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A TRUE COPY CERTIFICATION ON LAST PAGE DocuSign Envelope ID: 8B50F830-95924E2A-A70D-CF9CEEF344CD J.R. SMITH, CLERK Directed Payment Program Letter of Agreement THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the 20th day of Sept 2022, by and between Indian River county LPPF (the "IGT Provider") on behalf of Region 9 , and the State of Florida, Agency for Health Care Administration (the "Agency"), for good and valuable consideration, the receipt and sufficiency of which is acknowledged. "Intergovernmental Transfers (IGTs)" means transfers of funds from a non -Medicaid governmental entity (e.g., counties, hospital taxing districts, providers operated by state or local government) to the Medicaid agency. IGTs must be compliant with 42 CFR Part 433 Subpart B. "Medicaid" means the medical assistance program authorized by Title XIX of the Social Security Act, 42 US.C. §§ 1396 et seq., and regulations thereunder, as administered in Florida by the Agency. "Directed Payment Program (DPP)," pursuant to the General Appropriation Act, Laws of Florida 2021-156, is the program that provides direct supplemental payments to eligible public and private entities that provide inpatient and outpatient services to Medicaid managed care recipients. A. GENERAL PROVISIONS 1. Per House Bill 5001, the General Appropriations Act of State Fiscal Year 2022- 2023,passed by the 2022 Florida Legislature, the IGT Provider and the Agency agree that the IGT Provider will remit IGT funds to the Agency in an amount not to exceed the total of $2,870,123.00 . The IGT Provider and the Agency have agreed that these IGT funds will only be used for the DPP program. 2. The IGT Provider will return the signed LOA to the Agency. 3. The IGT Provider will pay IGT funds to the Agency in an amount not to exceed the total of $2,870,123.00 The IGT Provider will transfer payments to the Agency in the following manner: a. Per Florida Statute 409.908, annual payments for the months of July 2022 through June 2023 are due to the Agency no later than October 31, 2022, unless an alternative plan is specifically approved by the agency. b. The Agency will bill the IGT Provider when payment is due. 4. The IGT Provider and the Agency agree that the Agency will maintain necessary records and supporting documentation applicable to health services covered by this LOA in accordance with public records laws and established retention schedules. a. AUDITS AND RECORDS i. IGT Provider agrees to maintain books, records, and documents (including Indian River County LPPF DPP LOA SFY 2022-23 Region 9