections Health Services, Jackson Health System)

WHEREAS, Jackson Memorial Hospital and all Community Mental Health Centers (CMHCs) located in

Miami-Dade County are designated receiving facilities for Baker Act (psychiatric) patients; and

WHEREAS, these CMHCs receive funding from the State of Florida, Department of Children and Families

which funding requires a 25% local matching funds contribution, which since the origin of this program have been

paid by the Public Health Trust; and

WHEREAS, as explained in the attached memorandum, staff recommends continuing this funding through

a contractual relationship from October 1, 2012, through September 30, 2013; and

WHEREAS, the Public Health Trust contribution of the 25% local match funding for each CMHC would

amount to: $488,878.00 to Citrus Health Network Community Mental Health Center, $489,739.00 to Citrus Health

Network (CCSU) Community Mental Health Center, $348,910.00 to Community Health of South Florida

Community Mental Health Center, $345,647.00 to Miami Behavioral Health Center, Inc. $335,957.00 to Jackson

North Community Mental Health Center, and $339,010.00 to New Horizons Community Mental Health Center, for

a total Public Health Trust contribution of $2,348,141.00 payable in twelve equal monthly installments; and

WHEREAS, the President and the Fiscal Committee recommend approval.



President or his designee to approve and execute renewal agreements with the following Community Mental Health

Centers: Citrus Health Network, Inc., Citrus Health Network (CCSU) Inc., Community Health of South Florida,

Inc., Jackson North Community Mental Health Center, Miami Behavioral Health Center, Inc., and New Horizons

CMHC, Inc., for the provision of mental health services in the total amount of$2,348,141.

TO: The Financial Recovery Board of the Public Health Trust of Miami Dade FROM: John Repique, VP/Chief Administrative Officer Jackson Mental Health Hospital DATE: December 4, 2012 SUBJECT: Renewal of Baker Act Match Contracts for Mental Health RECOMMENDATION The President and CEO recommends that the Board hereby authorizes the renewal of Baker Act match contracts with all Community Mental Health Centers (CMHCs) located in Miami-Dade County designated by the Department of Children and Families for the provision of mental health services in District 11 (Miami-Dade and Monroe Counties), which by law (Fla. Stat. 394.76) mandates local participation on a 75-to-25 state-to-local ratio. Under this ratio, the applicable local participation for fiscal year October 1, 2012, to September 30, 2013, to be paid in 12 monthly installments, is as follows:


1 Citrus Health Network Community Mental Health Center $488,878.00

2 Citrus Health Network (CCSU) Community Mental Health $489,739.00

3 Community Health of South Florida Community Mental Health Center

$348,910.00

4 Miami Behavioral Health Center, Inc. $345,647.00

5 Jackson North Community Mental Health Center . $335,957.00

6 New Horizons Community Mental Health Center $339,010.00

TOTAL $2,348,141.00

BACKGROUND The Baker Act is the law governing involuntary hospitalization for psychiatric patients in Florida. Funding for designated Baker Act Receiving Facilities, which treat primarily indigent patients covered under this law (all CMHCs are such facilities), is provided under the state budget through the Department of Children and Families. Each county is required to match the state funds designated for these centers on a 75/25 ratio. In the mid 1980s, this obligation for Miami-Dade County was assumed by the Public

Health Trust. This year Baker Act contracts were finalized after the start of the current fiscal year due to state funding cycle necessities.

FY 2012-2013 BAKER ACT MATCH PAYMENT AGREEMENTS BETWEEN PUBLIC HEALTH TRUST AND

COMMUNITY MENTAL HEALTH CENTERS (CMHCs) REQUEST Staff requests renewal of Baker Act match contracts with all Community Mental Health Centers

(CMHCs) located in Miami-Dade County designated by the Department of Children and Families for the

provision of mental health services in District 11 (Miami-Dade and Monroe Counties), which by law (Fla.

Stat. 394.76) mandates local participation on a 75-to-25 state-to-local ratio. Under this ratio, the

applicable local participation for fiscal year October 1, 2012, to September 30, 2013, to be paid in 12

monthly installments, is as follows:


1 Citrus Health Network Community Mental Health Center $488,878.00 2 Citrus Health Network (CCSU) Community Mental Health $489,739.00 3 Community Health of South Florida Community Mental Health

Center $348,910.00

4 Miami Behavioral Health Center, Inc. $345,647.00 5 Jackson North Community Mental Health Center . $335,957.00 6 New Horizons Community Mental Health Center $339,010.00 TOTAL $2,348,141.00.00

BACKGROUND The Baker Act is the law governing involuntary hospitalization for psychiatric patients in Florida.

Funding for designated Baker Act Receiving Facilities, which treat primarily indigent patients covered

under this law (all CMHCs are such facilities), is provided under the state budget through the Department

of Children and Families. Each county is required to match the state funds designated for these centers on

a 75/25 ratio. In the mid 1980s this obligation for Miami-Dade County was assumed by the Public

Health Trust. This year Baker Act contracts were finalized after the start of the current fiscal year due to

state funding cycle necessities.

Agenda Item 4 (b) Special PHT Financial Recovery Board December 13, 2012

PHT RESOLUTION NO. 12/12 –

RESOLUTION AUTHORIZING EXECUTION OF A SETTLEMENT AGREEMENT WITH AND PYMENT TO THE UNIVERSITY OF MIAMI DEPARTMENT OF PSYCHIATRY IN THE AMOUNT OF TWO HUNDRED TWENTY FIVE THOUSAND, ONE HUNDRED THIRTY SEVEN DOLLARS AND TWENTY SIX CENTS ($225,137.26) AS A FULL AND FINAL SETTLEMENT FOR SERVICES PROVIDED BY THE UNIVERSITY OF MIAMI DEPARTMENT OF PSYCHIATRY AT JACKSON MENTAL HEALTH HOSPITAL

(John Repique, Sr. Vice President, Chief Administrative Officer and Chief Nursing Officer, Mental Health and Corrections Health Services, Jackson Health System)

WHEREAS, the Public Health Trust operates the Jackson Mental Health Hospital (“JMHH”)

which includes providing mental health crisis emergency department services daily; and

WHEREAS, in 2011, the Chief Administrative Officer of the JMHH arranged for staffing of the

Emergency Department by the University of Miami Department of Psychiatry (“Department”); and

WHEREAS, the Department agreed to provide physician coverage for the JMHH Emergency

Department with the expectation the services would be compensated through the Annual Operating

Agreement between the Public Health Trust and University of Miami; and

WHEREAS, the Department staffed the JMHH Crisis ER with psychiatrists during the period of

October 1, 2011 through May 31, 2012; and

WHEREAS, the JMHH received the services beginning October 1, 2011 but did not compensate

the Department through the Annual Operating Agreement for those services; and

WHEREAS, the parties have mutually agreed to a Settlement Agreement, in substantially the form

attached hereto, which provides payment for the provided services; and

WHEREAS, the administration recommends authorizing the Settlement Agreement and payment

of $225,137.26 as being in the best interest of the Public Health Trust in order to avoid the expense of

uncertainty of litigation.

