Agreement - Indiana Family & Social Services Administration - Medicaid Managed Care Ambulance Services for SBFD

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AGREEMENT BETWEEN SOUTH BEND FIRE DEPARTMENT/EMS AND THE STATE OF INDIANA FOR ITS 2014 GOVERNMENTAL AMBULANCE PAYMENT ADJUSTMENT FOR MANAGED CARE SERVICES This Agreement is entered into by South Bend Fire Department/EMS of St. Joseph County, Indiana ("Provider"), a governmental ambulance provider, and the State of Indiana, through the Family and Social Services Administration, Office of Medicaid Policy and Planning ("OMPP" or "the State"). This Agreement is an amendment to the Indiana Health Coverage Programs (IHCP) Provider Agreement for South Bend Fire Department/EMS. WHEREAS, in .Tune 2017 the Provider will make a permissible intergovernmental transfer (IGT) of funds in order to fund the Fiscal Year 2014 Governmental Ambulance Payment Adjustment for managed care services (the "Payments"). The Payments will be paid to Provider in 2017 by the state's contracted managed care entities; and WHEREAS, the Provider and the State recognize that the Centers for Medicare & Medicaid Services ("CMS") has the authority to determine whether the Payments are Medicaid expenditures of funds which are eligible for federal financial participation ("FFP"); NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein, it is hereby agreed as follows: 1. The Provider will make an IGT of funds via check in the amount of Four Hundred Seventy -One Thousand Eighty -Eight Dollars and Thirty -One Cents ($471,088.31), which are not federal funds, or are federal funds authorized by federal law to match other federal funds. 2. The State's Payment to the Provider will be made by the state's contracted managed care entities in the amount of One Million Four Hundred Eleven Thousand Nine Hundred Thirty -One Dollars and Forty -Seven Cents ($1,411,931.47), the total amount. 3. The Provider will retain one hundred percent (100%) of the Payment described in Paragraph 2, above. 4. In the event that the State is notified by CMS that FFP will not be recognized, CMS defers the State's claim for FFP, or CMS issues a notice of disallowance, the Provider shall do the following: (a) If CMS defers the State's claim for FFP for any reason, the Provider shall provide to the State any and all information requested by CMS to support the claim and resolve the deferral. The parties agree that the State has no responsibility, other than to submit information to CMS that is provided by the Provider, to attempt to resolve the deferral in favor of the Provider. (b) If CMS issues a notice of disallowance, the Provider shall, within fifteen (15) calendar days after notification by the State that CMS has declined to approve the Payments for purposes of FFP eligibility: deliver to the State funds in the amount of One Million Four Hundred Eleven Thousand Nine Hundred Thirty - One Dollars and Forty -Seven Cents ($1,411,931.47). Such payment shall be the amount of the Provider's ambulance payment adjustment described in Paragraph 2, above.