Better Health Care for All Floridians AHCA.MyFlorida.com HCRA Health Care Responsibility Act Presented by: Karin Boatwright, Bureau of Managed Health Care [email protected]m (850) 412-4312
Transcript
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Better Health Care for All Floridians AHCA.MyFlorida.com HCRA
Health Care Responsibility Act Presented by: Karin Boatwright,
Bureau of Managed Health Care [email protected]
(850) 412-4312
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Better Health Care for All Floridians AHCA.MyFlorida.com HCRA
Governed by Chapter 154, Florida Statutes; Chapter 59H-1, Florida
Administrative Code; and HCRA Handbook
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Better Health Care for All Floridians AHCA.MyFlorida.com HCRA
Basic Purpose To reimburse out-of-county hospitals for emergency
services provided to county indigents. Inpatient and outpatient
services Counties can use up to of HCRA funds for in-county
Counties can pre-approve non-emergency care. Services cant be
available in county
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Better Health Care for All Floridians AHCA.MyFlorida.com HCRA
Covered Services Emergency out-patient up to $1,500 per year 100%
Medicaid reimbursement rate Emergency in-patient up to 45 days per
year 80-100% of the hospitals Medicaid per diem rate Non-emergency
pre-approved services Same reimbursement rates as above
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Better Health Care for All Floridians AHCA.MyFlorida.com HCRA
Eligibility Out-of-county resident; Not eligible for Medicaid or
other government health care programs; No or inadequate insurance;
Income of up to 100-150% of poverty level; Assets up to the
medically needy limits; Not a resident of a public institution; and
Is a U.S. citizen or lawfully admitted alien.
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Better Health Care for All Floridians AHCA.MyFlorida.com HCRA
Funding Every county must participate $4 dollars per capita
Counties with 100,000 or less residents can reduce the funding
based on number of persons living in institutions operated by the
Government and by the number of active- duty military personnel
residing in the county.
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Better Health Care for All Floridians AHCA.MyFlorida.com HCRA
Participating Hospital Criteria Must meet 2% over-all charity care
obligation and have either: Agreement with resident county to treat
its indigent poor; or Have 2.5% of its uncompensated charity care
generated by out-of-county residents.
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Better Health Care for All Floridians AHCA.MyFlorida.com HCRA
Agencys role Day to day administration on a statewide basis;
Updates and/or amends administrative rules; Develops forms and
reports; Technical assistance; and Receive and maintain
reports.
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Better Health Care for All Floridians AHCA.MyFlorida.com HCRA
Hospitals role Assist with the HCRA application; Submit application
and documentation to the county within 30 days of admission; and
Submit claims for payment to the county within 6 months of date on
the Notification of Eligibility.
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Better Health Care for All Floridians AHCA.MyFlorida.com HCRA
Countys role Determine eligibility within 60 days of receiving
application; Pay claims within 90 days of receiving; and Notify
hospitals and the Agency when maximum financial obligations is
met.
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Better Health Care for All Floridians AHCA.MyFlorida.com HCRA
Applicant screening process The applicant must: Be a Florida
resident and a U.S. citizen or legal alien; Have inadequate 3 rd
party coverage; Not be eligible for other state or federal
programs; Not be residing in a public institution; and Be within
the assets and income limitations.
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Better Health Care for All Floridians AHCA.MyFlorida.com HCRA
Residency Acceptable documentation: Drivers license; Mortgage,
lease, rental receipt or letter from the landlord; Proof of home
ownership; Water, electric or other public utility bill; A state,
county or federal document mailed to the applicant;
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Better Health Care for All Floridians AHCA.MyFlorida.com HCRA
Residency cont. Vehicle registration; Voter registration; Proof of
children enrolled in public schools; Recent historical record of
residence documented through a county departments case record;
Other documents of equal weight as above; and In the absence of any
of the above, a declaration of domicile must be accepted.
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Better Health Care for All Floridians AHCA.MyFlorida.com HCRA
Third party insurance If there is insurance that will pay at least
80% of the Medicaid per diem rate, then the applicant will not be
eligible.
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Better Health Care for All Floridians AHCA.MyFlorida.com HCRA
Other state and federal programs The hospital must determine, to
the extent possible, if the patient is potentially eligible for
other state or federal programs providing hospital care (i.e.-
Medicaid, Medicare, Workers Compensation, etc;).
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Better Health Care for All Floridians AHCA.MyFlorida.com HCRA
Public institutions Incarcerated; In a correctional institution;
Holding facility for prisoners; Arrested or detained awaiting
disposition of charges; Held under court order as a material
witness or juvenile; or Patient in a state mental hospital.
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Assets Applicants are allowed to exclude the following: One
homestead; Household furnishings; One automobile; Clothing; Tools
used in employment; Cemetery plots, crypts, vaults, mausoleums and
urns; and Produce and animals.
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Assets cont. Assets to be considered Checking and saving accounts;
Equity value of property other than homestead; Cash surrender value
of life insurance; Additional automobiles or motor vehicles;
Recreational vehicles; Trusts; and Stocks, bonds and other
investments assets.
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Income to be considered Gross wages and salary; Child support;
Alimony; Unemployment compensation; Workers Compensation; Veterans
pension; Social Security;
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Income to be considered cont. Pensions or annuities; Dividends;
Interest on savings or bonds; Income from estates or trusts; Net
rental income or royalties including rent received from any roomers
or boarders; Net income from self-employment; and Contributions
from any source.
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Income NOT to be considered Food stamps; Income tax refunds; A
childs earnings; Student financial aid; and The income of any
roomers or boarders.
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Better Health Care for All Floridians AHCA.MyFlorida.com HCRA
Application timeline The hospital must submit the application to
the county within 30 days of the admission date. The county must
review and determine eligibility and mail the Notice of Eligibility
(NOE) within 60 days of receiving application. The hospital must
submit the claim for approved applicants within 6 months from the
date on the NOE for payment. The county must review and pay/deny
the claim within 90 days from receiving it.
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Better Health Care for All Floridians AHCA.MyFlorida.com HCRA
Karin Boatwright (850) 412-4312 [email protected][email protected] HCRA information Website
http://www.fdhc.state.fl.us/mchq/Managed_Health_Care/HCRA/index.shtml
Handbook
http://www.fdhc.state.fl.us/mchq/Managed_Health_Care/HCRA/hcrahb.shtml
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Questions