Agenda Item 4 (b) Special PHT Financial Recovery Board December 13, 2012

-Page 2-



authorizes the Public Health Trust President and Chief Executive Officer or his designee to execute a

Settlement Agreement with and to pay the University of Miami Department of Psychiatry in the amount of

Two Hundred Twenty Five Thousand, One Hundred Thirty Seven Dollars and Twenty Six Cents

($225,173.26) as settlement in full for Jackson Mental Health Hospital Crisis ER coverage during the

period of October 1, 2011 through May 31, 2012 provided by the University of Miami Department of

Psychiatry Department at Jackson Mental Health Hospital.

To: Financial Recovery Board Public Health Trust From: John Repique VP/Chief Administrative Officer Jackson Mental Health Hospital Date: December 6, 2012 Subject: Settlement Agreement for Psychiatric Services between the Public Health Trust

of Miami-Dade County and the University of Miami Department of Psychiatry REQUEST: Approval of payment in the amount of $225,137.26 to the University of Miami Department of Psychiatry (“Department”) as part of a settlement agreement (and execution of said agreement) resolving a payment dispute for services provided by the Department at Jackson Mental Health Hospital (“JMHH”). BACKGROUND: In October of 2011, Ms. Melida Akiti (Former JMHH Vice President/CAO) discussed modifying the JMHH relationship with the Department, intending to reallocate the money paid to the Department through the Annual Operating Agreement (“AOA”). The proposed changes consisted of removing Recruitment payments and adding Crisis ER physician coverage as a purchased services line item to the AOA. Although a written agreement was never generated from this verbal discussion to note the changes officially the Department provided the discussed coverage in good faith. In an effort to resolve this earned-but-unpaid-compensation matter expeditiously and amicably, the parties have agreed to settle any potential dispute regarding payment for services rendered through a settlement agreement. The parties have agreed that payment shall be in the amount of two hundred twenty five thousand, one hundred thirty seven dollars and twenty six cents ($225,137.26) for Crisis ER physician coverage services rendered by the Department from October 1, 2011 to May 31, 2012. This amount is calculated by using $160.000 as base salary for the psychiatrists, which is within the recommended range of the AAMC salary survey and including adjustments made to offset collections The Jackson Mental Health Hospital and the University of Miami/Department of Psychiatry agree that this amount represents full and correct payment for the services provided. These dollars are budgeted and included in the approved FY 11-12 operating budget for JMHH, and expenses have been accrued for the period of time services were provided by the Department at JMHH. RECOMMENDATION: That the Financial Recovery Board of the Public Health Trust approves payment in the amount of two hundred twenty five thousand, one hundred thirty seven dollars and twenty six cents ($225,137.26) to the University of Miami Department of Psychiatry for physician services provided by the Department at JMHH Crisis ER unit during October 2011 to May 2012.

November 2, 2012 Attention: Jared Abramson, Vice Chairman for Administration Miami, Fl - 33136 Re: Settlement Agreement for Psychiatric Emergency Services between the Public Health Trust of Miami-Dade County and the University of Miami Department of Psychiatry and Behavioral Sciences Dear Mr. Abramson: The Public Health Trust has been in negotiation with the Department of Psychiatry and Behavioral Sciences at the University of Miami (“UM”) since October 1st, 2011, to finalize the terms and conditions of the Psychiatric Emergency Services Contract at Jackson Mental Health Hospital. Despite extensive negotiations, the parties have not yet executed said contract. The parties agree that the Department of Psychiatry and Behavioral Sciences at the University of Miami has provided Psychiatry attending services in the Crisis Emergency Room in good faith at Jackson Mental Health Hospital for the months October 1st, 2011through May 31st, 2012. The services were rendered based on the understanding that the Department of Psychiatry and Behavioral Sciences would get reimbursed based on mutually agreed upon conditions: (1) the University of Miami would provide up to 5 physician FTEs at an annual total compensation of $160,000 each; (2) University of Miami would provide up to 500 hours of moonlighting services reimbursed at $90/hr; (3) The Trust will net the collections for each active physician assigned to Crisis against their total compensation; (4) The Trust would reimburse the University of Miami 8.5% of collections for billing of the physician charges. UM has not received the anticipated compensation, although the parties acknowledge the services were provided to the Trust. At this time, to avoid the expense and uncertainty of litigation and to resolve this matter expeditiously and amicably, the parties have agreed to settle any potential dispute regarding payment for the services rendered. Both parties have agreed to the total amount of two hundred twenty five thousand, one hundred thirty seven dollars and twenty six cents ($225,137.26), payable within 60 days of the execution of this letter of settlement agreement, as the settlement payment amount to resolve this dispute. This document serves as a settlement agreement for the payments to be made by the Public Health Trust to the University of Miami Department of Psychiatry and Behavioral Sciences for providing Psychiatry attending services in Crisis during the period October 1st, 2011 to May 31st, 2012. This settlement agreement is a resolution of disputed sums and shall not be deemed an admission of liability by any party.

Subject to the noted payment for services rendered, the University and Department of Psychiatry and Behavioral Sciences hereby release, waive and forever discharge the Trust with respect to any and all claims, causes of action, lawsuits, arbitrations, debts, sums of money, demands, liabilities, damages or losses of every kind and character, whether asserted or unasserted, whether known or unknown, suspected or unsuspected, in law or in equity, in connection with the Public Health Trust’s payment for the Psychiatry attending services identified above. This release does not release the Public Health Trust from any medical malpractice claims arising out of the medical services provided by the Psychiatry attending services to patients of the Trust. The parties agree, as expressed in the Annual Operating Agreement, that the Psychiatry attending services were serving as agents of the Trust when providing the referenced services and treating Trust patients. Thus, the Trust believes sovereign immunity should address said medical malpractice claims. To the extent you desire to agree with the terms specified in the above paragraphs of this Agreement, please indicate your acceptance of the Public Health Trust’s offer by signing this letter and returning an executed copy to the Administrative Offices of Jackson Mental Health Hospital, Miami, Florida 33136. The copy of such letter, as executed by you on behalf of the University of Miami Department of Psychiatry and Behavioral Sciences, shall serve as the mutual written agreement and will also serve as an evidence of the existing relationship between the parties. Should you have any questions, please feel free to contact R. John Repique, Vice President and Chief Administrative Office, at (305) 355-8234.

