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Public Emergency Medical Transportation Letter of Agreement <br />THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the <br />day of 2021, by and between Indian River County Emergency Services District on <br />behalf of Indian River County ALS, and the State of Florida, Agency for Health Care <br />Administration (the "Agency"), for good and valuable consideration, the receipt and sufficiency <br />of which is acknowledged. <br />DEFINITIONS <br />"Intergovernmental Transfers (IGTs)" means transfers of funds from a non -Medicaid <br />governmental entity (e.g., counties, hospital taxing districts, providers operated by state or local <br />government) to the Medicaid agency. IGTs must be compliant with 42 CFR Part 433 Subpart B. <br />"Medicaid" means the medical assistance program authorized by Title XIX of the Social Security <br />Act, 42 US.C. §§ 1396 et seq., and regulations thereunder, as administered in Florida by the <br />Agency. <br />"Public Emergency Medical Transportation (PEMT)," pursuant to the General Appropriation Act, <br />Laws of Florida 2021-111, is the program that provides supplemental payments for eligible Public <br />Emergency Medical Transportation (PEMT) entities that meet specified requirements and provide <br />emergency medical transportation services to Medicaid beneficiaries. <br />A. GENERAL PROVISIONS <br />Per Senate Bill 2500, the General Appropriations Act of State Fiscal Year 2021-2022, <br />passed by the 2021 Florida Legislature, the Indian River County Emergency Services <br />District and the Agency agree that the Indian River County Emergency Services <br />District will remit IGT funds to the Agency in an amount not to exceed the total of <br />$212,912.84. The Indian River County Emergency Services District and the Agency <br />have agreed that these IGT funds will only be used for the PEMT program. <br />2. The Indian River County Emergency Services District will return the signed LOA to <br />the Agency. <br />3. The Indian River County Emergency Services District will pay IGT funds to the <br />Agency in an amount not to exceed the total of $212,912.84. The Indian River County <br />Emergency Services District will transfer payments to the Agency in the following <br />manner: <br />a. Per Florida Statute 409.908, annual payments for the months of July 2021 <br />through June 2022 are due to the Agency no later than October 31, 2021 unless <br />an alternative plan is specifically approved by the agency. <br />b. The Agency will bill the Indian River County Emergency Services District <br />when payment is due. <br />4. The Indian River County Emergency Services District and the Agency agree that the <br />Agency will maintain necessary records and supporting documentation applicable to <br />Indian River County Emergency Services District—Indian River County ALS—PEMT LOA_SFY 2021-22 <br />