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06/20/2012 Agreement DANNY L. KOLHAGE CLERK OF THE CIRCUIT COURT DATE: June 28, 2012 TO: Kim Wilkes Wean, Sr. Grants Coordinator - Social Services FROM: Pamela G. Hanco k, . C. At the June 20, 2012, Board of County Commissioner's meeting the Board granted approval and authorized execution of the following: Item C7 Standard Memorandum of Agreement for Limited County Access to Florida System Data between the Florida Department of Children and Families (the Department) and Monroe County Board of County Commissioners.This required MOU is part of the Agency for Health Care Administration (AHCA) plan for successful implementation of the provisions in House Bill 5301, which references County Medicaid Billing. Item C38 Modification #006 to the Weatherization Assistance Program, American Recovery and Reinvestment Act sub -grant Agreement (ARRA WAP), Contract # 10 WX- 7X- 11 -54 -01 -719 between Monroe County Board of County Commissioners (Community Services /Social Services) and the State of Florida, Department of Economic Opportunity. Item C39 Modification #002 to Weatherization Assistance -Low Income Home Energy Assistance Program, Sub -grant Agreement (WAP- LIHEAP), Contract #12LH- 9Z- 11 -54 -01 -039 between Monroe County Board of County Commissioners (Community Services /Social Services) and the State of Florida, Department of Economic Opportunity. Enclosed are five duplicate originals of each of the above - mentioned, executed on behalf of Monroe County, for your handling. Please be sure to return two fully executed duplicate originals as soon as possible. Should you have any questions, please feel free to contact my office. cc: County Attorney w/o documents Finance File/ eT �S � `:. FbrMa oepnnmem of Chlldrm & Families State of Florida Rick Scott Governor Department of Children and Families David E. Wilkins Secretary STANDARD MEMORANDUM OF AGREEMENT FOR LIMITED COUNTY ACCESS TO FLORIDA SYSTEM DATA This Memorandum of Agreement for Limited County Access to FLORIDA System data (MOU) is entered into between the Florida Department of Children and Families (the Department) and M otAD+ County (the County). WHEREAS, the Department maintains certain information in its Florida Online Recipient Integrated Data Access system (FLORIDA) System regarding applicants seeking to qualify for Medicaid Services; WHEREAS, the County needs to access limited data on the FLORIDA System to confirm limited information regarding recipients of Medicaid Services within the County for payment purposes; and WHEREAS, the Department is willing to provide the County with limited access to the data in the FLORIDA System for such purposes, provided that the County complies with certain security requirements. NOW THEREFORE, IT IS AGREED AS FOLLOWS: 1. The foregoing recitations are true and incorporated into the terms of this MOU by reference. 2. Conditioned on the County's compliance with the terms of "Exhibit A° to this MOU and the terms below, the Department will grant authorized County personnel limited access to the FLORIDA System to verify Medicaid recipient addresses. Authorized County personnel will be provided view only" access to the screens shown in "Exhibit B° to this MOU (the limited FLORIDA data). The Department will have sole discretion to determine the means of access and the manner of display of the limited FLORIDA data. 3. The County hereby agrees to comply with the terms of "Exhibit A° and will access the limited FLORIDA data exclusively for purposes of verifying Medicaid recipient addresses and will not utilize nor permit any person to utilize the limited FLORIDA data for any other purpose. Any County record of the limited FLORIDA data shall be maintained and used only in accordance with the terms of this MOU. 4. The Department will provide appropriate and timely training and support to the county with regard to FLORIDA system access. 1317 Winewood Boulevard, Tallahassee, Florida 32399 -0700 Mission: Protect the Vulnerable, Promote Strong and Economically Self- Sufficient Families, and Advance Personal and Family Recovery and Resiliency .1 , . is 5. Prior to granting access to the FLORIDA System to individual users at the County level, the following must be accomplished: a. The Department must be in receipt of a signed MOU with the appropriate County entity(ies). b. The Department must be in receipt of a FLORIDA Individual Security Information Form ("Exhibit C ") for each user requesting access to the FLORIDA System. c. The Department must be in receipt of a signed DCF CF 114 form "Security Agreement Form" (Exhibit D). This form should accompany Exhibit C. d. Individual users must have received confirmation from the FLORIDA Application Data Security Administrator that access has been granted and received a user ID and an initial password. e. Individual users have completed FLORIDA access training. f. Individuals have completed the required initial Department online security training, and have printed out their completion certificate for their local personnel file. A copy of the security - training certificate should accompany Exhibit C. This training is required annually after completion of the initial training. 6. Term and termination. This MOU shall commence the last day executed by all parties and shall continue for a period of five years, provided, however, that the confidentiality requirements regarding the limited FLORIDA data shall survive the expiration or termination of this MOU. This MOU may be terminated by either party without cause upon 30 days written notice. This MOU may be terminated by either party for cause upon no less than 24 hours written notice. The Department may administratively suspend access to the FLORIDA System at any time the Department has reason to believe that the County is not in full compliance with the provisions of this MOU. 7. To the extent permitted by law, including Section 768.28, Florida Statutes, and without waiving the limits of sovereign immunity, the County shall indemnify the Department, its officers, employees and agents from any suits, actions, damages, claims and costs of every name and description, including attorneys' fees, relating to access to or use of the limited FLORIDA data by the County, its officers, employees or agents. 8. This MOU executed and entered into in the State of Florida, shall be construed, performed and enforced in all respects in accordance with Florida law and venue shall be in Leon County, Florida. 9. There are no provisions, terms, conditions, or obligations other than those contained herein, and this MOU shall supersede all previous communications, representations, or agreements, either verbal or written between the parties. 10. If any term or provision of this MOU is legally determined unlawful or unenforceable, the remainder of the MOU shall remain in full force and effect and such term or provision shall be stricken. 11. Modifications of provisions of this MOU shall be valid only when they have been reduced to writing and duly executed by the duly authorized officials of both parties. 12. The parties contact coordinators for the administration of this MOU are: County contact/coordinator: Name - 5VNen t Gna -hay^" Title - Soua..t tYfukc , e-g D Re-c- a-, Organization Movnfoe_ ��'�j a o a.r-d oP C` , UA C o &"M- �SSilo1'�e -Rs Mailin Address (city, state ZIP kl pp 5 ��, 2 - Z57 Phone - 30 2-12- 451 p 1 �i (�t}e,y } F I. 330� Email - Gnos r _ Department contact/coordinator: J Bruce R. Belrose Chief, Operations and Research Florida Department of Children and Families Economic Self - Sufficiency Program Office 1317 Winewood Boulevard, 3 -426 Tallahassee, FL 32399 -0700 850 - 717 -4083 Bruce belroseCcadcf.stateftus IN WITNESS THEREOF, the parties hereto have caused this Memorandum of Agreement to be executed by their undersigned officials as duly authorized. MONROE COUNTY BOARD FLORIDA DEPARTMENT OF CHILDREN OF COUNTY COMMISSIONERS AND AM IES /22�' 06/20/2012 �h �' ignature Date Signature Date Mayor David P. Rica =' Ann M. Berner Director, Economic Self- Sufficiency (name and title) Program r a ,_ - n DEP! CLER!