Item D3
~r::i?~
Louis LaTorre/Social Services Directo
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: Auqust 15. 2001
Division: Community Services
Bulk Item: Yes..lL. No
Department: Social Services
AGENDA ITEM WORDING: Health Care Responsibility Act (HCRA) Request for Reduction of
Calculation of HCRA County Obligation
ITEM BACKGROUND: The 2001 Legislature amended Chapter 154.306 Florida Statutes to allow
Counties with a population of less than 100,000 to decrease their HCRA obligation by specific
Categories of persons. The law requires a decision by Counties on this issue on or before
September 30, 2001. See attached.
PREVIOUS RELEVANT BOCC ACTION: None, other than the law enacted in 1977.
CONTRACT/AGREEMENT CHANGES: Do not sign the attached Agreement if you concur with staff
Recommendation.
STAFF RECOMMENDATION: The County has a choice of remaining under the Statutes as is or agreeing
to go with the new amended rules. Staff, the Social Services Director and Legal staff,Suzanne Hutton
have reviewed this issue thoroughly and strongly recommend that it is in the best interest of the County
that they remain with the option to stay under the current rule and not under the new amended rule.
We request the County not agree to this new amended change. If the Board agrees with staff, we
will notify the HCRA Agency that Monroe County will remain under the old rules.
TOTAL COST: $353.840 (Leqal Obliqation)
COST TO COUNTY: $353,840 (Legal Obligation)
BUDGETED: Yes X (Only $100.00
REVENUE PRODUCING: Yes
No X
AMOUNT PER MONTH
YEA~
APPROVED BY: County Atty
DIVISION DIRECTOR APPROVAL:
DIVISION DIRECTOR NAME: James E.
DOCUMENTATION: Included:--K- To Follow:_ Not Required:
nagement_
DISPOSITION:
Agenda Item #:
/-..2) ...Y
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nISTORY: T~e :-:eal:h Care Responsibility Act (HC?..;;) was first: enacted
revised by the 1988 Legislature to place the financial obligation for
hospitals for er:tergency in-patient and out-patient: services provided
county indigent ~atients on the counties in which the patients reside,
in 1977 and
reimbursing
to out-of-
The 1991 Legislature amended the Act to increase the number of eligible applicants
through the creation of a spend-down program and to increase hospital reimbursement
rates. 30th of these measures pertained ONLY to counties t:hat: were not at their 10
mill cap on ad valorem taxes as of October 1, 1991. Such counties are referred to
as spend-down provision eligible counties.
The 1998 Legislature further amended the Act to allow counties
county eligible hospitals up to one-half of the total HCRA funds
indigent: resident:s.
to reimburse in-
for non-Medicaid
COVERED SERVICES: The Act covers emergency services provided on either an
inpatient or outpatient basis. The county may choose to cover elective and non-
emergency services if such services are not available at a county funded hospital
within the patient's county. The county may choose to cover services for in-county
indigent care beginning July 1, 1998 for services at participating hospitals within
the patient's county.
HOSPITAL ELIGIBILITY CRITERIA: To receive reimbursement, a hospital must meet
minimum standards. Teaching hospitals that meet the two-percent overall charity
care obligation also are eligible for HCRA. Non-teaching hospitals must first be
certified by the Agency for Health Care Administration, Bureau of Certificate of
Need/Financial Analysis as having met a two-percent charity care obligation and
then have either:
.
Demonstrated to
least 2.5% of
residents; or
Bureau of Certificate of
its overall charity care
Need/Financial Analysis that at
was provided to out-of-county
. Have an agreement with the patient's county of residence to provide
emergency care to that county's indigent population.
APPLICANT ELIGIBILITY CRITERIA: To be eligible, an applicant must:
· Have received services covered by HCRA at a HCRA eligible out-of-county
hospital;
· Have received services covered by HCRA at a HCRA eligible in-county
hospital if the county uses up to one-half of its HCRA funds for in-count:y
indigent care;
· 3e certified by the county or the Agency as being a county resident;
· Have at a maximum, if a resident of a county, which was at its 10 mill cap on
ad valorem taxes, a gross income of 100% of the federal poverty level;
· Have at a maximum, if a resident of a spend-down provision eligible county,
a gross income of 150% of the federal poverty level, provided the applicant
"spends down" to 100% of the federal poverty level;
.
Not be eligible for any ot:her federally or state
reimbursement program (such as Medicaid or Medicare) ;
funded hospi tal
· Not live in a public institution;
HeRA Summary Page 2 of 2
Revised February 15, 2000
. Have assets less than the Medicaid medically needy levels;
. nave no or inadequate private insurance; and
. Be a 0.S. citizen or lawfully a~~itted alien.
APPLICATION PROCESSING RESPONSIBILITIES FOR THE HOSPITAL: The hospitab providing
emergency se:::-vices to the indigent is responsible for submitting an application
(.~C.Z\ Form 5220-000ll by certiEied mail to the indigent applicant's COU:1ty of
residence '",ithin 30 days of the date that the emergency inpatient or outpatie:1t
services were provided.
APPLICATIONS PROCESSING RESPONSIBILITIES FOR THE COUNTY: The county of residence
is responsible for determining residency and eligibility. If the county is unable
to determine residency, the Agency will determine residency for the county. The
county has the right of refusal in determining HCRA eligibility. If the county so
chooses, the eligibility function will be performed by the .Z\gency for Health Care
Administration office in Tallahassee.
