1. Better Health Care for All Floridians AHCA.MyFlorida.com HCRA Health Care Responsibility Act Presented by: Karin Boatwright, Bureau of Managed Health Care Karin.Boatwright@ahca.myflorida.com (850) 412-4312

2. Better Health Care for All Floridians AHCA.MyFlorida.com HCRA Governed by – Chapter 154, Florida Statutes; – Chapter 59H-1, Florida Administrative Code; and – HCRA Handbook

3. Better Health Care for All Floridians AHCA.MyFlorida.com HCRA 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

4. Better Health Care for All Floridians AHCA.MyFlorida.com HCRA 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

5. Better Health Care for All Floridians AHCA.MyFlorida.com HCRA 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.

6. Better Health Care for All Floridians AHCA.MyFlorida.com HCRA 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 active- duty military personnel residing in the county.

7. Better Health Care for All Floridians AHCA.MyFlorida.com HCRA 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.

8. Better Health Care for All Floridians AHCA.MyFlorida.com HCRA 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.

9. Better Health Care for All Floridians AHCA.MyFlorida.com HCRA 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.

10. Better Health Care for All Floridians AHCA.MyFlorida.com HCRA 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.

11. Better Health Care for All Floridians AHCA.MyFlorida.com HCRA Applicant screening process – The applicant must: Be a Florida resident and a U.S. citizen or legal alien; Have inadequate 3 rd 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.

12. Better Health Care for All Floridians AHCA.MyFlorida.com HCRA Residency – Acceptable documentation: 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;

13. Better Health Care for All Floridians AHCA.MyFlorida.com HCRA Residency cont. 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.

14. Better Health Care for All Floridians AHCA.MyFlorida.com HCRA 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.

15. Better Health Care for All Floridians AHCA.MyFlorida.com HCRA 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;).

16. Better Health Care for All Floridians AHCA.MyFlorida.com HCRA Public institutions – 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.

17. Better Health Care for All Floridians AHCA.MyFlorida.com HCRA Assets – Applicants are allowed to exclude the following: One homestead; Household furnishings; One automobile; Clothing; Tools used in employment; Cemetery plots, crypts, vaults, mausoleums and urns; and Produce and animals.

18. Better Health Care for All Floridians AHCA.MyFlorida.com HCRA Assets cont. – Assets to be considered 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.

19. Better Health Care for All Floridians AHCA.MyFlorida.com HCRA Income to be considered – Gross wages and salary; – Child support; – Alimony; – Unemployment compensation; – Worker’s Compensation; – Veterans’ pension; – Social Security;

20. Better Health Care for All Floridians AHCA.MyFlorida.com HCRA Income to be considered cont. – 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.

21. Better Health Care for All Floridians AHCA.MyFlorida.com HCRA 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.

22. Better Health Care for All Floridians AHCA.MyFlorida.com HCRA 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.

23. Better Health Care for All Floridians AHCA.MyFlorida.com HCRA Karin Boatwright – (850) 412-4312 – Karin.boatwright@ahca.myflorida.com Karin.boatwright@ahca.myflorida.com 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

24. Better Health Care for All Floridians AHCA.MyFlorida.com HCRA Questions