� U� Attachments: Exhibit A — Use and Security Requirements Exhibit B — FLORIDA system screen shots o Exhibit C — FLORIDA Individual Security Information form r =; o :;0 Exhibit D — DCF CF114 Security Agreement Form --i ° I . i l EXHIBIT A — COUNTY USE AND SECURITY REQUIREMENTS The County agrees to comply with the following use and security requirements: 1. That the information obtained from the Department's system pursuant to the MOA (hereinafter "the limited FLORIDA data ") is confidential in nature and protected from disclosure by State and Federal Law. 2. To restrict the transmission of the limited FLORIDA data using secure file transfer protocols to County personnel who have a verifiable need to know in the performance of their official duties for the purposes stated in Section 3 of the MOA. 3. To maintain a listing of County personnel granted on -line access privileges to the Department's system pursuant to this MOA and, upon request, make such information available to the Department. At a minimum, the list will include the user's first and last name, User Identification (USERID), date access was granted /changed /deleted, dates of initial security training and annual awareness training. This information will be maintained for a period of 5 years after access has been terminated or until administrative purposes have been served, whichever is longer. 4. To abide by IT Security Awareness training provided by the Department at http: / /www.dcf. state .fl.us /admin /training.shtml or an equivalent security training provided to court IT security officers. Initial and annual refresher IT Security Awareness training shall be documented. 5. To comply with State of Florida network security requirements specified in Florida Administrative Code 60DD- 2.006, Network Security. 6. That the limited FLORIDA data may not be re- disclosed by the County or its personnel verbally, electronically or in any other forms except as specifically authorized by law or regulation and in compliance with 42 C.F.R., Subpart F. 7. That any the limited FLORIDA data will be used only for the purposes stated in Section 3 of the MOA and may be disclosed only for such purposes. 8. That the limited FLORIDA data shall be stored in a place physically secure from access by unauthorized persons. 9. To safeguard access to the limited FLORIDA data in such away that unauthorized persons cannot view, print, copy or retrieve the information by any means. 10. To instruct all personnel granted on -line access privileges to the Department's system or granted access to the limited FLORIDA data in the County's possession regarding the confidential nature of the information, the safeguards and requirements of this MOA and the provisions of Chapters 71A -1 and 71A -2, Florida Administrative Code as well as Chapters 119, 812, 815, 817, 839 or 877, Florida Statutes, or similar state and federal requirements. 11. To adhere to the confidentiality requirements stated herein, and to fully and promptly report any infraction of these requirements to the respective contacts specified in Section 10 of the MOA. e' 12. To promptly notify the Department of any breach of security related to the limited FLORIDA data in its possession and to be responsible for full compliance with section 817.5681, F.S., if applicable, in the event of a breach of security concerning confidential personal information in its possession received from one another, including but not limited to, providing notification to affected persons. 13. To provide any such breach notification, if applicable, to the Department for prior review and approval of the contents of the notice. 7 1. "EXHIBIT B" Limited FLORIDA Data 51,E esstEr• LSS and printer -llluelone Mainframe Display,; ! � - N File Edit aesson Qpdons Iransfer View Macro Script Help Aril INDIVIDUAL INFORMATION RETRIEVAL 05/08/2012 1?:08 P50424 8 GILBERT PIN PIN ■ NEXT TRIM: PARMS: CLRC PA Letters QA Navigation Data Exchange WebAppAcc Intake Spedalist I FS Derral Date S1 ;Ready. 05.176.250.66 FLAS4584 8 i -[17:0817 5/8/2012( _ NUM ( [00:18:10� 07,0.. "EXHIBIT B" Limited FLORIDA Data .S1„q essip:,.LSS And,printer -131ueLone_Mainframe Display 'AMIN File Edit cession Options transfer View Macro Ssrlpt (idP -? 4ipi A ate rG a D r' s� CZ • a II ► 4 / 1r AICI CASE INFORMATION 05/0B/2012 16:51 CASE: CASELOAD: P50424 B GILBERT EFFECTIVE BEGIN DATE: 02/07/2012 SERVICE SITE: 06403 STATUS: OPEN CASE FILE LOCATION: IN LOCATION DATE: 02072012 ERROR PRONE PROFILE: 11 15 00 ' FIRST MI LAST SUF NOTICE LANG LIVES IN HH PIP: E Y NUMBER UNIT DIR STREET/RURAL ROUTE SFX DIR APT HOUSEHOLD LIVING ADDRESS: — PHONE: . CITY: STATE: ZIP: _ CNTY: EMAIL: CELL: IS MAILING ADDRESS SAME AS ABOVE? Y 1 HOUSEHOLD HAILING ADDRESS: _ _ (IF DIFF FROM ABOVE) CITY: STATE: _ ZIP: DC: ' PIP MAILING ADDRESS: (IF NOT RESIDENT IN HOUSEHOLD) PHONE: CITY: STATE: ZIP: DC: NEXT THAN: PARMS: CLRC PA LettersQA Navgatlon Data Exchange I Web sppAcc 1 Intake Speciaist 1 FS Denial Date , ;S1 i Ready, !205.176.260.66 . FLAS4584 8 r-__ 16:51:58 5/8/2012 r -I NUM (- 100:01:51 -I 23,0.. "EXHIBIT B" Limited FLORIDA Data • 1 -esstp- ESS and printer -flluelene Mainframe Display File €c5t aesslon Qptlons transfer ylew Macro Sglpt !dell) AIPR CERTIFICATION OF PRIOR RESIDENCE ADDRESS 05/08/2012 17:02 CASE: PIN: P50424 B GILBERT EFFECTIVE BEGIN DATE: 03/26/2012 STATUS: OPEN DC NBR FIRST MI LAST SUF SSN 1 LAST LEGAL RESIDENCE: NUMBER UNIT DIR STREET/RURAL ROUTE SFX DIR APE PHONE: CITY: I STATE: . ZIP: CNTY: __ CONTACT PERSON FOR VERIFICATION: NAME: FIRST MI LAST SUF RELATIONSHIP ADDRESS: NUMBER UNIT DIR STREET/RURAL ROUTE SFX DIR APT PHONE: CITY: STATE: ZIP: NEXT TRAN: PARKS: �, ._.. . ,vur v m, ., .. _ -........aVtw ri<,,....,. •- .6_ „F..aY.w::L.. ..�+f.NCs..r..,,a.. _..w.«..��.xd..._ _ CLRC PA Letters QA Navigation Data Exchange f WebAppAcc I Intake Specialist I FS Denial Date S1 Ready...1205.176.250.66 FLAS4584 8 I 117:02:10 5/8/2012 7 NUM F .00:12:03 i 23,0... ' "EXHIBIT B" Limited FLORIDA Data c,S1 -esstp CSS and,pr inter,-t3lue/one Mainframe Display,: i,• ilf:111 File Edit Session Options Transfer View Macro Script Help 3 .7 _ .... it HMCI CASE INFORMHIION RETRIEVAL 05/08/2012 17:06 P50424 B GILBERT { CASE CASE NEXT TRAN: PARMS: CLRC PA Letters Navigation Date Exchange I WebAppAcc ( Intake Specialist I FS Dowel Date. §1 - Rendy...[ 7:5.176.250. 6 _ -IPLAS45B4.S(^ r 17:07.01 5/8/2012 r - NUM- 1 (00:16:54- 107,0... r� 0 W O E O x M�1 a U d' A z �•r A a 0 W O z� z u � O Lid U b t= o m 72 m U 1% 0 r, I V z z N a a � U O �C n o+ � N u d 0 6l � y w GO U � � y � > N C U U Cn d 0A d C6 N � O to ct A Q 0 a a rn �-4 v a w O z 1. U O y O � H N O✓ 0 Q o w � A IA I H . U D' OC w O U J 1. U O 4. 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M •o � � A � ° ° M p N = O , 2 0 42 0 M = .s oc E o .c N ^" p a w o o 0 0 ° ¢ Id o v o 1 .0 N 0 ° .� vi b ti 2 vi 4: v i � vi •�".r C to LL C C EO N O N O N O (V U it 5t w i a2 w e� a� C .0 V C y y .y Y, THE FLORIDA INDIVIDUAL SECURITY INFORMATION FORM INSTRUCTIONS The following information is needed for all personnel who request access to the FLORIDA Application. Below is a description of the information necessary for the FLORIDA Individual Security Information Form. 1. LAST NAME: The User's last name (max 15 characters). 2. FIRST NAME: The User's first name (max 15 characters). 3. MIDDLE INITIAL: The User's middle name - optional. 4. PREFIX: The User's prefix. Example MR, MRS, MS (max 4 characters) optional 5. SOCIAL SECURITY NUMBER: The User's social security numbers (max 9 characters). 6. POSITION TITLE: The User's position title (Clerk Typist, Receptionist, and Public Assistance Specialist). 7. UCB: Indicates if individual requires access to the Agency For Workforce Innovation System. 8. AGENCY/BUSINESS: The agency or business the User is employed by. 9. CONTRACTED WTTII: List the Agency the User is contracted with (DCF, DOR, AHCA, etc.). 10. ACCESS TO FEDERAL TAX INFORMATION: Indicates if individual requires access to Federal Tax Information. 10a. ACCESS TO SAVE: Indicates if individual requires access to US Citizenship and Immigration Services. 10b. ACCESS TO AMS: Indicates if individual requires access to AMS. 10c. AMS ROLE: The AMS Roles controls the user access. The roles listed below can be assigned. • Administrator • Call Center Administrator • Call Center Agent • Case Maintenance ESSS • Case Processor • Change ESSS • Child In Care ESSS • Clerk / Receptionist • Inquiry Only / Help Desk • Intake Specialist • Interview Clerk 3 • Program Office • Regional Security Officer • Statewide Security Officer • Transfer Coordinator • Unit Supervisor • Unit Supervisor Inquiry Only access to RR • Universal 11. ACTION REQUIRED: Indicate the action needed for each User ID. A = ADD, C = CHANGE, D = Delete, S = Suspend, R = RESUME. 