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A TRUE COPY <br />CERTIFICATION ON LAST PAGE <br />RYAN L. BUTLER, CLERK <br />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 2023, by and between Indian River County Emergency Services Distirct 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 2023-156 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 />Per Senate Bill 2500, the General Appropriations Act of State Fiscal Year 2023-2024, <br />passed by the 2023 Florida Legislature, the Indian River County Emergency Services <br />Distirct and the Agency agree that the Indian River County Emergency Services <br />Distirct will remit IGT funds to the Agency in an amount not to exceed the total of <br />$363,337.25. The Indian River County Emergency Services Distirct 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 Distirct will return the signed LOA to <br />the Agency. <br />3. The Indian River County Emergency Services Distirct will pay IGT funds to the <br />Agency in an amount not to exceed the total of $363,337.25. The Indian River County <br />Emergency Services Distirct 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 2023 <br />through June 2024 are due to the Agency no later than October 31, 2023, unless <br />an alternative plan is specifically approved by the agency. <br />b. The Agency will bill the Indian River County Emergency Services Distirct <br />when payment is due. <br />4. The Indian River County Emergency Services Distirct and the Agency agree that the <br />Agency will maintain necessary records and supporting documentation applicable to <br />Indian River County Emergency Services Distirct Indian River County ALS—PEMT LOA_SFY 2023-24 <br />