The county must notify the hospital and the patient regarding eligibility within 60
days of receipt of the completed application by using the Notification of
Eligibility (AHCA Form 5220-0002). If the certifying agency cannot determine
eligibility within the 60 days, a written explanation must be provided to the
hospital.
HOSPITAL/COUNTY REIMBURSEMENT PROCEDURES: Upon receipt of the notice that the
patient is eligible, the hospital has six (6) months to submit its claim to the
county of residence. The county has 90 days to reimburse the hospital. If payment
is not received, the hospital may certify to the State Comptroller the amount owed
by the county. The Comptroller will then pay the hospital (within 45 days of
receipt of the claim) from any revenue sharing or tax-sharing funds due the county,
except as otherwise provided by the state constitution.
The hospital must refund the county or the State Comptroller for any payments
received from third party payers or from any federal or state programs.
HOSPITAL REIMBURSEMENT: Counties are obligated to pay up to 45 days of out-of-
county hospital services per eligible HCRA applicant per county fiscal year. The
maximum amount that a county is obligated to spend through HCRA for any county
fiscal year is $4 per capita. The out-of-county amount may be lessened to one-half
if the funds are used to pay for in-county hospital services for qualified non-
Medicaid indigent residents.
For patients who are residents of counties, which were at their 10 mill cap on ad
valorem taxes at October 1, 1991, counties must reimburse hospitals at 80% of their
Medicaid per diem rates, unless another reimbursement rate is negotiated. For
patients who are residents of spend-down provision eligible counties, counties must
reimburse hospi tals at 100% of their Medicaid rates, unless another reimbursement
rate has been negotiated. HCRA reimbursement for covered services is considered
payment in full and the hospital cannot charge the recipient for any remaining
balance.
AGENCY RESPONSIBILITIES: The Agency provides technical assistance to counties and
participating hospitals, which include providing the following information: each
county's maximum fiscal obligation. a HCR.."\ handbook, and lists of all eligible
hospi tals, spend-down provision el igible counties. Medicaid per diem rates (sent
each January and July), and county and hospital contacts.
HeRA Summary Page 2 of 2
Revised February 15. 2000
STATE OF FLORIDA
HeA
'.
""flrf " , . A " ,'"'if"iAY
To:
All Counties With Estimated Populations Less Than 100,000
From:
Hazel Greenberg, CPM
Bureau of Managed Health Care
Data Analysis Unit
. JUN 8 ~OQl
Monroe lOu",! c:>
J) r/.;<'"
OC/4L Sc?-.-.t' .
Subject:
Health Care Responsibility Act (HCRA)
2001 Legislative Change
Date: May 24, 2001
As you were recently informed, the 2001 Legislature arnended Chapter 154.306, Florida Statutes,
to allow counties with a population of less than 100,000 to decrease their HCRA obligation by
specific categories of persons. The new language also states that in order to take advantage of
this decrease, the county must accept as valid and true and not require any re-verification of the
documentation of financial eligibility and county residency that the HCRA participating or
regional referral hospital submits with the application. The documentation must be complete and
in cornpliance with Section 154.3105, F.S.
In order for the Agency to accurately compute the county obligations for fiscal year 2001 - 2002,
each county that wishes to participate in the reduction of population as stated in Chapter
154.306(3), F.S., must complete and return the enclosed form to my attention on or before
Septernber 30, 2001.
Any county not wishing to participate or fails to return this form will have its HCRA obligation
for fiscal year 2001 - 2002 calculated by using the estimated population without the reductions.
Please complete the enclosed form and return to:
Hazel Greenberg, CPM, Medical Health Care Prograrn Analyst
Agency for Health Care Administration
2727 Mahan Drive, Bldg. 1, Rrn. 337, Stop Mail Code 26
Tallahassee, FL 32308
Thanking you in advance for your cooperation,
dl-aul
Page 1 of 2
2727 Mahan Drive. Mail Stop 26
Tallahassee. FL 32308
Visit AHCA Online at
www.fdhc.stare.f!.us
Health Care Responsibility Act (HCRA)
REQUEST FOR REDUCTION FOR
CALCULATION OF HeRA COUNTY OBLIGATION
Florida Statute 154.306(3)
The county of
has a population of less than
100,000 and hereby request that its HCRA obligation be reduced by the number of inmates
and patients residing in the county in institutions operated by the Federal Government, the
Department of Corrections, the Department of Health, or the Department of Children and
Fu:rJly Se:.-vkes, and by the number' of active-duty military personnel residing in the
county.
The County Board of Commissioners (or appropriate other governing body),
agrees that it will accept the documentation submitted with the application by the
participating or regional referral hospital for financial eligibility and county residency as
valid and true as long as the documentation is complete and in compliance with Florida
Statute 154.3105. The county agency designated to determine eligibility under the HCRA
will not require the applicant to re-verify or re-submit the financial or county residency
documentation.
The county understands that non-compliance with this requirement will void
its participation in the reduced population calculation.
Agreed to for the County of
by:
Board of County Commissioners - Chairman
Date
Representative for the County HCRA Eligibility Unit
Date
County HCRA Eligibility Unit Name