12. USER ID: This is the RACF User ID. The User ID will be assigned by ISCO. 13. WORKER TYPE: Indicates the types of access the worker will have in the system: • PY for Confidential Caseload Personnel, i.e.: Child in Care and employee clients. • P for Public Assistance • PD for Public Assistance District Change Worker • PS for Public Assistance Service Site Change Workers • C for Child Support Enforcement • PC for Confidential Caseload Personnel — can work on cases statewide • PT for Statewide Worker • PM for Public Assistance District Change Worker — allows access to disability screens NOTE: PC and PT can only be assigned by the Sate Security officer in Headquarters. WHO SHOULD HAVE THE PS AND PD WORKER TYPES? The PS a nd PD worker types have the ability to cross validation lines for either a service center or an entire district. For this reason, these worker types must remain tightly restrictive and should only be assigned on an extremely limited basis, in accordance with the following: • Out posted staff (primarily hospital based • Medicaid Eligibility File Coordinators and/or • Change workers SECURITY PROCEDURES FOR ASSIGNING THE PS AND PD WORKER TYPES • PS (Service Site): The Individual Security Information form (CF FORM 113) must be signed by the Operations Program Administrator (OPA) for the service site. • PD (District): The Economic Services Program Administrator must sign the Individual Security Information Form (CF FORM 113). 14. SECURITY PROFILE NAME: The PROFILE assignment controls, which screen what a user can access. Please refer to Attachment A — User Profiles and Their Security Levels 15. SECURITY LEVEL: The Security Level is used in conjunction with the Administrative Structure and the Security Profile to specify user access. Refer to Attachment A, USER 4 PROFILES AND THEIR SECURITY LEVELS, for the levels that can be assigned to Profile Names. The security levels that are assigned to each Profile Name will be adhered to at all times. • 10 for Clerical • 50 for Workers • 75 for Supervisors • 80 for Coordinators • 98 for Administrators and BR Staff • 99 for State/District Personnel and Security Coordinators 16. PROFILE BEGIN DATE: Enter the date the profile should become active. 17. PROFILE END DATE: Enter the date the profile should be deactivated. 18. DISTRICT /CSE REGION: Enter your district/region number (01 - 15), Region 23 (Suncoast Region), 90 for Headquarters Personnel,. 19. SERVICE -SITE COUNTY No.: Enter the County where the user is physically located. Valid entries are 01 - 67. (Max 2 characters) 20. SERVICE -SITE LOCATION NO.: Enter the Service -Site Number for the building the user is physically located. (Max 3 characters) NOTE: The Service -site county and the Service -site location must be a valid entry in the Service Site Table, TCTY. 21. SUNCOM #: The user's SUNCOM telephone number (max 3 characters) 22. AREA CODE and PHONE #: The user's area code (max 3 characters) and the local telephone number, (max 7 characters). Include the telephone extension number when applicable, (Maximum 5 characters). 23. User E -Mail address: Enter the users E -Mail address 24. ADMINISTRATIVE UNIT ASSIGNED: Enter the Administrative unit the user is assigned to. (Max 5 characters) 25. SUPERVISORY UNIT ASSIGNED: Enter the supervisory unit the user is assigned to (Max 5 characters). 26. PRIMARY UNIT SUPERVISOR'S ID: Enter the ID of the user's primary unit supervisor. (Max 7 characters). 27. CASELOAD NUMBER: Enter the user's caseload number. (Max 6 characters) 28. SUPERVISOR'S NAME: Enter the NAME of the user's primary supervisor 29. PHONE #: Enter the PHONE # of the primary supervisor (Max 7 characters). Include the telephone extension when applicable (Max 5 characters). 30. JUSTIFICATION /C01VIMENTS: Use this field to clarify changes, to explain why a nontraditional (non- public assistance, PI, or CSR workers) user requires access to the FLORIDA System. 5 31. SIGNATURE OF REQUESTER AND DATE: The signature and date of the requester /supervisor is required. 32. SIGNATURE OF ADMINISTRATOR OR NEXT LEVEL SUPERVISOR DATE: The Administrator or next level Supervisor must review this form prior to signing and dating. 33. SIGNATURE OF DISTRICT SECURITY OFFICER: The Security Officer will sign when the user information has been entered into the FLORIDA Application. 34. SIGNATURE OF HQTR SECURITY OFFICER: 35. SIGNATURE OF OPA/PROGRAM ADMINISTRATOR: If the WORKER TYPE is "PS: then OPA/POA's signature is required. If the WORKER TYPE is "PD" the Program Administrator's signature is required. c"" SECURITY AGREEMENT FORM The Department of Children and Families has authorized you: Employee's or Contractor's Name /Organization to have access to sensitive data using computer - related media (e.g., printed reports, microfiche, system inquiry, on -line update, or any magnetic media). Computer crimes are a violation of the department's Standards of Conduct. In addition to departmental discipline, committing computer crimes may result in Federal or State felony criminal charges. I understand that a security violation may result in criminal prosecution according to the provisions of Federal and State statutes and may also result in disciplinary action against me according to the department's Standards of Conduct in the Employee Handbook. By my signature below, I acknowledge that I have received, read, understand and agree to be bound by the following: • The Computer Related Crimes Act, Chapter 815, F.S. • Sections 7213, 7213A, and 7431 of the Internal Revenue Code; which provide civil and criminal penalties for unauthorized inspection or disclosure of Federal tax data. • 6103(1)(7) of the Internal Revenue Code, which provides confidentiality and disclosure of returns and return information. • CFOP 50 -2. • It is the policy of the Department of Children and Families that no contract employee shall have access to IRS tax information or FDLE information, unless approved in writing, by name and position to access specified information, as authorized by regulation and /or statute. • It is the policy of the Department of Children and Families that I do not disclose personal passwords. • It is the policy of the Department of Children and Families that I do not obtain information for my own or another person's personal use. • 1 will only access or view information or data for which I am authorized and have a legitimate business reason to see when performing my duties. I shall maintain the integrity of all confidential and sensitive information accessed. • "Casual viewing" of employee or client data, even data that is not confidential or otherwise exempt from disclosure as a public record, constitutes misuse of access and is not acceptable. • The Department of Children and Families will perform regular database queries to identify misuse of access. • Chapter 119.0712, Florida Statutes, and the Driver Privacy Protection Act (DPPA PRIVACY ACT STATEMENT: Disclosure of your social security number is voluntary, but must be provided in order to gain access to department systems. It is requested, however, pursuant to Section 282.318, Florida Statutes, the Security of Data and Information Technology Resources Act. The Department requests social security numbers to ensure secure access to data systems, prevent unauthorized access to confidential and sensitive information collected and stored by the Department, and provide a unique identifier in our systems. Print Employee /Contractor Name Signature of Employee /Contractor Date Print Supervisor Name CF 114. PDF 06/2010 Signature of Supervisor Date y I ­- ­­ ­ wi uncracz rne; Copy — Employee /Contractor t= Xl✓ll�'J1}' CHAPTER 815: COMPUTER - RELATED CRIMES 815.01 Short title. The provisions of this act shall be known and may be cited as the "Florida Computer Crimes Act." (History: s. 1, ch. 78 -92.) 815.02 Legislative Intent. The Legislature finds and declares that: (1) Computer - related crime is a growing problem in government as well as in the private sector. (2) Computer - related crime occurs at great cost to the public since losses for each incident of computer crime tend to be far greater than the losses associated with each incident of other white collar crime. (3) The opportunities for computer - related crimes In financial institutions, government programs, government records, and other business enterprises through the introduction of fraudulent records into a computer system, the unauthorized use of computer facilities, the alteration or destruction of computerized information or files, and the stealing of financial instruments, data, and other assets are great. (4) While various forms of computer crime might possibly be the subject of criminal charges based on other provisions of law, it is appropriate and desirable that a supplemental and additional statute be provided which proscribes various forms of computer abuse. (History: s. 1, ch. 78 -92.) 