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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 2022, by and between Indian River County ALS (the "IGT <br />Provider') on behalf of Indian River County Emergency Services District , and the State of Florida, <br />Agency for Health Care Administration (the `Agency"), for good and valuable <br />consideration, the receipt and sufficiency 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 2022-156 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 />1. Per House Bill 5001, the General Appropriations Act of State Fiscal Year 2022-2023, <br />passed by the 2022 Florida Legislature, the IGT Provider and the Agency agree that the IGT <br />Provider will remit IGT funds to the Agency in an amount not to exceed the total of <br />$335,068.78. The IGT Provider and the Agency have agreed that these IGT funds will only be <br />used for the PEMT program. <br />2. The IGT Provider will return the signed LOA to the Agency. <br />3. The IGT Provider will pay IGT funds to the Agency in an amount not to exceed the total of <br />$335,068.78 . The IGT Provider 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 2022 through <br />June 2023 are due to the Agency no later than October 31, 2022, unless an <br />alternative plan is specifically approved by the agency. <br />b. The Agency will bill the IGT Provider when payment is due. <br />4. The IGT Provider and the Agency agree that the Agency will maintain necessary records and <br />supporting documentation applicable to health services covered by this LOA in accordance <br />with public records laws and established retention schedules. <br />a. AUDITS AND RECORDS <br />Indian River County ALS _PEMT LOA_SFY 2022-23 <br />Indian River County Emergency Services District <br />201 <br />