Sincerely,

THE PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA

____________________________________

Carlos Migoya, MBA President and Chief Executive Officer ACCEPTED AND ACKNOWLEDGEMENT, ____________________________________ Charles B. Nemeroff, MD, PhD

Leonard M. Miller Professor and Chair Department of Psychiatry and Behavioral Sciences University of Miami Miller School of Medicine Clinical Service Chief, Jackson Memorial Hospital

Agenda Item 4 (c) Special PHT Financial Recovery Board

December 13, 2012


RESOLUTION AUTHORIZING AND APPROVING THE PRESIDENT OF THE PUBLIC HEALTH TRUST TO EXECUTE MEMORANDUM OF UNDERSTANDING BY AND BETWEEN MIAMI-DADE COUNTY AND THE PUBLIC HEALTH TRUST REGARDING THE REVOLVING LINE OF CREDIT FACILITY TO BE PROVIDED BY WELLS FARGO BANK, N.A. IN AN AMOUNT NOT TO EXCEED $75,000,000, SUBJECT TO APPROVAL BY THE BOARD OF COUNTY COMMISSIONERS BY ORDINANCE

(Brian Dean, Vice President, Finance Division, Jackson Health System) WHEREAS, in October 2012, the Financial Recovery Board approved Resolution No. PHT 10/12-

074 requesting and recommending that the Board of County Commissioners (the “Commission”) authorize

and approve the establishment of a revolving line of credit in an amount not to exceed $75,000,000 with

Wells Fargo Bank, N.A. for the benefit of the Public Health Trust (the “Trust”); and

WHEREAS, based upon such request, on December 4, 2012, the Commission adopted an

Ordinance on first reading to approve issuance and terms of the Wells Fargo Bank, N.A. revolving line of

credit facility on behalf of the Trust in an amount not to exceed $75,000,000; and

WHEREAS, because Miami-Dade County is securing the credit facility with its credit on behalf of

the Trust, it is necessary that the Miami-Dade County and the Trust enter into the attached Memorandum of

Understanding for the purposes of governing the Trust’s repayment obligation to Miami-Dade County and

other obligations relating to the revolving line of credit; and

WHEREAS, the President and Fiscal Committee recommend authorizing and approving the

President’s execution of the Memorandum of Understanding by and between Miami-Dade County and the

Trust, subject to the Commission’s passing and adopting the Ordinance regarding the Wells Fargo Bank,

N.A. revolving line of credit facility.



authorizes the President to execute the attached Memorandum of Understanding by and between Miami-

Dade County and the Public Health Trust regarding the revolving line of credit facility to be provided by

Wells Fargo Bank, N.A. in an amount not to exceed $75,000,000, subject to approval by the Board of

County Commissioners by Ordinance.

Agenda Item 4 (e) Special PHT Financial Recovery Board December 13, 2012

RESOLUTION NO. PHT 12/12 -

RESOLUTION AUTHORIZING PAYMENT TO THE UNIVERSITY OF MIAMI DEPARTMENT OF ANESTHESIA IN THE AMOUNT OF FIVE HUNDRED SEVENTY SIX THOUSAND DOLLARS AND ZERO CENTS ($576,000.00) AS A FULL AND FINAL SETTLEMENT FOR SERVICES PROVIDED BY THE UNIVERSITY OF MIAMI DEPARTMENT OF ANESTHESIA AT HOLTZ CHILDREN’S HOSPITAL


WHEREAS, the Public Health Trust operates the Holtz Children’s Hospital (“HCH”) which includes

providing pediatric cardio thoracic surgery services daily; and

WHEREAS, in January 2011, the Chief Administrative Officer of the HCH arranged for

anesthesia services for pediatric cardio thoracic surgeries from the University of Miami Department of

Anesthesia (“Department”); and

WHEREAS, the Department agreed to provide anesthesia physician coverage to the HCH for

pediatric cardio thoracic surgeries with the expectation the services would be compensated through the

Annual Operating Agreement between the Trust and the University of Miami; and

WHEREAS, the Department staffed the HCH pediatric cardio thoracic surgeries with

anesthesiologists during the period of January 1, 2011 through May 31, 2012; and

WHEREAS, the HCH received the services beginning January 1, 2011 but did not compensate the


WHEREAS, the parties have mutually agreed to a Settlement Agreement which provides payment for

the provided service; and

Agenda Item 4 (e) Special PHT Financial Recovery Board December 13, 2012

-Page 2-



litigation.



to pay the University of Miami Department of Anesthesia in the amount of five hundred seventy six

thousand and zero cents ($576,000.00) as settlement in full for Holtz Children’s Hospital pediatric cardio

thoracic surgery anesthesia coverage during January 1, 2011 through May 31, 2012 provided by the

University of Miami Department of Anesthesia at Holtz Children’s Hospital.

To: Fiscal Affairs, Financial Recovery Board Public Health Trust From: Steven Burghart Chief Administrative Officer Holtz Children’s Hospital and Jackson Women’s Hospital Center Date: Settlement Agreement for Pediatric Cardio Thoracic Surgery Anesthesia Services

between the Public Health Trust of Miami-Dade County and the University of Miami Department of Anesthesia

REQUEST: Approval of payment in the amount of $576,000.00 to the University of Miami Department of Anesthesia (“Department”) as a settlement agreement for services provided by the Department at Holtz Children’s Hospital (“HCH”). These dollars are budgeted and included in the approved FY 11-12 operating budget for HCH, and expenses have been accrued for the period of time services were provided by the Department at HCH. BACKGROUND: In January of 2011, Dr. Eneida Roldan (Former JHS President/CEO) discussed an agreement with Dr. David Lubarsky (former Professor and Chair of the Um Department of Anesthesia, to have the Department provide anesthesia services for pediatric thoracic surgeries on a go forward basis. These services were intended to become part of the AOA agreement but were never executed officially, while the Department provided the anesthesia coverage in good faith. In an effort to resolve this earned-but-unpaid-compensation matter expeditiously and amicably, the parties have agreed to settle any potential dispute regarding payment for services rendered through a settlement agreement, The parties have agreed that payment shall be in the amount of five hundred seventy six thousand dollars and zero cents ($576,000.00) for pediatric cardio thoracic anesthesia services rendered by the Department from January 1, 2011 to May 31, 2012. The Holtz Children’s Hospital and the University of Miami/Department of Anesthesia agree that this amount represents full and correct payment for the services provided. RECOMMENDATION: That the Financial Recovery Board of the Public Health Trust approves payment in the amount of five hundred seventy six thousand dollars and zero cents ($576,000.00) to the University of Miami Department of Anesthesia for physician services provided by the Department at HCH during January 2011 to May 2012.

Comment [c1]: Written, oral, other? Please produce the agreement.