815.03 Definitions. As used in this chapter, unless the context clearly indicates otherw computer, computer system, or computer network. ise: (1) "Access" means to approach, instruct, communicate wit h, store data in, retrieve data from, or otherwise make use of any resources of a (2) "Computer" means an internally programmed, automatic device that performs data processing. (3) "Computer contaminant" means any set of computer instructions designed to modify, damage, destroy, record, or transmit information within a computer, computer system, or computer network without the intent or permission of the owner of the information. The term includes, but is not limited to, a group of computer instructions commonly called viruses or worms which are self - replicating or self - propagating and which are designed to contaminant other computer programs or computer data; consume computer resources; modify, destroy, record, or transmit data; or in some other fashion usurp the normal operation of the computer, computer system, or computer network. (4) "Computer network" means any system that provides communications between one or more computer systems and its input or output devices, including, but not limited to, display terminals and printers that are connected by telecommunication facilities. (5) "Computer program or computer software" means a set of instructions or statements and related data which, when executed in actual or modified form, cause a computer, computer system, or computer network to perform specified functions. (6) "Computer services" include, but are not limited to, computer time; data processing or storage functions; or other uses of a computer, computer system, or computer network. (7) "Computer system" means a device or collection of devices, including support devices, one or more of which contain computer programs, electronic instructions, or input data and output data, and which perform functions, including, but not limited to, logic, arithmetic, data storage, retrieval, communication, or control. The term does not include calculators that are not programmable and that are not capable of being used in conjunction with external files. (8) "Data" means a representation of information, knowledge, facts, concepts, computer software, computer programs, or instructions. Data may be in any form, in storage media or stored in the memory of the computer, or in transit or presented on a display device. (9) "Financial Instrument" means any check, draft, money order, certificate of deposit, letter of credit, bill of exchange, credit card, or marketable security. (10) "Intellectual property" means data, including programs. (11) "Property" means anything of value as defined in [Footnote 11 s. 812.011 and includes, but is not limited to, financial instruments, information, including electronically produced data and computer software and programs in either machine - readable or human- readable form, and any other tangible or intangible item of value. (History: s. 1, ch. 78 -92; s. 9, ch. 2001 -54.) ([Footnote 11 Note: Repealed by s. 16, ch. 77 -342.) 815.04 Offenses against intellectual property; public records exemption. (1) Whoever willfully, knowingly, and without authorization modifies data, programs, or supporting documentation residing or existing internal or external to a computer, computer system, or computer network commits an offense against intellectual property. (2) Whoever willfully, knowingly, and without authorization destroys data, programs, or supporting documentation residing or existing internal or external to a computer, computer system, or computer network commits an offense against intellectual property. (3) (a) Data, programs, or supporting documentation which is a trade secret as defined in s. 812.081 which resides or exists internal or external to a computer, computer system, or computer network which is held by an agency as defined in chapter 119 is confidential and exempt from the provisions of s. 119.07(1) and s. 24(a), Art. I of the State Constitution. (b) Whoever willfully, knowingly, and without authorization discloses or takes data, programs, or supporting documentation which is a trade secret as defined in S. 812.081 or is confidential as provided by law residing or existing internal or external to a computer, computer system, or computer network commits an offense against intellectual property. (4) (a) Except as otherwise provided in this subsection, an offense against intellectual property is a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084. (b) If the offense is committed for the purpose of devising or executing any scheme or artifice to defraud or to obtain any property, then the offender is guilty of a felony of the second degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084. (History: s. 1, ch. 78 -92; s. 1, ch. 94 -100; s. 431, ch. 96 -406.) 815.045 Trade secret information. The Legislature finds that it is a public necessity that trade secret information as defined in s. 812.081, and as provided for in s. 815.04(3), be expressly made confidential and exempt from the public records law because it is a felony to disclose such records. Due to the legal uncertainty as to whether a public employee would be protected from a felony conviction if otherwise compl ying with chapter 119, and with s. 24(a), Art. I of the State Constitution, it is imperative that a public records exemption be created. The Legislature in making disclosure of trade secrets a crime has clearly established the importance attached to trade secret protection. Disclosing trade secrets in an agency's possession would negatively impact the business interests of those providing an agency such trade secrets by damaging them in the marketplace, and those entities and individuals disclosing such trade secrets would hesitate to cooperate with that agency, which would impair the effective and efficient administration of governmental functions. Thus, the public and private harm in disclosing trade secrets significantly outweighs any public benefit derived from disclosure, and the public's ability to scrutinize and monitor agency action is not diminished by nondisclosure of trade secrets. (History: s. 2, ch. 94 -100.) (Note. Former s. 119.165) 815.06 Offenses against computer users. (1) Whoever willfully, knowingly, and without authorization: (a) Accesses or causes to be accessed any computer, computer system, or computer network; (b) Disrupts or denies or causes the denial of computer system services to an authorized user of such computer system 1 of 5 services, which, in whole or part, is owned by, under contract to, or operated for, on behalf of, or in conjunction with another; (c) Destroys, takes, injures, or damages equipment or supplies used or intended to be used in a computer, computer system, or computer network; (d) Destroys, injures, or damages any computer, computer system, or computer network; or (e) Introduces any computer contaminant into any computer, computer system, or computer network, commits an offense against computer users. (2) (a) Except as provided in paragraphs (b) and (c), whoever violates subsection (1) commits a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084. (b) Whoever violates subsection (1) and: 1. Damages a computer, computer equipment, computer supplies, a computer system, or a computer network, and the monetary damage or loss incurred as a result of the violation is $5,000 or greater; 2. Commits the offense for the purpose of devising or executing any scheme or artifice to defraud or obtain property; or 3. Interrupts or impairs a governmental operation or public communication, transportation, or supply of water, gas, or other public service, commits a felony of the second degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084. (c) Whoever violates subsection (1) and the violation endangers human life commits a felony of the first degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084. (3) Whoever