HCRA

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

2. HCRA • Governed by • Chapter 154, Florida Statutes; • Chapter 59H-1, Florida Administrative Code; and • HCRA Handbook

3. 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. 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. 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. 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. 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. 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. 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. 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. HCRA • Applicant screening process • The applicant must: • 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.

12. 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. 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. 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. 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. 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. 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. 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. HCRA • Income to be considered • Gross wages and salary; • Child support; • Alimony; • Unemployment compensation; • Worker’s Compensation; • Veterans’ pension; • Social Security;

20. 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. 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. 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. HCRA • Karin Boatwright • (850) 412-4312 • 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. HCRA • Questions