November 20, 2012 Attention: David Lubarsky, MD MBA, MD Miami, Fl - 33136 Re: Settlement Agreement for Pediatric Cardio-Thoracic Anesthesia between the Public Health Trust of Miami-Dade County and the University of Miami Department of Anesthesia. Dear Dr. Lubarsky, The Public Health Trust has been in negotiation with the Department of Anesthesia at the University of Miami (“UM”) since January 2011, to finalize the terms and conditions of the Pediatric Cardio-Thoracic Anesthesia Services Contract at Holtz Children’s Hospital. UM maintains that based on representations from the Chief Executive Officer of the Jackson Health System, UM employed physicians and provided Cardio Thoracic Anesthesia services in reliance on Jackson Health System’s agreement to reimburse the Department of Anesthesia. The parties agree that the Department of Anesthesia at the University of Miami has provided Cardio Thoracic Anesthesia services in good faith at Holtz Children’s Hospital for the months January 2011 through May 2012. UM maintains that the services were rendered based on the understanding that the Department of Anesthesia would get reimbursed at fair market value for this provision of purchased services based on the terms of the applicable Basic Affiliation Agreement and Annual Operating Agreements. At this time, to avoid the expense and uncertainty of litigation and to resolve this matter expeditiously and amicably, the parties have agreed to settle any potential dispute regarding payment for the services rendered. This document serves as a settlement agreement for the payments to be made by the Public Health Trust to the University of Miami Anesthesia Department for providing Cardio Thoracic Anesthesia services for the period January 2011 through May 2012. This settlement agreement is a resolution of disputed sums and shall not be deemed an admission of liability by any party. Subject to the noted payment for services rendered, the University and Department of Anesthesia hereby release, waive and forever discharge the Trust with respect to any and all claims, causes of action, lawsuits, arbitrations, debts, sums of money, demands, liabilities, damages or losses of every kind and character, whether asserted or unasserted, whether known or unknown, suspected or unsuspected, in law or in equity, in connection with the Public Health Trust’s payment of $ 576,000 for the Cardio Thoracic Anesthesia services as identified above. This release does not release the Public Health Trust from any medical malpractice claims arising out of the medical services provided by physicians who provided anesthesia services to patients of the Trust. The parties agree, as expressed in the Annual Operating Agreement, that any physicians who provided anesthesia services were serving as agents of the Trust when providing the referenced services and treating Trust patients. Thus, the Trust believes sovereign immunity should address said medical malpractice claims.

To the extent you desire to agree with the terms specified in the above paragraphs of this Agreement, please indicate your acceptance of the Public Health Trust’s offer by signing this letter and returning an executed copy to the Administrative Offices of the JHS Department of Physician Services, Miami, Florida 33136. The copy of such letter, as executed by you on behalf of the University of Miami Department of Anesthesia, shall serve as the mutual written agreement and will also serve as an evidence of the existing relationship between the parties. Should you have any questions, please feel free to contact Mitchell Wallace, Director of Finance, Holtz Children’s Hospital and the Women’s Center at Jackson Health System, at (305) 585-7911. Sincerely, THE PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA ____________________________________ Carlos A. Migoya President and Chief Executive Officer ACCEPTED AND ACKNOWLEDGEMENT, ____________________________________ David Lubarsky, MD MBA Emanuel M. Papper Professor and Chair of Anesthesiology University of Miami Miller School of Medicine ____________________________________ Humberto Speziani Assistant Vice President Business Services University of Miami

Agenda Item 4 (f) Special PHT Financial Recovery December 13, 2012


RESOLUTION AUTHORIZING PAYMENT TO THE UNIVERSITY OF MIAMI DEPARTMENT OF SURGERY IN THE AMOUNT OF SIX HUNDRED THIRTY FOUR THOUSAND DOLLARS AND ZERO CENTS ($634,000.00) AS A FULL AND FINAL SETTLEMENT FOR SERVICES PROVIDED BY THE UNIVERSITY OF MIAMI DEPARTMENT OF SURGERY AT HOLTZ CHILDREN’S HOSPITAL


WHEREAS, the Public Health Trust operates the Holtz Children’s Hospital (“HCH”) which

includes providing pediatric cardio thoracic surgery services daily; and

WHEREAS, in October 2009, the Chief Administrative Officer of the HCH arranged for pediatric

cardio thoracic surgeries to be provided from the University of Miami Department of Surgery

(“Department”); and

WHEREAS, the Department agreed to provide pediatric cardio thoracic surgery physician

coverage to the HCH for pediatric cardio thoracic surgeries with the expectation the services would be

compensated through the Annual Operating Agreement between the Trust and the University of Miami;

and

WHEREAS, the Department staffed the HCH pediatric cardio thoracic surgeries with pediatric

cardio thoracic surgeons during the period of October 1, 2009 through May 31, 2012; and

WHEREAS, the HCH received the services beginning October 1, 2009 but did not compensate the


WHEREAS, the parties have mutually agreed to a Settlement Agreement which provides payment

for the provided service; and

Agenda Item 4 (f) Special PHT Financial Recovery December 13, 2012

-Page 2-



litigation.



to pay the University of Miami Department of Surgery in the amount of six hundred thirty four thousand

and zero cents ($634,000.00) as settlement in full for Holtz Children’s Hospital pediatric cardio thoracic

surgery coverage during October 1, 2009 through May 31, 2012 provided by the University of Miami

Department of Surgery at Holtz Children’s Hospital.

To: Fiscal Affairs, Financial Recovery Board Public Health Trust From: Steven Burghart Chief Administrative Officer Holtz Children’s Hospital and Jackson Women’s Hospital Center Date: Settlement Agreement for Pediatric Cardio Thoracic Surgery Services between the Public

Health Trust of Miami-Dade County and the University of Miami Department of Surgery REQUEST: Approval of payment in the amount of $634,000.00 to the University of Miami Department of Surgery (“Department”) as a settlement agreement for services provided by the Department at Holtz Children’s Hospital (“HCH”). These dollars are budgeted and included in the approved FY 10-12 operating budgets for HCH, and expenses have been accrued for the period of time services were provided by the Department at HCH. BACKGROUND: In October 2009 HCH discussed an agreement with the Department, to have the Department provide pediatric cardio thoracic surgeons for pediatric thoracic surgeries on a go forward basis. These services were intended to become part of the AOA agreement but were never executed officially, while the Department provided the pediatric cardio thoracic surgeon coverage in good faith. In an effort to resolve this earned-but-unpaid-compensation matter expeditiously and amicably, the parties have agreed to settle any potential dispute regarding payment for services rendered through a settlement agreement, The parties have agreed that payment shall be in the amount of six hundred thirty four thousand dollars and zero cents ($634,000.00) for pediatric cardio thoracic surgery services rendered by the Department from October 1, 2009 to May 31, 2012. The Holtz Children’s Hospital and the University of Miami/Department of Surgery agree that this amount represents full and correct payment for the services provided. RECOMMENDATION: That the Financial Recovery Board of the Public Health Trust approves payment in the amount of six hundred thirty four thousand dollars and zero cents ($634,000.00) to the University of Miami Department of Surgery for physician services provided by the Department at HCH during October 2009 to May 2012.

