Transcript HCRA - Florida Buccaneer AAHAM-Home

Better Health Care for All Floridians
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
HCRA
• Governed by
– Chapter 154, Florida Statutes;
– Chapter 59H-1, Florida Administrative Code; and
– HCRA Handbook
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• Basic Purpose
– To reimburse out-of-county hospitals for emergency
services provided to county indigents.
• Inpatient and outpatient services
– Counties can use up to ½ of HCRA funds for in-county
– Counties can pre-approve non-emergency care.
• Services can’t be available in county
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• 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 hospital’s Medicaid per diem rate
– Non-emergency pre-approved services
• Same reimbursement rates as above
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• 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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• 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 activeduty military personnel residing in the county.
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• 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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• Agency’s 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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• Hospital’s 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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• County’s 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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• Applicant screening process
– The applicant must:
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Be a Florida resident and a U.S. citizen or legal alien;
Have inadequate 3rd 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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• Residency
– Acceptable documentation:
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Driver’s 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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• Residency cont.
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Vehicle registration;
Voter registration;
Proof of children enrolled in public schools;
Recent historical record of residence documented through a
county department’s 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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• 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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• 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, Worker’s
Compensation, etc;).
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• Public institutions
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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:
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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
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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
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Gross wages and salary;
Child support;
Alimony;
Unemployment compensation;
Worker’s Compensation;
Veterans’ pension;
Social Security;
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• Income to be considered cont.
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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 child’s earnings;
– Student financial aid; and
– The income of any roomers or boarders.
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• 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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• Karin Boatwright
– (850) 412-4312
– [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
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