willingly, knowingly, and without authorization modifies equipment or supplies used or intended to be used in a computer, computer system, or computer network commits a misdemeanor of the first degree, punishable as provided in s. 775.082 or s. 775.083. (4) (a) In addition to any other civil remedy available, the owner or lessee of the computer, computer system, computer network, computer program, computer equipment, computer supplies, or computer data may bring a civil action against any person convicted under this section for compensatory damages. (b) In any action brought under this subsection, the court may award reasonable attorney fees to the prevailing party. (5) Any computer, computer system, computer network, computer software, or computer data owned by a defendant which is used during the data obtained in violation of this section is subject to forfeiture as provided under ss. 932.701 commission of any violation of this section or any computer owned by the defendant which is used as a repository for the storage of so data 932.704. ftware or (6) This section does not apply to any person who accesses his or her employer's compute or computer data when acting within the scope of his or her lawful employment. r system, computer network, computer program, (7) For purposes of bringing a civil or criminal action under this section, a person who causes, by any means, the access to a computer, computer system, or computer network in one jurisdiction from another jurisdiction is deemed to have personally accessed the computer, computer system, or computer network in both jurisdictions. (History: s. 1, ch. 78 -92; s. 11, ch. 2001 -54.) 815.07 This chapter not exclusive. The provisions of this chapter shall not be construed to preclude the applicability of any other provision of the criminal law of this state which presently applies or may in the future apply to any transaction which violates this chapter, unless such provision is inconsistent with the terms of this chapter. (History: s. 1, ch. 78 -92.) SECTION 7213 — UNAUTHORIZED DISCLOSURE OF INFORMATION (a) RETURNS AND RETURN INFORMATION - (1) FEDERAL EMPLOYEES AND OTHER PERSONS — It shall be unlawful for any officer or employee of the United States or any person described in section 6103(n)(or an officer or employee of any such person),or any former officer or employee, willfully to disclose to any person, except as authorized in this title, any return or return information [as defined in section 6103(b)]. Any violation of this paragraph shall be a felony punishable upon conviction by a fine in any amount not exceeding $5,000, or imprisonment of not more than 5 years, or both, together with the costs of prosecution, and if such offense is committed by any officer or employee of the United States, he shall, in addition to any other punishment, be dismissed from office or discharged from employment upon conviction for such offense. (2) STATE AND OTHER EMPLOYEES — It shall be unlawful for any person [not described in paragraph (1)] willfully to disclose to any person, except as authorized in this title, any return or return information [as defined in section 6103(b)] acquired by him or another person under subsection (d) )(6),(7),(8),(9),(10),(12),(15) or (16) or (m)(2),(4),(5),(6), or (7) of section 6103. Any violation of this paragraph shall be a felony punishable by a fine in any amount not exceeding $5,000, or imprisonment of not more than 5 years, or both, together with the cost of prosecution. (3) OTHER PERSONS — It shall be unlawful for any person to whom any return or return information [as defined in section 6103(b)] is disclosed in an manner unauthorized by this title thereafter willfully to print or publish in any manner not provided by law any such return or return information. Any violation of this paragraph shall be a felony punishable by a fine in any amount not exceeding $5,000, or imprisonment of not more than 5 years, or both, together with the cost of prosecution. (4) SOLICITATION — It shall be unlawful for any person willfully to offer any item of material value in exchange for any return or return information [as defined in 6103(b)] and to receive as a result of such solicitation any such return or return information. Any violation of this paragraph shall be a felony punishable by a fine in any amount not exceeding $5,000, or imprisonment of not more than 5 years, or both, together with the cost of prosecution. (5) SHAREHOLDERS — It shall be unlawful for any person to whom return or return information [as defined in 6103(b)] is disclosed pursuant to the provisions of 6103((e)(1)(D)(iii) willfully to disclose such return or return information in any manner not provided by law. Any violation of this paragraph shall be a felony punishable by a fine in any amount not exceeding $5,000, or imprisonment of not more than 5 years, or both, together with the cost of prosecution. SECTION 7213A — UNAUTHORIZED INSPECTION OF RETURNS OR RETURN INFORMATION (a) PROHIBITIONS — (1) FEDERAL EMPLOYEES AND OTHER PERSONS — It shall be unlawful for - (A) any officer or employee of the United States, or (B) any person described in section 6103(n) or an officer willfully to inspect, except as authorized in this title, any return or return information. (2) STATE AND OTHER EMPLOYEES — It shall be unlawful for any person [not described in paragraph(I)] willfully to inspect, except as authorized by this title, any return information acquired by such person or another person under a provision of section 6103 referred to in section 7213(a)(2). (b) PENALTY — (1) IN GENERAL —Any violation of subsection (a) shall be punishable upon conviction by a fine in any amount not exceeding $1000, or imprisonment of not more than 1 year, or both, together with the costs of prosecution. (2) FEDERAL OFFICERS OR EMPLOYEES — An officer or employee of the United States who is convicted of any violation of subsection (a) shall, in addition to any other punishment, be dismissed from office or discharged from employment. (c) DEFINITIONS — For purposes of this section, the terms "inspect', "return ", and "return information" have respective meanings given such terms by section 6103(b). 2 of 5 SECTION 7431 — CIVIL DAMAGES FOR UNAUTHORIZED DISCLOSURE OF RETURNS AND RETURN INFORMATION (a) IN GENERAL — (1) INSPECTION OR DISCLOSURE BY EMPLOYEE OF UNITED STATES — If any officer or employee of the United States knowingly, or by reason of negligence, inspects or discloses any return or return information with respect to a taxpayer in violation of any provision of section 6103, such taxpayer may bring a civil action for damages against the United States in a district court of the United States. (2) INSPECTION OR DISCLOSURE BY A PERSON WHO IS NOT AN EMPLOYEE OF THE UNITED STATES — If any person who is not an officer or employee of the United States knowingly, or by reason of negligence, inspects or discloses any return or return information with respect to a taxpayer in violation of any provision of section 6103, such taxpayer may bring a civil action for damages against such person in a district court of the United States. (b) EXCEPTIONS — No liability shall arise under this section with respect to any inspection or disclosure - (1) which results from good faith, but erroneous, interpretation of section 6103, or (2) which is requested by the taxpayer. (c) DAMAGES — In any action brought under subsection (a), upon a finding of liability on the part of the defendant, the defendant shall be liable to the plaintiff in an amount equal to the sum of- (1) the greater of— (A) $1,000 for each act of unauthorized inspection or disclosure of a return or return information with respect to which such defendant is found liable, or (B) the sum of: (i) the actual damages sustained by the plaintiff as a result of such unauthorized inspection or disclosure, plus (ii) in the case of a willful inspection or disclosure or an inspection or disclosure which is the result of gross negligence, punitive damages, plus (2) the cost of the action. (d) PERIOD FOR BRINGING ACTION — Notwithstanding any other provision of law, an action to enforce any liability created under this section may be brought, without regard to the amount in controversy, at any time within 2 years after the date of discovery by the plaintiff of the unauthorized inspection or disclosure. SECTION 6103 — CONFIDENTIALITY AND DISCLOSURE OF RETURNS AND RETURN INFORMATION (1) DISCLOSURE OF RETURNS