November 20, 2012 Attention: Alan Livingstone, MD Miami, Fl - 33136 Re: Settlement Agreement for Pediatric Cardio-Thoracic Surgery between the Public Health Trust of Miami-Dade County and the University of Miami Department of Surgery. Dear Dr. Livingstone: The Public Health Trust has been in negotiation with the Department of Surgery at the University of Miami (“UM”) since October 2009, to finalize the terms and conditions of the Pediatric Cardio-Thoracic Surgery Services Contract at Holtz Children’s Hospital. UM maintains that based on representations from the Chief Executive Officer of the Jackson Health System, UM employed Drs. Eliot Rosenkranz and Marco Ricci and provided Cardio Thoracic Surgery services in reliance on Jackson Health System’s agreement to reimburse the Department of Surgery. The parties agree that the Department of Surgery at the University of Miami has provided Cardio Thoracic Surgery services in good faith at Holtz Children’s Hospital for the months October 2009 through May 2012. UM maintains that the services were rendered based on the understanding that the Department of Surgery would get reimbursed at fair market value for this provision of purchased services based on the terms of the applicable Basic Affiliation Agreement and Annual Operating Agreements. At this time, to avoid the expense and uncertainty of litigation and to resolve this matter expeditiously and amicably, the parties have agreed to settle any potential dispute regarding payment for the services rendered. This document serves as a settlement agreement for the payments to be made by the Public Health Trust to the University of Miami Surgery Department for providing Cardio Thoracic Surgery services for the period October 2009 through May 2012. This settlement agreement is a resolution of disputed sums and shall not be deemed an admission of liability by any party. Subject to the noted payment for services rendered, the University and Department of Surgery hereby release, waive and forever discharge the Trust with respect to any and all claims, causes of action, lawsuits, arbitrations, debts, sums of money, demands, liabilities, damages or losses of every kind and character, whether asserted or unasserted, whether known or unknown, suspected or unsuspected, in law or in equity, in connection with the Public Health Trust’s payment of $634,000 representing the outstanding balance for the Cardio Thoracic Surgery services as identified above. This release does not release the Public Health Trust from any medical malpractice claims arising out of the medical services provided by Drs. Rosenkranz or Ricci to patients of the Trust. The parties agree, as expressed in the Annual Operating Agreement, that Drs. Rosenkranz or Ricci were serving as agents of the Trust when providing the referenced services and treating Trust patients. Thus, the Trust believes sovereign immunity should address said medical malpractice claims.

To the extent you desire to agree with the terms specified in the above paragraphs of this Agreement, please indicate your acceptance of the Public Health Trust’s offer by signing this letter and returning an executed copy to the Administrative Offices of the JHS Department of Physician Services, Miami, Florida 33136. The copy of such letter, as executed by you on behalf of the University of Miami Department of Surgery, shall serve as the mutual written agreement and will also serve as an evidence of the existing relationship between the parties. Should you have any questions, please feel free to contact Mitchell Wallace, Director of Finance, Holtz Children’s Hospital and the Women’s Center at Jackson Health System, at (305) 585-7911. Sincerely, THE PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA ____________________________________ Carlos A. Migoya President and Chief Executive Officer ACCEPTED AND ACKNOWLEDGEMENT, ____________________________________ Alan Livingstone, MD Professor and Chair Department of Surgery University of Miami Miller School of Medicine Clinical Service Chief, Jackson Memorial Hospital ____________________________________ Humberto Speziani Assistant Vice President of Business Services University of Miami

Agenda Item 4 (g) Special PHT Financial Recovery Board December 13, 2012


RESOLUTION APPROVING THE PUBLIC HEALTH TRUST DEFINED BENEFIT RETIREMENT PLAN ACTUARIAL REPORT FOR THE PLAN YEAR ENDING DECEMBER 31, 2013


WHEREAS, the Public Health Trust Defined Benefit Retirement Plan (“Plan”) as required under Part VII,

Chapter 112, Florida Statutes requiring Actuarial Valuations on the Plan’s condition; and

WHEREAS, this Actuarial Report is presenting to management the contribution requirements for the 2013

Plan Year and also the current funding of Plan Accumulated Benefits; and

NOW, THEREFORE, BE IT RESOLVED BY THE FINANCIL RECOVERY BOARD OF THE PUBLIC

HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby approves the Public Health

Trust Defined Retirement Plan Actuarial Report for the Plan Year ending December 31, 2013.

Agenda Item 4 (h) Special PHT Financial Recovery Board December 13, 2012


RESOLUTION APPROVING THE PUBLIC HEALTH TRUST DEFINED BENEFIT RETIREMENT PLAN AMENDED INVESTMENT POLICY STATEMENT


WHEREAS, this Board seeks to accomplish certain investment objectives for the Defined Benefit

Retirement Plan; and

WHEREAS, this Amended Investment Policy Statement establishes the policy by which investment

activities are to be in conducted; and



PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby approves the

Amended Investment Policy Statement.

Agenda Item 4 (i) Special PHT Financial Recovery Board December 13, 2012


RESOLUTION APPROVING THE PUBLIC HEALTH TRUST APPOINTMENT OF PETER L. BERMONT TO THE PENSION PLAN SUBCOMMITTEE


WHEREAS, this Board seeks to add an at-large member from the community to the Pension Plan

Subcommittee; and



PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby approves the addition

of Peter L. Bermont to the Pension Plan Subcommittee as the at-large member, as more fully set forth in the

memorandum attached hereto and incorporated herein.


1611 N.W. 12th Avenue

West Wing – Rm 108

Miami, Fla 33136

Telephone: 305-585-6778

MEMORANDUM

TO: Financial Recovery Board Public Health Trust FROM: Brian Dean, Vice President, Finance DATE: 12/13/2012 SUBJECT: Pension Plan Subcommittee At-Large Member Recommendation

Recommendation That this Board hereby approves the appointment of Mr. Peter L. Bermont to the Pension Plan Subcommittee. Background The Investment Policy Statement (“IPS”) adopted by the FRB specified the addition of an At-Large member to the Pension Plan Committee as its seventh member. The At-Large member must meet certain experience and background requirements as outlined in section 1 of the IPS. Attached to this memorandum is the CV for Mr. Peter L. Bermont. Mr. Bermont’s vast experience in institutional asset management as well as the nuances of defined benefit plans provides support for his candidacy for the At-Large Pension Plan Committee Member.

