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-1.0035 - Definitions

Current through Reg. 50, No. 138; July 16, 2024
The following words and phrases shall have the following
				  meanings for the purpose of this rule chapter.
(1) Act: The Florida Health Care
				Responsibility Act (HCRA or Program).
(2) Adequate Third Party Insurance: Coverage
				of the hospitalization by a third party insurer that would be equal to or
				greater than either: 80 percent of the amount the hospital would receive if
				reimbursed at the hospital's outpatient or inpatient reimbursement rate allowed
				for Florida Medicaid or the reimbursement rate negotiated by the county with
				the affected hospitals, if that negotiated rate is greater than 80 percent of
				the hospital's outpatient or inpatient reimbursement rate allowed for Florida
				Medicaid.
(3) Agency: As defined in
				Section 154.304(1),
				F.S., (AHCA).
(4) Applicant: Any
				person who applies, through written application, for medical assistance under
				the Act.
(5) Application: The
				Health Care Assistance Application, AHCA Form 5220-0001, used to apply for
				coverage for hospital services under the Act. The application must include at
				least the individual's name, date of birth, living address, mailing address,
				citizenship and signature to initiate the process. Only one hospital visit per
				applicant shall be submitted on a single application. Interested parties may
				obtain copies of the application from the HCRA Handbook.
(6) Assets: Those items defined as assets in
				20 CFR 416 for determining eligibility for Supplemental Security Income (SSI),
				except as otherwise provided in Rule
				59H-1.008, F.A.C., shall be used
				in determining eligibility under the Act.
(7) Asset Limits: The overall amount of
				countable assets an applicant may retain and still remain eligible. This amount
				shall be the same as used in the Medicaid medically needy program as defined in
				Rule 65A-1.716, F.A.C.
(8) Certified Resident: A United States
				citizen or lawfully admitted alien who has been certified by a Florida county
				or the Agency as being a resident of that county at the time hospital care was
				rendered.
(9) Certifying Agency:
				The person or office designated by the county of residence responsible for
				determining patient eligibility and certifying the county of residency under
				the Act. The Agency will make this determination on behalf of the county of
				residence only if it is unable to do so for circumstances beyond its control.
				Such determinations made by the Agency may not be disputed by the county of
				residence.
(10) Charity Care
				Obligation: As defined in Section
				154.304(4),
				F.S.
(11) Claim: The universal
				hospital billing form, UB 04/CMS-1450. Only one original claim form may be used
				for each eligible individual. All information must be in black type with no
				written modifications. The claim shall be completed pursuant to subsection
				59H-1.0065(1)
				F.A.C. A copy of the form is provided in the HCRA Handbook.
(12) County fiscal year: October 1 of a given
				year through September 30 of the subsequent calendar year.
(13) County of Residence:
(a) A specific county within the State of
				Florida where an individual establishes or maintains a living arrangement,
				outside of a medical facility, and which the individual, or someone responsible
				for the individual, considers to be the individual home with the intent to
				remain a resident of that county. A visit to another county for any purpose
				does not make a person a resident of that county, nor does a temporary living
				arrangement prior to admission in a medical facility. The length of time a
				person physically resides in a county is not a factor in determining residency.
				If the applicant or a member of the applicant's family unit maintains a primary
				residence in another county with the intent to return to that county, then the
				county of residence is the county in which the primary residence is
				located.
(b) A student attending
				school away from home is considered a resident of the county in which the
				student's parents reside if the student is claimed as a dependent for Federal
				Income Tax purposes. In those situations where one parent resides in-state and
				one parent resides out-of-state, the county where a parent resides in-state is
				the county of residence, even if the in-state parent is not claiming the
				student as a dependent for tax purposes.