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Home My WebLink About2026-191A TRUE COPY CERTIFICATION ON LAST PAGE RYAN L. BUTLER, CLERK Public Emergency Medical Transportation Letter of Agreement THIS LETTER OF AGREEMENT ("LOA") is made and entered into in duplicate on the day of 2026, by and between Indian River County Emergency Services Distirct (the "IGT Provider") on behalf of Indian River County Department of Em, 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. DEFINITIONS "Public Emergency Medical Transportation (PEMT)," pursuant to the General Appropriation Act, Laws of Florida 2025-231 is the program that provides supplemental payments for eligible Public Emergency Medical Transportation (PEMT) entities that meet specified requirements and provide emergency medical transportation services to Medicaid beneficiaries. "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. A. GENERAL PROVISIONS 1. 1. Per House Bill 5001, the General Appropriations Act of State Fiscal Year 2026-2027, passed by the 2026 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 $1.00. 2. The IGT Provider must return the signed LOA to the Agency no later than October 1, 2026. 3. The IGT Provider will pay IGT funds to the Agency in an amount not to exceed the total of $1.00. 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 2026 through June 2027 are due to the Agency no later than October 31, 2026, 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. Indian River County Emergency Services Distirct_ Indian River County Department of Em_PEMT LOA SFY 2026-27 A TRUE COPY � 7RTIFICATION ON LAST PAGE L. BUTLER, CLERK 6. The IGT Provider confirms that there are no pre -arranged agreements (contractual or otherwise) between the respective counties, taxing districts, and/or the providers to re- direct any portion of these aforementioned supplemental payments in order to satisfy non - Medicaid, non -uninsured, and non -underinsured activities. 7. The IGT Provider agrees the following provision shall be included in any agreements between Indian River County Emergency Services Distirct IGT Provider and local providers where IGT funding is provided pursuant to this LOA. Funding provided in this agreement shall be prioritized so that designated IGT funding shall first be used to fund the Medicaid program and used secondarily for other purposes. 8. This LOA covers the period of July 1, 2026, through June 30, 2027, and shall be terminated September 30, 2027, which includes the states certified forward period. 9. This LOA may be executed in multiple counterparts, each of which shall constitute an original, and each of which shall be fully binding on any party signing at least one counterpart. PEMT Local Intergovernmental Transfers Program / Amount State Fiscal Year 2026-2027 Estimated IGTs $1.00 Total Funding Not to Exceed $1.00 WITNESSETH: IN WITNESS WHEREOF, the parties have caused this 3 -page Letter of Agreement to be executed by their undersigned officials as duly authorized. INDIAN RIVER COUNTY EMERGENCY SERVICES DISTIRCT SIGNED BY: i NAME: John A. Titkanich, Jr. TITLE: County Administrator STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION SIGNED BY: NAME: Stephanie Scanlon TITLE: ADS for Medicaid Finance and Analytics DATE: Ctrtober 6, 2026 DATE: APPROVED AS TO FORM AND LEGA F ICIENCY B Indian River tc _ Indian River County Department of Em_PEMT LOA_SFY 2026-27 ASS STA TNT A TRUE COPY CERTIFICATION ON LAST PAGE RYAN L. BUTLER, CLERK Letter of Agreement Amendment This Amendment is made to the 2026-2027 Public Emergency Medical Transportation Letter of Agreement previously executed by and between the Indian River County Emergency Services District (the "IGT Provider") on behalf of Indian River County Department of Emergency Services and the Agency for Health Care Administration, with an effective date of 9/16/2026. It is mutually understood and agreed upon by and between the undersigned contracting parties to amend the previously executed Agreement dated September 16, 2026, as follows: General Provisions Deleted: 1. Per House Bill 5001, the General Appropriations Act of State Fiscal Year 2026- 2027, passed by the 2026 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 $1.00. Inserted: 1. Per House Bill 5001, the General Appropriations Act of State Fiscal Year 2026- 2027, passed by the 2026 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 $933,953.53. Deleted: 2. The IGT Provider will pay IGT funds to the Agency in an amount not to exceed the total of $1.00. The IGT Provider will transfer payments to the Agency in the following manner: a. Per Florida Statue 409.908, annual payments for the months of July 2026 through June 2027 are due to the Agency no later than October 31, 2026, unless an alternative plan is specifically approved by the agency. b. The Agency will bill the IGT Provider when payment is due. Inserted: 2. The IGT Provider will pay IGT funds to the Agency in an amount not to exceed the total of $933,953.53. The IGT Provider will transfer payments to the Agency in the following manner: a. Per Florida Statue 409.908, annual payments for the months of July 2026 through June 2027 are due to the Agency no later than October 31, 2026, unless an alternative plan is specifically approved by the agency. b. The Agency will bill the IGT Provider when payment is due. Deleted: PEMT Local Intergovernmental Transfers Program / Amount State Fiscal Year 2024-2025 Estimated IGTs $1.00 Total Funding Not to Exceed $1.00 Inserted: TRUE COPY •iTIFICATION ON LAST PAGE _. BUTLER, CLERK PEMT Local Intergovernmental Transfers Program / Amount State Fiscal Year 2024-2025 Estimated IGTs $ $933,953.53 Total Funding Not to Exceed $ $933,953.53 All provisions not in conflict with this amendment remain in effect. This amendment is hereby made a part of the Letter of Agreement. INDIAN RIVER COUNTY EMERGENCY SERVICES DIST CT SIGNED lG BY: G�i�1 G%C NAME: John A. Titkanich, Jr. TITLE: DATE: Qfl±er 6, 2026 APPROVED AS TO FORM AND GAL F ICIENCY BY CHRIST H R A. HICKS ASSISTANT OU TY ATTORNEY STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION SIGNED BY: NAME: Stephanie Scanlon TITLE: ADS for Medicaid Finance and Analytics DATE: A TRUE COPY CERTIFICATION ON LAST PAGE RYAN L. BUTLER, CLERK Intergovernmental Transfers Questionnaire IGT Provider Name: Indian River County Health Care Provider Name: Indian River County ALS IGT Amount: $933,953.53 State Fiscal Year Ending: 6/30/2026 1. What type of governmental entity is your organization considered? (county, city, hospital taxing district, or other) I County If other, please explain The Emergency Services District is a Dependent Special District of Indian River County 2. Does your organization have a relationship with the provider for which you contribute IGTs as named in the preamble of the enclosed Letter of Agreement (LOA)? Yes If yes, please describe your relationship, including services provided to/by the provider to/by the organization and any other financial transactions between the provider and the organization. The District is both the provider of and the agency that will be making the required IGT 3. Please describe the source of the IGT funding for your organization, including whether the source is from a tax, a provider donation, or other funds. Provide the amount of funding from each source. Source Amount Ad Valorem Tax Revenue FY26/27 $ 933,954 $ $ If other, please explain a. Verify whether the funds are public funds as defined by 42 CFR § 433.51, and exclude any federal funds. Yes It no, please explain 4. Does your organization have taxing authority? I Yes A TRUE COPY CERTIFICATION ON LAST PAGE 5. If the source of IGT funding is from taxes, please answer the following questi AN L. BUTLER, CLERK a. Is the tax a state, county, city, or hospital district tax? County It other, please explain b. W c. W iat entities are taxed? Properties iat is the tax structure (i.e. property tax, percentage of revenue, assessment, etc.)? 2.3531 Mills at is the amount or percent of the tax? e. Does at least 85% of the burden of the tax revenue fall on health care providers as defined in 42 CFR §433.55? (Provide the total tax revenue and the health care provider tax burden) If so, please answer the following questions: Amount Total Tax Burden $ - 1Healthcare Provider Tax Burden $ - i) Is the tax broad based? A broad based tax can be defined as a tax that is imposed on at least all health care items or services in the class or providers of such items or services furnished by all non -Federal, non-public providers in the State, and is imposed uniformly, pursuant to 42 CFR § 433.68. It no, please explain STATE CF ;LORiDA INDIAN RIVER COUNTY THIS IS TO CERTIFY THAT THIS IS A TRUE AND CORRECT COPY OF THE ORIGINAL ON FILE IN THIS OFFI E. RYyN L, gU R CLERK BV DATE �'C' ii) Is the tax uniform across all entities being taxed? Based on 42 CFR § 433.68, a health care - related tax will be considered to be imposed uniformly even if it excludes Medicaid or Medicare payments (in whole or in part), or both; or in the case of health care -related tax based on revenue or receipts with respect to a class of items or services, if it excludes either Medicaid or Medicare revenue with respect to a class of items or services, or both. The exclusion of Medicaid revenue must be applied uniformly to all providers being taxed. It no, please explain iii) Is the tax generally redistributive and a waiver of the broad -based or uniform tax requirement was granted in accordance with 42 CFR §433.68(e)? iv) Does the tax program comply with the hold harmless provisions included in 42 CFR § 433.68(f)? If no, please explain v) Does every tax paying entity receive a supplemental payment equal to or exceeding its tax cost? If yes, please explain 6. Please answer the following regarding provider funds received from the healthcare entity and/or other health care entities. a. Are provider voluntary payments or in -kind services received by the organization as defined in 42 CFR § 433.52? No b. How much of the organization's revenue is received from provider -related donations (Provide the total revenue and the provider -related donation amounts)? Amount Total Revenue $ - �Provider Related Donations R - c. Do individual provider donations exceed $5,000 per year or $50,000 per year for a health care organizational entity? I No If yes, please list the provider and payment amount. Provider Name Funding Source Amount $ $ d. Does any portion of the provider donation constitute as a "bona fide donation" pursuant to 42 CFR § 433.54? 42 CFR § 433.54 requires donations will not be returned to the individual provider, the provider class, or related entity under a hold harmless provision. e. Is there an agreement between the IGT provider and the health care entity? If so, please specify whether the agreement is written and provide the details. 7. Were funds utilized for the IGT specifically appropriated by the organization's board? If yes, provide the board minutes and date of the appropriation. I John A. Titkanich, Jr. certify that the statements and information contained in this submittal are true, accurate, and complete. nature of Officer or Administrator County Administrator Title October 6, 2026 Date APPROVED AS TO FORM AND ICIENCY BY CHRIST P ER A. HICKS ASSISTANT CO NTY ATTORNEY