Agenda Item 4 (k) Special PHT Financial Recovery Board

December 13, 2012

RESOLUTION NO. PHT 12/12–
















REQUEST



Agenda Item 4 (l) Special PHT Financial Recovery Board December 13, 2012

RESOLUTION NO. PHT 12/12 – RESOLUTION AUTHORIZING AND APPROVING AWARD OF BIDS AND PROPOSALS, WAIVER OF BIDS, AND OTHER PURCHASING ACTIONS AS RECOMMENDED FROM THE FISCAL COMMITTEE FOR DECEMBER 2012 BASED ON THE PROCUREMENT POLICY, RESOLUTION NO. PHT 12/05-231

(Mark T. Knight, Executive Vice President and Chief Financial Officer,

Jackson Health System)

WHEREAS, bids and proposals were solicited, received and reviewed by staff; and

WHEREAS, the Purchasing Subcommittee met on December 13, 2012 and reviewed staff’s recommendations

as submitted under the PHT”s Procurement Policy, Resolution No. PHT 12/05-231, effective February 1, 2006; and

WHEREAS, the Fiscal Committee met on December 13, 2012 and reviewed staff’s recommendations for each

item under the report, which are attached hereto and hereby incorporated by reference; and

WHEREAS, upon the written recommendation of the President recommends that the Financial Recovery

Board waive competitive bidding for items under the heading of “Bid Waiver” and “Waiver of Full and Competitive

Bidding” in the respective Purchasing Report, finding such action to be in the best interests of the Public Health Trust;

and

WHEREAS, the Financial Recovery Board recommends various other purchasing actions, as indicated in the

attached Purchasing Report.


Agenda Item 4 (l) Special PHT Financial Recovery Board December 13, 2012

Page -2-

NOW, THEREFORE, BE IT RESOLVED BY THE FINANCIAL RECOVERY BOARD OF THE PUBLIC

HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, hereby authorizes and approves the award of bids and

proposals and all the purchasing actions as set forth in the attached Purchasing Report, under the PHT’s Procurement

Policy, Resolution No. PHT 12/05-231, effective February 1, 2006; finds it in the best interest of the Public Health

Trust to waive competitive bidding for those items listed under the heading “Bid Waiver” and “Waiver of Full and

Competitive Bidding” in the respective report; and to take such action as is necessary and authorized to implement these

awards and actions.



December 13, 2012





(for 3 years)




Background















Recommendation








(for 6 years)












Recommendation








(for 5 years)


Background








Urine Immunotyping

Hemoglobinopathy

Thalassemia testing









No items to report.



Agenda Item 4 (m) Special PHT Financial Recovery Board December 13, 2012


RESOLUTION APPROVING THE MEDICAL STAFF AND HEALTH PROFESSIONAL AFFILIATE STAFF MEMBERSHIP AND CLINICAL PRIVILEGES; APPROVING INITIAL APPOINTMENTS, REAPPOINTMENTS AND CLINICAL PRIVILEGES AND ACTIVITIES; APPROVING MODIFICATIONS TO MEDICAL STAFF MEMBERSHIP CATEGORY AND CLINICAL PRIVILEGES; ACCEPTING RESIGNATIONS AND LEAVES OF ABSENCE – DECEMBER 2012


WHEREAS, the Financial Recovery Board is charged with considering and acting upon applications for medical staff

membership and clinical privileges pursuant to Section 25A-4(f) of the Miami-Dade County Code as well as state and federal law and

regulations; and

WHEREAS, the Financial Recovery Board is charged with considering and acting upon applications for health professional

affiliate staff membership and clinical privileges, protocols and/or scope of service pursuant to state and federal laws and regulations;

and

WHEREAS, all applications for initial appointment and reappointment to the medical staff and health professional affiliate

staff, modifications of medical staff membership, requests for and modifications to clinical privileges/admitting

priorities/protocols/scopes of service, resignations and leaves of absence have been thoroughly reviewed by the Public Health Trust’s

Corporate Credentialing Office, the appropriate Chief of Service, Associate Chief of Service or designee, the Credentials Committee,

the Medical Executive Committee and, where appropriate, the Office of Risk Management; and

Agenda Item 4 (m) Special PHT Financial Recovery Board December 13, 2012

-Page 2-

WHEREAS, the Credentials Committee provided its recommendation to the Medical Executive Committee; and

WHEREAS, the Medical Executive Committee provided its recommendations to the Joint Conference & Efficiencies

Committee.

NOW, THEREFORE, BE IT RESOLVED BY THE FINANCIAL RECOVERY BOARD OF THE PUBLIC HEALTH

TRUST OF MIAMI-DADE COUNTY, FLORIDA, hereby approves the initial appointments and reappointments to the medical staff

and health professional affiliate staff and grants clinical privileges, admitting priorities, protocols and scopes of service as detailed in

the attachment; approves the modifications to the medical staff membership category and modifications to clinical privileges,

admitting priorities, protocols and scopes of service as detailed in the attachment; and finally, the Financial Recovery Board accepts

the resignations and leaves of absence from the medical staff and health professional affiliate staff as detailed in the attachment.

Agenda Item 4 (n) Special PHT Financial Recovery Board December 13, 2012


RESOLUTION APPROVING AND ADOPTING A JACKSON HEALTH SYSTEM SURGICAL ASSISTANT (SA) DELINEATION OF PRIVILEGES OF THE MEDICAL STAFF – DECEMBER 2012


WHEREAS, the Medical Staff Surgical Assistant delineation of privileges (“SA DOP”) was revised so as

to be in compliance with the Joint Commission on Accreditation of Health Care Organization standards, statutory

requirements, and the current practice of the Medical Staff; and

WHEREAS, the Medical Executive Committee of the Medical Staff reviewed and approved the changes to

the SA DOP on November 13, 2012; and

WHEREAS, the recommended revisions were provided to the Joint Conference & Efficiencies Committee

on

December 13, 2012; and

WHEREAS, a copy of the SA DOP, as amended, has been attached hereto and incorporated herein by reference.


PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that it hereby adopts the attached

comprehensive amendment to the Public Health Trust Surgical Assistant delineation of privileges of the Medical Staff; and that this

resolution shall be effective upon its passage.