AND RETURN INFORMATION FOR PURPOSES OTHER THAN TAX ADMINISTRATION (7) Disclosure of return information to Federal, State, and local agencies administering certain programs under the Social Security Act, the Food Stamp Act of 1977, or title 38, United States Code, or certain housing assistance programs ) return information from returns with respect to net earnings from self-employment (as defined in section 1402)! wages (as defined in 3121 (a) or 3401 (a)), and payments of retirement income, which have been disclosed to the Social Security Administration as provided by paragraph (1) or (5) of this subsection, to any Federal, State, or local agency administering a program listed in subparagraph (D). (B) Return information from Internal Revenue Service — The Secretary shall, upon written request, disclose current return information from returns with respect to unearned income from the Internal Revenue Service files to any Federal, State, or local agency administering a program listed in subparagraph (D). (C) Restriction on disclosure — The Commissioner of Social Security and the Secretary shall disclose return information under subparagraphs (A) and (B) only for purposes of, and to the extent necessary in, determining eligibility for, or the correct amount of, benefits under a program listed in subparagraph (D). (D) Programs to which rule applies — The programs to which this paragraph applies are: (i) a State program funded under part A of title IV of the Social Security Act; (ii) medical assistance provided under a State plan approved under title XIX of the Social Security Act or subsidies provided under section 1860D -14 of such Act; (iii) supplemental security income benefits provided under title XVI of the Social Security Act, and federally administered supplementary payments of the type described in section 1616(a) of such Act (including payments pursuant to an agreement entered into under section 212(a) of Public Law 93 -66); (iv) any benefits provided under a State plan approved under title I, X, XIV, or XVI of the Social Security Act (as those titles apply to Puerto Rico, Guam, and the Virgin islands); (v) unemployment compensation provided under a State law described in section 3304 of this title; (vi) assistance provided under the Food Stamp Act of 1977; (vii) State - administered supplementary payments of the type described in section 1616(a) of the Social Security Act (including payments pursuant to an agreement entered into under section 212(a) of Public Law 93 -66); (viii) (1) any needs -based pension provided under chapter 15 of title 38, United States Code, or under any other law administered by the Secretary of Veterans Affairs; (11) parents' dependency and indemnity compensation provided under section 1315 of title 38, United States Code; (111) health -care services furnished under section 1710(a)(1)(1), 1710(a)(2), 1710(b), and 1712(a)(2)(B) of such title; and (IV) compensation paid under chapter 11 of title 38, United States Code, at the 100 percent rate based solely on unemployability and without regard to the fact that the disability or disabilities are not rated as 100 percent disabling under the rating schedule; and (ix) any housing assistance program administered by the Department of Housing and Urban Development that involves initial and periodic review of an applicant's or participant's income, except that return information may be disclosed under this clause only on written request by the Secretary of Housing and Urban Development and only for use by officers and employees of the Department of Housing and Urban Development with respect to applicants for and participants in such programs. Only return information from returns with respect to net earnings from self - employment and wages may be disclosed under this paragraph for use with respect to any program described in clause (viii)(IV). Clause (viii) shall not apply after September 30, 2008. 3 of 5 DRIVER PRIVACY PROTECTION ACT (DPPA) Under state law, motor vehicle, driver license, and vehicular crash records are subject to public disclosure. The Driver Privacy Protection Act (DPPA) keeps your personal information private by limiting who has access to the information. ( http:// www .flhsmv.gov /ddl /DPPAinfo.html) 119.0712 Executive branch agency - specific exemptions from inspection or copying of public records. (2) DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES. (a) Personal information contained in a motor vehicle record that identifies an individual is confidential and exempt from s. 119.07(1) and s. 24(a), Art. I of the State Constitution except as provided in this subsection. Personal information includes, but is not limited to, an individual's social security number, driver identification number or identification card number, name, address, telephone number, medical or disability information, and emergency contact information. For purposes of this subsection, personal information does not include information relating to vehicular crashes, driving violations, and driver's status. For purposes of this subsection, the term "motor vehicle record" means any record that pertains to a motor vehicle operator's permit, motor vehicle title, motor vehicle registration, or identification card issued by the Department of Highway Safety and Motor Vehicles. (b) Personal information contained in motor vehicle records made confidential and exempt by this subsection may be released by the department for any of the following uses: 1. For use in connection with matters of motor vehicle or driver safety and theft; motor vehicle emissions, motor vehicle product alterations, recalls, or advisories; performance monitoring of motor vehicles and dealers by motor vehicle manufacturers; and removal of nonowner records from the original owner records of motor vehicle manufacturers, to carry out the purposes of Titles I and IV of the Anti Car Theft Act of 1992, the Automobile Information Disclosure Act (15 U.S.C. ss. 1231 et seq.), the Clean Air Act (42 U.S.C. ss. 7401 et seq.), and chapters 301, 305, and 321 -331 of Title 49, United States Code. 2. For use by any government agency, including any court or law enforcement agency, in carrying out its functions, or any private person or entity acting on behalf of a federal, state, or local agency in carrying out its functions. 3. For use in connection with matters of motor vehicle or driver safety and theft; motor vehicle emissions; motor vehicle product alterations, recalls, or advisories; performance monitoring of motor vehicles, motor vehicle parts, and dealers; motor vehicle market research activities, including survey research; and removal of nonowner records from the original owner records of motor vehicle manufacturers. 4. For use in the normal course of business by a legitimate business or its agents, employees, or contractors, but only: and a. To verify the accuracy of personal information submitted by the individual to the business or its agents, employees, or contractors; b. If such information as so submitted is not correct or is no longer correct, to obtain the correct information, but only for the purposes of preventing fraud by, pursuing legal remedies against, or recovering on a debt or security interest against, the individual. 5. For use in connection with any civil, criminal, administrative, or arbitral proceeding in any court or agency or before any self - regulatory body for: state. a. Service of process by any certified process server, special process server, or other person authorized to serve process in this b. Investigation in anticipation of litigation by an attorney licensed to practice law in this state or the agent of the attorney; however, the information may not be used for mass commercial solicitation of clients for litigation against motor vehicle dealers. c. Investigation by any person in connection with any filed proceeding; however, the information may not be used for mass commercial solicitation of clients for litigation against motor vehicle dealers. d. Execution or enforcement of judgments and orders. e. Compliance with an order of any court. 6. For use in research activities and for use in producing statistical reports, so long as the personal information is not published, redisclosed, or used to contact individuals. 7. For use by any insurer or insurance support organization, or by a self- insured entity, or its agents, employees, or contractors, in connection with claims investigation activities, anti -fraud activities, rating, or underwriting. 