HomeMy WebLinkAboutIowa Department of Human Services - Intergovernmental Transfer of Public Funds Agreement - 11/12/2019RECEIVED DEC 3 2019
INTERGOVERNMENTAL TRANSFER OF PUBLIC
FUNDS AGREEMENT BETWEEN
THE IOWA DEPARTMENT OF HUMAN SERVICES AND
City of Waterloo, Iowa
Please return rhos copy to:
City Clerk $ Finance Dept.
715 Mulberry St.
Waterloo, IA 50103
Ground Emergency Medical Transportation Provider (GEMT Provider)
This Intergovernmental Transfer Agreement (Agreement) is entered into between the Iowa
Department of Human Services (IDHS) and the ground emergency medical transportation
(GEMT) Provider. It provides for an intergovernmental transfer of funds to the IDHS from the
GEMT Provider in order to provide the non-federal share of the reconciled cost reimbursement
amount for the uncompensated Medicaid cost associated with GEMT services.
The GEMT Provider is authorized by House File (HF) 2285 of the 2018 Iowa legislative
session to enter into and carry out an Intergovernmental Transfer (IGT) Agreement to transfer
funds through IGTs to the IDHS for use as the non-federal share of Medicaid expenditures.
AGREEMENT
1. GEMT Program Compliance. Attached hereto as Exhibit A is State Plan Amendment
IA-19-002 (SPA), which address the GEMT Program. The GEMT Provider shall at all
times comply with all requirements of the SPA.
2. Compliance with Provider Agreement and GEMT Program Eligibility. The GEMT
Provider's Iowa Medicaid Provider Agreement is incorporated herein by reference. The
parties stipulate to the inclusion of any future amendments or replacement of any such
provider agreements by this reference. The GEMT Provider hereby represents, warrants
and covenants that is and at all relevant times will be an Eligible GEMT Provider as that
term is defined in the SPA. If at any time the GEMT Provider's status changes such that
it is no longer an Eligible GEMT Provider, the GEMT Provider shall immediately notify
the IDHS.
3. Fund Transfer. The GEMT Provider agrees to transfer funds to IDI•IS at the times and
in the amounts determined in accordance with the following paragraphs of this
Agreement. The transfer shall be made prior to the payment by IDHS for the
uncompensated Medicaid cost associated with GEMT services. The GEMT Provider
will transfer funds to IDHS equivalent to the non-federal share of the payments to be
made upon notification by IDHS.
4. Funds Certification. The GEMT Provider shall certify that the funds transferred
qualify for federal financial participation (FFP) pursuant to 42 CFR part 433 subpart B,
and are not derived from impermissible sources such as recycled Medicaid payments,
federal money excluded from use as State match, impermissible taxes, and non -bona
fide provider -related donations. Impermissible sources do not include revenue received
from programs such as Medicare or Medicaid to the extent that the program revenue is
not obligated to the State as the source of funding.
UpdatedOctober14, 2019
FtI_.CEIVE.ID DEC 3 2019
payments that exceed the permissible amount allowed pursuant to the SPA, the parties
hereby deem the excess funds received by the GEMT Provider to be an "overpayment"
subject to return to the IDHS within 60 days pursuant to Section 2.5 of the Provider
Agreement.
8. Assignment: This Agreement is not assignable.
9. No Third Party Beneficiaries. There are no third party beneficiaries to this Agreement.
This Agreement is intended only to benefit the IDHS and the GEMT Provider.
10. Amendment: This Agreement may be modified at any time by the written agreement of
both parties.
11. Term & Termination: This Agreement covers the period beginning on or after July 1,
2019 and ending June 30, 2020. This Agreement may be canceled by either party after
giving thirty (30) days prior notice in writing to the other party. All obligations of the
parties incurred or existing under this Agreement as of the date of expiration or
termination survive the expiration or termination of the Agreement.
12 Execution: In consideration of the mutual covenants in this Agreement and for other
good and valuable consideration, the receipt, adequacy and legal sufficiency of which are
hereby acknowledged, the parties have entered into this Agreement and have caused their
duly authorized representatives to execute this Agreement.
City of Waterloo, Iowa
GEMT Provider
f,JJVISt V7.f
Signature
Quentin Hart
Printed Name
Mayor
Title
IOWA PEOF
ENT OF HUMAN SERVICES
I,k, ., As
Director
Date
Date
Updated October 14, 2019