Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59H - Health Care Responsibility Program › Chapter 59H-1 - FLORIDA HEALTH CARE INDIGENCY ELIGIBILITY CERTIFICATION STANDARDS › Section 59H-1.008 - Determination of a Qualified Indigent Patient

Current through Reg. 50, No. 138; July 16, 2024
(1) The county of residence has the primary
				responsibility for determining eligibility for individuals applying for
				coverage, using the eligibility determination procedures described in this
				section. The Agency shall conduct eligibility determinations only when the
				county demonstrates to the Agency that staff are not available. The county
				shall notify the Agency of its intent to determine eligibility. The
				participating hospital may elect to provide some of the eligibility
				documentation to the certifying agency.
(2) The governing board of the county shall
				designate a person or county agency to be responsible for the administration of
				the Act. The name, title, address, and phone number of the person or county
				agency, which shall determine eligibility and certify county of residence under
				the Act shall be provided to the Agency on an annual basis, and when modified.
				The county is reponsible for informing the Agency of any changes in this
				information within 30 calendar days of such change. The Agency shall provide
				such information to the participating hospitals and regional referral hospitals
				on an annual and modified basis.
(3) Hospitals shall screen applicants to
				determine the availability and adequacy of third party insurance and potential
				eligibility for Medicaid or other State or Federal governmental programs.
				Participating hospitals are responsible for initiating the eligibility
				determination procedures and assisting the applicant in completing the
				application. The hospital has 30 calendar days from the date of admission or
				emergency treatment to notify the certifying agency by certified mail of an
				individual who may qualify or the hospital forfeits its right to reimbursement.
				The postage date shall be used to determine such deadline.
(4) Notification shall consist of an
				application signed by the applicant or the applicant's designated
				representative.
(5) In those
				situations where the applicant is comatose or is physically incapacitated to
				the extent that an application cannot be completed, and there is no designated
				representative to complete the application, the hospital may serve as
				designated representative.
(6) The
				hospital shall include with the application any documentation available that
				would assist the certifying agency in determining eligibility or residency, and
				shall include hospital bills applicable to the applicant's meeting the
				applicant's share of cost. Lack of documentation will not preclude submission
				of the application nor constitute a reason to delay the submission of the
				application within proscribed time limits.
(7) The certifying agency has 60 days
				following receipt of an application from the hospital to determine eligibility.
				When the applicant provides all required information or verification, the
				certifying agency determines eligibility for the HCRA program. If for any
				reason eligibility cannot be determined within 60 days, the hospital shall be
				notified, in writing, of the reason for the delay. If the due date falls on a
				weekend or holiday, the deadline is the next business day.
(8) If the certifying agency determines at
				any time during the application process, including interviews, that the
				applicant must provide additional information or verification, the certifying
				agency must give the applicant written notice to provide the requested
				information, allowing at least 10 calendar days from request or the interview,
				whichever is later. If the due date falls on a weekend or holiday, the deadline
				is the next business day.
(9) The
				certifying agency shall use gross family income to determine if the family
				unit's income is less than or equal to 100 percent of the poverty guidelines or
				less than or equal to 150 percent of the poverty guidelines for residents of
				spend-down provision eligible counties. Verification of earnings shall be
				requested for the 4-week period prior to the date of determination pursuant to
				Section 154.308(4),
				F.S. The certifying agency shall require additional income verification for the
				preceding 12-month period if the income received for the 4-weeks prior to
				determination is not representative of the family unit's gross
				income.
(10) If the family unit's
				monthly gross income is more than 100 percent of the poverty guidelines and the
				applicant is a resident of a spend-down provision eligible county, the
				certifying agency shall use monthly gross family income to determine if the
				family unit's income is between 100 percent and 150 percent of the poverty
				guidelines. Verification of earnings shall be for the one month period prior to
				the applicant's date of determination. The certifying agency shall require
				additional income verification for the preceding 12-month period if the income
				received for the month prior to the date of determination is not representative
				of the family unit's annual gross income.
(11) Verification of income, except as
				provided in subsection
				59H-1.0035(41),
				F.A.C., may be a written or oral statement that certifies the applicant's
				income includes:
(a) A statement from a state
				or federal agency which attests to the patient's financial status;
(b) A statement from the employer;
(c) Pay stubs for 4 weeks if available or if
				needed, information for the preceding 12 month period; or
(d) A statement from the source providing
				unearned income to the applicant or family unit.