8. For use in providing notice to the owners of towed or impounded vehicles. 9. For use by any licensed private investigative agency or licensed security service for any purpose permitted under this subsection. Personal information obtained based on an exempt driver's record may not be provided to a client who cannot demonstrate a need based on a police report, court order, or business or personal relationship with the subject of the investigation. 10. For use by an employer or its agent or insurer to obtain or verify information relating to a holder of a commercial driver's license that is required under 49 U.S.C. ss. 31301 et seq. 11. For use in connection with the operation of private toll transportation facilities. 12. For bulk distribution for surveys, marketing, or solicitations when the department has obtained the express consent of the person to whom such personal information pertains. 13. For any use if the requesting person demonstrates that he or she has obtained the written consent of the person who is the subject of the motor vehicle record. 14. For any other use specifically authorized by state law, if such use is related to the operation of a motor vehicle or public safety. 15. For any other use if the person to whom the information pertains has given express consent in a format prescribed by the department. Such consent shall remain in effect until it is revoked by the person on a form prescribed by the department. (c) Notwithstanding paragraph (b), without the express consent of the person to whom such information applies, the following information contained in motor vehicle records may only be released as specified in this paragraph: 1. Social security numbers may be released only as provided in subparagraphs (b)2., 5., 7., and 10. 2. An individual's photograph or image may be released only as provided in s. 322.142. 3. Medical disability information may be released only as provided in ss. 322.125 and 322.126. 4. Emergency contact information may be released only to law enforcement agencies for purposes of contacting those listed in the event of an emergency. (d) The restrictions on disclosure of personal information provided by this subsection shall not in any way affect the use of organ donation information on individual driver licenses or affect the administration of organ donation initiatives in this state. (e)1. Personal information made confidential and exempt may be disclosed by the Department of Highway Safety and Motor Vehicles to an individual, firm, corporation, or similar business entity whose primary business interest is to resell or redisclose the personal information to persons who are authorized to receive such information. Prior to the department's disclosure of personal information, such individual, firm, corporation, or similar business entity must first enter into a contract with the department regarding the care, custody, and control of the personal information to ensure compliance with the federal Driver's Privacy Protection Act of 1994 and applicable state laws. 4 of 2. An authorized recipient of personal information contained in a motor vehicle record, except a recipient under subparagraph (b)12., may contract with the Department of Highway Safety and Motor Vehicles to resell or redisclose the information for any use permitted under this section. However, only authorized recipients of personal information under subparagraph (b)12. may resell or redisclose personal information pursuant to subparagraph (b)12. 3. Any authorized recipient who resells or rediscloses personal information shall maintain, for a period of 5 years, records identifying each person or entity that receives the personal information and the permitted purpose for which it will be used. Such records shall be made available for inspection upon request by the department. (f) The department may adopt rules to carry out the purposes of this subsection and the federal Driver's Privacy Protection Act of 1994, 18 U.S.C. ss. 2721 et seq. Rules adopted by the department may provide for the payment of applicable fees and, prior to the disclosure of personal information pursuant to this subsection, may require the meeting of conditions by the requesting person for the purposes of obtaining reasonable assurance concerning the identity of such requesting person, and, to the extent required, assurance that the use will be only as authorized or that the consent of the person who is the subject of the personal information has been obtained. Such conditions may include, but need not be limited to, the making and filing of a written application in such form and containing such information and certification requirements as the department requires. (g) This subsection is subject to the Open Government Sunset Review Act in accordance with s. 119.15 and shall stand repealed October 2, 2012, unless reviewed and saved from repeal through reenactment by the Legislature 5 of AGENCY FOR HEALTH CARE ADMINISTRATION COUNTY BILLING GUIDELINES UPDATED 5/17/2012 Table of Contents PREFACE....................................................................................................................................... .............................. LEGISLATIVEREQUIREMENTS ................................................................................................ .............................. BILLINGWORKFLOW ................................................................................................................ .............................. ESTABLISHING COUNTY OF RESIDENCY ............................................................................. ..............................4 HOSPITALCHARGES ................................................................................................................. ............................... 5 1. Overview of Inpatient Hospital Charges ........................................................................... ............................... 5 2. Number of Days (of County Responsibility) ...................................................................... ..............................5 3 Calculation of County Share ............................................................................................. ............................... 5 4 Billing for Medicaid HMO Patients .................................................................................. ............................... 5 NURSINGHOME CHARGES ....................................................................................................... ..............................6 1. Overview of Nursing Home Charges ................................................................................ ............................... 6 2 Calculation of County Share ............................................................................................... ..............................6 3 Out of State Residents ......................................................................................................... ..............................6 MONTHLYBILLINGS .................................................................................................................. .............................. 1 Billing Cycle ...................................................................................................................... .............................. 2 Processing Charges ............................................................................................................ .............................. 3 Certification of Charges .................................................................................................... ............................... 7 SCREENSHOTSOF UPDATED PORTAL ................................................................................... ..............................8 REQUESTINGAN ADVANCE REFUND .................................................................................... ..............................9 I Due Date ............................................................................................................................. .............................. 2. Determining an Advanced Refund Request ...................................................................... ............................... 