HomeMy WebLinkAboutFY28_IGT_Agreement_10.19.26470-0086 (08/26)
INTERGOVERNMENTAL TRANSFER OF PUBLIC FUNDS AGREEMENT
BETWEEN THE IOWA DEPARTMENT OF HEALTH AND HUMAN SERVICES
AND
Ground Emergency Medical Transportation Provider (GEMT Provider)
This Intergovernmental Transfer Agreement (Agreement) is entered into between the Iowa
Department of Health and Human Services (HHS) and the ground emergency medical
transportation (GEMT) Provider. It provides for an intergovernmental transfer of funds to the
HHS from the GEMT Provider 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 and carry out an Intergovernmental Transfer (IGT) Agreement to transfer
funds through IGTs to the HHS for use as the non-federal share of Medicaid expenditures.
AGREEMENT
1.GEMT Program Compliance. Attached hereto as Attachment A is State Plan
Amendment IA-19-002 (SPA), which address the GEMT Program. The GEMT Provider
shall always 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 HHS.
3.Fund Transfer. The GEMT Provider agrees to transfer funds to HHS 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 HHS for the uncompensated
Medicaid cost associated with GEMT services. The GEMT Provider will transfer funds
to HHS equivalent to the non-federal share of the payments to be made upon
notification by HHS.
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.
5.Record Retention and Access. The parties agree that each shall maintain necessary
records and supporting documentation applicable to the uncompensated Medicaid
City of Waterloo dba Waterloo Fire Rescue
Docusign Envelope ID: FF4E8A21-7F74-8B4F-835E-D7F4B551F9DB
470-0086 (08/26)
cost associated with GEMT services payments to assure that claims for total funds
and federal funds are in accordance with applicable federal requirements, including
but not limited to those record retention requirements set forth in the SPA. The
parties agree to make those records available to the parties and to all state or
federal oversight authorities immediately upon request.
6.Notices: Any written notice required by this Agreement shall be sent to:
For:
Printed Name:
Title:
Address:
Email Address:
For HHS:
Printed Name:
Title:
7.Repayment Obligation: In the event that any State and/or federal funds are deferred
and/or disallowed because of any audits or expended in violation of the laws applicable
to the expenditure of such funds, the GEMT Provider shall be liable to the Agency for
the full amount of any claim disallowed and for all related penalties incurred. The
requirements of this paragraph shall apply to the GEMT Provider as well as any
subcontractors of the GEMT Provider. To the extent that the GEMT Provider receives
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 HHS within 60 days pursuant to Section 2.5 of the Provider
Agreement.
Iowa Department of Health and Human Services
Iowa Medicaid
Address: 321 E. 12th Street
Des Moines, IA 50319
Email Address: costaudit@hhs.iowa.gov
GEMT Provider
Waterloo Fire Rescue
Jason Hernandez
Medical Supervisor
425 E 3rd St, Waterloo, IA 50703
Jason.Hernandez@Waterloo-IA.org
Docusign Envelope ID: FF4E8A21-7F74-8B4F-835E-D7F4B551F9DB
470-0086 (08/26)
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 HHS 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,
2027, and ending June 30, 2028. 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.
GEMT Provider Name
Authorized Representative Signature
Authorized Representative Printed Name
Authorized Representative Title
Date
Iowa Department of Health and Human Services
Director Date
Waterloo Fire Rescue
Dave Boesen
Mayor
Docusign Envelope ID: FF4E8A21-7F74-8B4F-835E-D7F4B551F9DB
10/19/2026
Attachment A – Approved State Plan Amendment IA-19-002
Docusign Envelope ID: FF4E8A21-7F74-8B4F-835E-D7F4B551F9DB
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