One-Time Supplemental Payment Attestation

, hereby attest that, to the best of my knowledge and belief, the above information is accurate and complete. I recognize that the purpose of the

 is to improve recruitment, retention, and capacity of home health agency staff for the Medicaid program. I hereby attest that at least 85% of the one-time supplemental payment will be spent on recruitment, development, and/or retention of eligible employees. I further attest that no more than 15% of the one-time supplemental payment will be spent on payroll costs directly related to any additional compensation for eligible employees. My agency will maintain payroll records to support this attestation, and such payroll records may be subject to audit by EOHHS. In the event that EOHHS determines that Program funds have been used for ineligible expenses, my agency may be required to repay such funds to EOHHS. My agency also commits to returning to EOHHS any Program funds not expended by the Program end date of March 31, 2024. My agency will maintain and submit quarterly Expenditure Reports and Workforce Reports as required by EOHHS. We verify payment should be paid to the account on file at Gainwell.