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2023-215A
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2023-215A
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Last modified
11/2/2023 1:26:27 PM
Creation date
11/2/2023 1:16:11 PM
Metadata
Fields
Template:
Official Documents
Official Document Type
Agreement
Approved Date
09/26/2023
Control Number
2023-215A
Agenda Item Number
15.A.2.
Entity Name
State of Florida Agency for health Care Administration
Subject
Letter of Agreement for Public Emergency Medical Transportation
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A TRUE COPY <br />CERTIFICATION ON LAST PAGE <br />RYAN L. BUTLER, CLERK <br />The Indian River County Emergency Services District and the Agency agree that any <br />modifications to this LOA shall be in the same form, namely the exchange of signed copies <br />of a revised LOA. <br />6. Indian River County Emergency Services District confirms that there are no pre- <br />arranged agreements (contractual or otherwise) between the respective counties, taxing <br />districts, and/or the providers to re -direct any portion of these aforementioned <br />supplemental payments in order to satisfy non -Medicaid, non -uninsured, and non - <br />underinsured activities. <br />7. Indian River County Emergency Services District agrees the following provision shall <br />be included in any agreements between Indian River County Emergency Services <br />District and local providers where IGT funding is provided pursuant to this LOA. Funding <br />provided in this agreement shall be prioritized so that designated IGT funding shall first be <br />used to fund the Medicaid program and used secondarily for other purposes. <br />8. This LOA covers the period of July 1, 2023, through June 30, 2024, and shall be <br />terminated September 30, 2024, which includes the states certified forward period. <br />9. This LOA may be executed in multiple counterparts, each of which shall constitute an <br />original, and each of which shall be fully binding on any party signing at least one <br />counterpart. <br />PEMT Local Inter overnmental Transfers <br />Program / Amount State Fiscal Year 2023-2024 <br />Estimated IGTs $363,337.25 <br />Total Funding Not to Exceed $363,337.25 <br />IN WITNESS WHEREOF, the parties have caused this page Letter of Agreement to be <br />executed by their undersigned officials as duly authorized. <br />Indian River County Emergency Services <br />District <br />SIGNED <br />BY: i <br />NAME: John A. Titkanich <br />TITLE: County Administrator <br />DATE: ( d //? / 1--3 <br />STATE OF FLORIDA, AGENCY FOR <br />HEALTH CARE ADMINISTRATION <br />SIGNED <br />BY: <br />NAME: Thomas Wallace <br />TITLE: Deputy Secretary, Division of <br />Medicaid <br />DATEgttest Ryan L. Butler. Clerk of <br />Circuit Court and Comptroller <br />APPROVED AS TO FORM <br />ANDI A 5UFMCIEN �� CiyLQ,p� <br />By: <br />puty Clerk <br />BY <br />WILLIAil &P my Emergency Services District_ Indian River County ALS_PENIT LOA SFY 2023-24 <br />COUNTY ATTORNEY <br />
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