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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 23rd day <br />of September 2025, by and between Indian River County Emergency Services Distirct (the <br />"IGT Provider") on behalf of Indian River County ALS, and the State of Florida, Agency for <br />Health Care Administration (the "Agency"), for good and valuable consideration, the receipt <br />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 2025-198 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 Senate Bill 2500, the General Appropriations Act of State Fiscal Year 2025-2026, <br />passed by the 2025 Florida Legislature, the IGT Provider and the Agency agree that the <br />IGT Provider will remit IGT funds to the Agency in an amount not to exceed the total of <br />$571,385.02. The IGT Provider and the Agency have agreed that these IGT funds will only <br />be 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 <br />of $571,385.02. 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 2025 <br />though June 2026 are due to the Agency no later than October 31, 2025, unless <br />an 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 <br />and supporting documentation applicable to health services covered by this LOA in <br />accordance with public records laws and established retention schedules. <br />a. AUDITS AND RECORDS <br />Indian River County Emergency Services Distirct_ Indian River County ALS_PEM LOA_SFY 2025-26 <br />