Medicaid County Billing Florida Association of Counties Annual Conference June 23, 2011

Authorization Section , Florida Statutes requires that each county pay a portion of the Medicaid costs associated with certain items of care and services rendered to their county’s eligible recipients. Charges are for both health maintenance members and fee-for-service beneficiaries.

Section , F.S. Inpatient hospitalization – 35% of the total cost for each recipient in excess of 10 days, but not to exceed 45 days per state fiscal year. Nursing home or intermediate facilities – 35% of the total cost in excess of $170 per month, but not to exceed $55 per month per person.

Section , F.S. County contributions are paid into the General Revenue Fund, unallocated. In a county with special taxing districts or authority, the board of county commissioners may divide the county’s financial responsibility. Districts must furnish their share to the board of county commissioners in time for the board to comply with the statutory requirements.

Hospital Charges The per diem rate is a daily rate paid to hospitals for the inpatient care and service. Rates are set in January and July each year. Hospital cost report adjustments could result in rate adjustments. Hospital adjustments occur when cost reports cause rate adjustments, recipient makes a co- payment or third party payment is applied.

Nursing Home Charges 35% of total cost in excess of $170, but not to exceed $55 per month.

Monthly Invoice Posted to the portal at the beginning of the month (paper bills no longer sent). Payment is due within sixty (60) days from the date the invoice is posted to the portal. Counties deny charges for recipients that are residence of another county or the recipient’s address is a PO Box or invalid address. Invalid address may be denied and AHCA staff will research and provide correct address or transfer to the correct county.

County of Residency Individuals establish their county of residence when they maintain a physical living arrangement, outside a medical facility, which they or someone responsible for them consider to be home. A visit to another county or a planned temporary living arrangement does not constitute establishment of residency.

County of Residency When an applicant has been admitted to a nursing home directly from a place of residence outside the State of Florida, so that no Florida residency has been established, the certified county of residence is the county where the nursing home is located. The person’s intent to reside in a county is the determining factor.

Eligibility Determined either by Department of Children and Families (DCF) or the Social Services Administration (SSA). DCF eligibility information recorded in FLORIDA system; SSA information recorded in federal system

Frequently Asked Questions Address issues (residency) Re-bills Hospitalization charges for recipients in nursing home Statute of limitation Rate updates

Contacts Karen Zeiler, Chief of Staff: (850) Paula Shirley, Chief, Finance & Accounting: (850) Henry Evans, Finance and Accounting Director: (850) Jean Lombardi, Accountant Supervisor: (850)

Questions For future questions please contact Jean Lombardi at (850) , or at

Thank you