NAME: _______________________________________________

Jackson Health System - Delineation Of Privileges - SURGICAL ASSISTANT JMH JNMC JSCH Requested Approved Condition

ALL

QUALIFICATIONS: Current demonstrated competence and an adequate volume of current experience with acceptable results and certification by, or formal active participation in the examination process leading to certification by the American Board and Surgical Assistants (ABSA) and/or National Board of Surgical Technology and SUrgical Assisting (NBSTSA). ______ ______ ______

Physician (U.S. or Foreign trained must provide evidence of Florida licensed MD or DO

or

Medical School graduate (ACGME approved) possessing an MD or DO degree and a Florida training license.or

Graduate of a Foreign Medical School and possesion of an ECFMG or qualified to sit for the ECFMG exam.and

A minimum of two years primary or advance surgical experience.

and

Provide evidence of having first assisted on at least 400 clinical surgical cases or 1500 clinical surgical hours at a Joint Commission (JC) accredited facility or in a U.S. approved program, during the past two years, where applicant is listed as the first assistant on the operative record. (Case log or computer print out required).

Florida licensed Nurses (RN's), Florida Licensed Practical Nurses (LPN's) or Certified Surgical Technologists (CST's) must provide evidence of completion of an American Board of Surgical Assistants (ABSA) aprpoved or Commission on Accreditation of Allied Health Education Programs (CAAHEP) approved formal surgical assistant training program and evidence of active participation in the certification exam process.

Physician Assistants and Nurse practitioners must provide evidence of current Florida licensure and documentation of having first assisted on at least 400 clinical surgical cases or 1500 clinical surgical hours at a JC accredited facility during the last two years where the applicant was listed as the surgical assistant on the record.

ACLS Certification required. (Note: BLS has been removed not a JHS Requirement)

MEDICAL RECORDS JMH JNMC JSCH

Dictate/Write History and Physical (to be countersigned by physician within 24 hours).______ ______ ______

Dictate/Write Progress Notes (to be countersigned by physician within 24 hours). ______ ______ ______ Dictate Discharge Summaries (to be countersigned by physician within 24 hours). ______ ______ ______

MEDICAL HISTORY AND PHYSICAL

Interview patient for medical history. ______ ______ ______ Perform general screening physical exam (as approved by physician employer). ______ ______ ______

PERFORM SPECIALTY PHYSICAL EXAM AND EVALUATION, SUCH AS:

Respiratory ______ ______ ______ Cardiovascular ______ ______ ______ Gastrointestinal ______ ______ ______ ENT ______ ______ ______ Neurological ______ ______ ______ Skeletal ______ ______ ______ Gynecology ______ ______ ______ Genito-Urinary ______ ______ ______

ROUTINE THERAPEUTIC DUTIES JMH JNMC JSCH

Cleanse and dress wounds.______ ______ ______

Suture minor wounds and lacerations (in the presence of physician employer).______ ______ ______

Remove sutures/staples.______ ______ ______

Perform nasogastric intubation.

______ ______ ______ Insert and change catheters.

______ ______ ______ Remove fecal impaction.

______ ______ ______ Assist with specifically requested by physician employer as follows:

______ ______ ______

PATIENT CONTACT DUTIES

Provide counseling on health habits, exercise, tobacco, alcohol. Supportive counseling.______ ______ ______

Provide discharge instructions as per physician employer's orders. ______ ______ _______________________________________________________________

DUTIES THAT MAY BE PERFORMED ONLY IN THE PHYSICAL PRESENCE OF THE

SPONSORING PHYSICIAN.

Assist in surgery. ______ ______ ______ Assist in management of injuries. ______ ______ ______ Assist in management of acute medical emergencies. ______ ______ ______ Assist in Critical Care Unit. ______ ______ ______ Emergency Tracheostomy. ______ ______ ______ Cut Down. ______ ______ ______Close Incisions. ______ ______ ______ Emergency Intubation.

______ ______ ______ Emergency Subclavian I.V. ______ ______ ______ Emergency Insert Chest Tubes. ______ ______ ______ Arterial Puncture. ______ ______ ______Clamp, ligate, and cut tissue per surgeon’s directive ______ ______ ______Harvest saphenous vein, including skin incision, per surgeon’s directive ______ ______ ______Dissect common femoral artery and bifurcate per surgeon’s directive

______ ______ ______Maintain integrity of sterile field

______ ______ ______Close all wound layers (facia, subcutaneous and skin) as per surgeon’s directive

______ ______ ______Insert drainage tubes per surgeon’s directive

______ ______ ______Select and apply wound dressings ______ ______ ______Assist with resuscitation of patient during cardiac arrest or other life-threatening events in the operating room ______ ______ ______Perform any other duties or procedures incident to the surgical procedure deemed necessary and as directed by the surgeon ______ ______ ______

Insertion laminaria in nonviable pregnancies ______ ______ ______Removal surgical staples/sutures ______ ______ ______Assist in External Version ______ ______ ______Wound dressing ______ ______ ______ (Note: This section reserved for use in describing conditional privileges by the

Governing Board).







(JMH):_____________________________________ Date:__________


(JNMC):____________________________________ Date:__________


(JSCH):____________________________________ Date:__________


(JNMC):____________________________________Date:___________



(JSCH):____________________________________Date:___________



Agenda Item 4 (p) Special PHT Financial Recovery Board December 13, 2012


RESOLUTION APPROVING AND ADOPTING A JACKSON HEALTH SYSTEM OPTOMETRIST DELINEATION OF PRIVILEGES OF THE MEDICAL STAFF – DECEMBER 2012


WHEREAS, the Medical Staff Optometrist delineation of privileges (“DOP”) was revised so as to

be in compliance with the Joint Commission on Accreditation of Health Care Organization standards,

statutory requirements, and the current practice of the Medical Staff; and

WHEREAS, the Executive Medical Committee of the Medical Staff reviewed and approved the

changes to the Optometrist DOP on December 10, 2012; and

WHEREAS, the recommended revisions were provided to the Joint Conference & Efficiencies

Committee on December 13, 2012; and

WHEREAS, a copy of the Optometrist DOP, as amended, has been attached hereto and incorporated herein

by reference.


THE PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that it hereby adopts the

attached comprehensive amendment to the Public Health Trust Optometrist delineation of privileges of the Medical

Staff; and that this resolution shall be effective upon its passage.

NAME: _______________________________________________

Jackson Health System - Delineation Of Privileges - OPTOMETRIST JMH JNMC JSCH Requested Approved Condition

ALL

QUALIFICATIONS: To be elegible to request clinical privileges in optometry, an applicant must meet the following minimum threshold criteria: ______ ______ ______ BASIC EDUCATION: Doctor of Optometry (OD)

MINIMUN FORMAL TRAINING: Applicants must be able to demonstrate successful completion of a professional optometric degree program leading to an OD. The program must be accredited by the ACOE.

