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-1.0045 - County Financial Responsibility

Current through Reg. 50, No. 138; July 16, 2024
(1) The
				maximum amount of HCRA funds that a county can allocate for in-county
				reimbursement is up to 1/2 of its total HCRA funds. No county shall have the
				authority to use out-of-county designated funds to supplement its in-county
				reimbursement amount above the aforementioned one half. Should a county exceed
				its designated in-county reimbursement limit, the additional funds must be
				provided through other funding sources from the county's budget and the amount
				exceeded shall not reduce the out-of-county obligation.
(2) A county's financial responsibility for
				each of its qualified indigent patients or spend-down provision eligible
				patients who received treatment in a participating hospital shall not exceed 45
				days of inpatient services per county fiscal year, per applicant. If a
				qualified indigent patient has at least one day of coverage remaining within
				his/her 45-day benefit limit at the time of admission, then the eligible days
				shall be equal to the full length of stay.
(3) Reimbursement for treatment in a hospital
				emergency room for emergency medical conditions shall be at the Medicaid
				outpatient reimbursement rate and shall be limited to the annual Medicaid
				reimbursement limits as defined in Rule
				59G-4.160, F.A.C.
(4) No county shall be required to pay more
				than the equivalent of $4 per capita as the maximum county financial
				responsibility in that county's fiscal year. As detailed in Section
				154.306(1),
				F.S., the Agency shall calculate and certify to each county and hospital by
				March 1 of each year the maximum county financial responsibility the county
				shall be required to pay during the subsequent county fiscal year.
(5) For counties that are spend-down
				provision eligible, the rate of reimbursement to participating hospitals shall
				not be less than 100 percent of the reimbursement rate in effect for the
				hospital under the Medicaid Program, unless the county and the hospital sign a
				formal agreement to treat such county's indigent patients at a lower or higher
				negotiated rate. The county shall provide written notification to the Agency of
				the rate negotiated for each hospital and the effective date within 30 calendar
				days of the date the agreement is signed. If the due date falls on a weekend or
				holiday, the deadline is the next business day.
(6) For counties that are not spend-down
				provision eligible, the rate of reimbursement to participating hospitals shall
				not be less than 80 percent of the reimbursement rate in effect for the
				hospital under the Medicaid Program unless the county and the hospital sign a
				formal agreement to treat such county's indigent patients at a lower or higher
				negotiated rate. The county shall provide written notification to the Agency of
				the rate negotiated for each hospital and the effective date within 30 calendar
				days of the date the agreement is signed. If the due date falls on a weekend or
				holiday, the deadline is the next business day.
(7) The Agency will provide annually a list
				of Medicaid hospital outpatient and inpatient reimbursement rates which would
				be effective July 1, or the beginning of the state fiscal year. If a hospital
				does not have a Medicaid reimbursement rate provided, the Agency shall take an
				average of other hospitals within the same county to determine the
				reimbursement rate. Hospitals are responsible for notifying the county of any
				interim adjustments to its reimbursement rate under the Medicaid Program. The
				reimbursement rate utilized at the time of claim adjudication is considered the
				final rate for that claim. No retroactive rate adjustment is allowed.
(8) Each county shall certify to the agency,
				within 60 days of the end of the county's fiscal year, the amount of
				reimbursement it paid to all out-of-county hospitals. Additionally, should a
				county reach its maximum county financial responsibility before the end of the
				fiscal year, the county has 60 days from the date the responsibility has been
				met to provide the certification to the agency that the responsibility has been
				met. If the due date falls on a weekend or holiday, the deadline is the next
				business day.
(9) If there is
				adequate third party insurance or coverage, the county shall make payment only
				if such third party insurance or coverage is less than 80 percent of the
				reimbursement amount allowed through HCRA. Joint payment may be made on a claim
				by both HCRA and such third party insurance or coverage provided the combined
				total payment does not exceed 100 percent of the reimbursement amount allowed
				through HCRA.
(10) At the end of
				each month, each county must complete a Monthly Caseload and Appeals Report,
				AHCA Form 3160-0017, documenting caseload activity for the specified month and
				submit this report to the Agency by the 15th of the month following the end of
				the reported month, to the address provided on the form. If a county has no
				caseload activity for any month, the county must file the Caseload and Appeals
				Report indicating no activity. Timely filing of the report is required. Copies
				of the form may be located as provided in subsection
				59H-1.0035(26),
				F.A.C.
(11) At the end of each
				quarter, each county must complete a Quarterly Financial Report, AHCA Form
				3160-0018, for expenditures and claim activity during a specified quarter and
				submit this report to the Agency within 30 calendar days following the end of
				the reported quarter to the address provided on the report form. If the due
				date falls on a weekend or holiday, the deadline is the next business day.
				Quarters are based on the county's fiscal year. If a county has no expenditures
				or activity for any quarter, the county must file the Quarterly Financial
				Report indicating no activity. Timely filing is required to insure accurate
				financial information is available to determine if and when the maximum
				financial responsibility has been met. Copies of the form may be located as
				provided in subsection
				59H-1.0035(33),
				F.A.C.
(12) When the maximum county
				financial responsibility has been met, the county shall notify the Agency,
				those hospitals with which they have agreements and those hospitals which serve
				county residents that the maximum county financial responsibility has been
				met.
(13) In order to be
				reimbursed, a participating hospital must have met its charity care obligation
				based on the most recent audited actual experience as reported and certified by
				the Agency's Financial Analysis Unit. As defined in Section
				154.306, F.S., and subsection
				59H-1.0055(5),
				F.A.C., the Agency will provide, to the hospitals and the counties, annually
				and more frequently when revised, a list of hospitals meeting their charity
				care obligation.
(14) Payment made
				to a hospital by the county under this chapter for covered services provided to
				an eligible individual shall be considered as payment in full and the eligible
				individual shall not be billed, except for the applicant's share of cost and
				the cost of any non-covered services.
Rulemaking Authority 154.3105 FS. Law Implemented 154.306
					 FS.
New 3-29-89, Amended 12-24-90, 2-24-92, Formerly
					 10C-26.0045, Amended 6-7-00, 8-25-16.