IN ADDITION, AN OPTOMETRIST SHOULD MEET THE FOLLOWING

REQUIREMENTS:

A. Valid state license to practice optometry. B. Appropriate certification by a state board of optometry when applicable.C. Current evidence of competence and an adequate volume of clinical experience with accept able results in the privileges requested for patients of all applicable age groups. D. Successful completion of required specialty training or CME training in procedures that were not a part of the applicant’s optometry training program. E.

Employment by or agreement with a physician(s) currently appointed to the medical staff of the hospital to supervise the optometrist’s practice in the hospital. According to a

written agreement, the physician must • assume responsibility for supervision or monitoring of the optometrist’s practice as

stated in the appropriate hospital or medical staff policy governing optometrists • be continuously available or designate an alternate to provide consultation when requested and to intervene when necessary • assume total responsibility for the care of any patient when requested by the optometrist by this policy or in the interest of patient care • cosign all orders entered by the optometrist on the medical records of all patients seen or treated by the optometrist

REQUIRED PREVIOUS EXPERIENCE: Applicants must be able to demonstrate that they have successfully provided inpatient, outpatient, or consultative optometry services to at least 50 patients in the past 12 months.

REFERENCES: A letter of reference must come from the director of the applicant’s

optometry training program. Alternatively, a letter of reference regarding competence should come from the optometrist’s supervisor at the institution where the applicant most

recently practiced, or peer optometrist or ophthalmogist.

MEDICAL HISTORY AND PHYSICAL JMH JNMC JSCH

Interview patient for medical history. ______ ______ ______

CORE PRIVILEGES: Core privileges in optometry include but are not limited to the following:

1. Perform primary care examinations, including refraction ______ ______ ______2. Diagnose vision problems and eye diseases ______ ______ ______3. Test patients’ visual acuity, depth and color perception, and ability to focus and

coordinate their eyes ______ ______ ______4. Analyze test results and develop a treatment plan ______ ______ ______5. Provide pre- and postoperative care to cataract patients as well as those who have had laser vision correction or other eye surgery ______ ______ ______6. Provide emergency eye care services ______ ______ ______7. Diagnose conditions due to systemic diseases such as diabetes and high blood pressure, refer¬ring patients to other health practitioners as needed ______ ______ ______8. Administer drugs for diagnostic and therapeutic purposes ______ ______ ______

CLINICS OR LONG TERM CARE PRIVILEGES/ACTIVITIES LIST: JMH JNMC JSCH

9. Comprehensive medical eye examination, diagnosis, and treatment basis ______ ______ ______9a. Tonometry, ______ ______ ______9b. Biomicroscopy, ______ ______ ______9c. Retinoscopy. ______ ______ ______9d. Refractive error evaluation and eyeglass prescription. ______ ______ ______

10. Prescribes visual aids as necessary. ______ ______ ______11. Use of instruments and pharmaceutical aganets to treat the eye, adnexa, and related structures. ______ ______ ______12. Co-management and follow up care of pre-and post surgical patients; write patient treatment orders. ______ ______ ______13. Post documentation of the eye, adnexa, and related structures. ______ ______ ______14. Gonioscopy. ______ ______ ______15. Foreign body removal (cornea, lid, conjuctiva). ______ ______ ______16. Dilation of irritation of lacrimal system. ______ ______ ______17. Direct and indirect ophthalmoscopy ______ ______ ______18. Eye lash epilation. ______ ______ ______

SPECIAL REQUESTS IN OPTOMETRY JMH JNMC JSCH

For each special request, threshold criteria (e.g., additional training or completion of a recognized course and required experience) must be established. Special requests for optometry include but are not limited to the following procedure(s) if they were not a part of the applicant’s optometry training program:

19. Sensory motor evaluation ______ ______ ______20. Vision therapy/orthoptics ______ ______ ______21. Eikonometry ______ ______ ______22. Ocular photography ______ ______ ______23. Electrodiagnosis ______ ______ ______24. Ultrasonography ______ ______ ______25. Scanning laser polarimetry ______ ______ ______

(Note: This section reserved for use in describing conditional privileges by the

Governing Board).



REAPPOINTMENT:

• Reappointment should be based on unbiased, objective results of care according to the

organization’s existing quality-assurance mechanisms.

• Applicants must be able to demonstrate that they have maintained competence by

documenting that they have successfully provided inpatient, outpatient, or consultative optometry services to at least 50 patients annually during the reappointment cycle.

• In addition, continuing education related to optometry should be required.




Supervising (Sponsoring) Physician (JMH): Print

Name:________________________ Signature:_______________________

Date:___________

Supervising (Sponsoring) Physician (Clinic/Long Term Care) Print

Name:________________________ Signature:_______________________

Date:___________

Supervising (Sponsoring) Physician (JNMC): Print

Name:________________________ Signature:_______________________

Date:___________

Supervising (Sponsoring) Physician (JSCH) Print

Name:________________________ Signature:_______________________

Date:___________


(JNMC):____________________________________Date:___________



(JSCH):____________________________________Date:___________



Agenda Item 4 (r) Special PHT Financial Recovery Board December 13, 2012

RESOLUTION NO. PHT 12/12 – RESOLUTION AUTHORIZING THE PRESIDENT OR HIS DESIGNEE TO NEGOTIATE AND EXECUTE THE FISCAL YEAR 2012-2013 ANNUAL OPERATING AGREEMENT WITH FLORIDA INTERNATIONAL UNIVERSITY COLLEGE OF MEDICINE, IN THE AMOUNT OT $3,135,605 FOR THE PROVISION OF PHYSICIAN SERVICES AT JACKSON NORTH MEDICAL CENTER (Sandy Sears, Senior Vice President and Chief Administrative Officer, Jackson North Medical Center) WHEREAS, in July 2007, the Public Health Trust entered into a Basic Affiliation Agreement with

the Florida International University College of Medicine (“FIU”) to serve as the location for the training of

medical students; and

WHEREAS, the Trust and FIU have determined, as further set forth in the attached memorandum,

which is incorporated in this Resolution as if fully set forth herein, that it is in their mutual interests to

conduct a major part of FIU’s inpatient medical school training at Jackson North Medical Center

(“JNMC”); and

WHEREAS, FIU has recruited and will continue recruiting full-time and part-time faculty

members who will practice at JNMC, providing medical staff leadership, and clinical services; and

WHEREAS, the President finds that it is in the best interest of the Trust to pursue negotiations

with FIU for a 2012-2013 Annual Operating Agreement and recommends continued negotiations, contract

execution and approval of the proposed budget.


THE PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board finds it in he

best interest of the Public Health Trust to authorize the President, or his designee, to negotiate and execute

the Fiscal Year 2012-2013 Annual Operating Agreement with Florida International University College of

Medicine in the amount of $3,135,605 for the provision of physician services, including, but not limited to,

medical staff leadership and clinical services.

Attachment VII

5. Special Meeting Adjourned