9 2. Marking an Advanced Refund Request in the Web Portal ................................................. ..............................9 REQUESTINGA BACK -END REFUND ..................................................................................... .............................10 1 Overview ........................................................................................................................... ............................. 2 Due Date ............................................................................................................................ .............................10 3 Submission of the Request ................................................................................................ .............................10 4 Review of the Request ....................................................................................................... .............................10 BACK -END REFUND TEMPLATE ............................................................................................. .............................11 DEFINITIONS............................................................................................................................... .............................12 GLOSSARYOF TERMS .............................................................................................................. .............................13 PA PREFACE This supersedes any previous publications and is not intended to set policy or rules. Any changes in statute or rule implemented will take precedence over this publication. LEGISLATIVE REQUIREMENTS Florida Law 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 Medicaid recipients. Eligibility of Medicaid services is determined by either the Department of Children and Family (DCF) or the Social Security Administration (SSA), and is based on financial and categorical requirements. Pursuant to Section 409.915, Florida Statues, each county is required to participate in the cost of providing medical assistance for inpatient hospitalization and nursing home care. Each county is to set aside sufficient funds to pay for the above items of care and service, regardless of where in the state the care or service is rendered BILLING WORKFLOW Under the current billing system, all hospitals and nursing homes participating in the Florida Medicaid Program submit claims to the Medicaid fiscal agent for the cost of providing care to eligible Medicaid recipients. Claims submitted by providers are paid by the fiscal agent. At the end of each month, certain data components for all claims processed during the month are extracted and compiled by the Florida Medicaid Management Information System (FMMIS) County Billing Subsystem and sorted by county. Personal profile and eligibility data for each recipient is obtained from the FLORIDA system, which is administered by DCF. The profile and eligibility data is combined with the monthly payment data to generate the monthly county billing invoice. The billings from 11/01/2001 through 04/30/2012 (retrospective), which includes provider claims processed through March 2012, will be handled pursuant to Section 409.915(7), Florida Statutes. The billings beginning 05/01/2012 (prospective), which includes provider claims processed in April 2012, will be handled pursuant to Section 409.915(9), Florida Statutes. ESTABLISHING COUNTY OF RESIDENCY According to Rule 59G- 1.020, Florida Administrative Code, 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. The county in which this living arrangement is maintained is the county of residence. A visit to another county or a planned temporary living arrangement, prior to admission to a medical facility, does not constitute establishment of residency. In all instances, the person's intent to reside in a county is the determining factor, regardless of the length of time involved. 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. Each county's eligible Medicaid recipients shall be determined by the recipient's address information contained in the federally approved Medicaid eligibility system. 4 HOSPITAL CHARGES 1. Overview of Inpatient Hospital Charges Pursuant to Section 409.915 (2), Florida Statutes, all counties are responsible for 35% of the total cost of providing inpatient hospital services to eligible Medicaid recipients. The exceptions are pregnant women and children whose income is in excess of the poverty level and who do not participate in the Medicaid medically needy program, and for lung transplant services. 2. Number of Days (of County Responsibility) The counties are responsible for the payment of inpatient hospitalization for days in excess of 10 but not in excess of 45 per State fiscal year. The invoice shows the number of days hospitalized for prior claims under the column header "Prior YTD Days ". The number of days hospitalized for the current coverage period are shown under the column header "Nbr Days ". A county is only responsible for the number of days in the current coverage period that are in excess of 10 days, but not in excess of 45 days of the YTD total, which is found under the header "Bill Days ". 3. Calculation of County Share The "Amount Paid" is the amount paid to the hospital, and is calculated by multiplying the per diem rate for the hospital by the number of days for the current coverage period. The "County Share" is calculated by multiplying the per diem rate by 35% then multiplying by the number of days that the county is responsible (Nbr Days). 4. Billing for Medicaid HMO Patients The 1996 legislature mandated that as of July 1, 1996 the county billing process is to include hospital inpatient days for eligible Medicaid recipients in Health Maintenance Organizations (HMO). Since this inpatient care is charged directly to the HMO, a claim is not filed with the Medicaid fiscal agent. Each HMO is required to file a report with the Agency quarterly which is used as the basis for the HMO portion of the invoice. The HMO is provided its own per diem rate. The "County Share" is calculated by multiplying the per diem rate by 35% then multiplying by the number of days that the county is responsible (Nbr Days). NURSING HOME CHARGES 1. Overview of Nursing Home Charges Pursuant to Section 409.915 (2), Florida Statutes, all counties are responsible for 35% of the total cost of providing nursing home or intermediate facility services to eligible Medicaid recipients. The exception is skilled nursing care for children under age 21. 2. Calculation of County Share Counties are responsible for 35% of payments in excess of $170 per month, but not to exceed $55 per month per person. 3. Out of State Residents When an individual is admitted to a nursing home directly from a place of residence outside the State of Florida, the county of residence is the county where the facility is located. MONTHLY BILLINGS 1. Billing Cycle Provider claims submitted during a calendar month are included in the monthly County Billing cycle. Additionally, HMO charges are processed on a quarterly basis and will be included as part of a monthly billing. The invoice will be posted on the County Billing portal on the second day of the following month. Below are screen shots of the portal. The county staff will have until the end of the invoice month to review the charges prior to the Agency certification. For example, claims submitted during May will be included in the county billing invoice posted the second day of June. The county staff will have until the end of June to review the charges. 2. Processing Charges The charges in the monthly invoice will be indentified by an Accounts Receivable (AR) number. When the invoice is posted to the portal, the status of the ARs will be "BILLED ". The county staff will have an option to change the status to "ADV REFUND REQUEST" until the end of the invoice month. The "ADV REFUND REQUEST" option will be available for May through October billings. Counties will have an option to request a back -end refund request through the end of the month following the invoice month (April claims billed in May, back -end request available through June). Both of the refund request processes are described in more detail below. 3. Certification of Charges The monthly ARs that are in the "BILLED" status after the end of the invoice month will be reclassified to "CERTIFIED" status. The items that are assigned to a certified status will be removed from the County Billing portal. The total amount of the certified ARs is the amount the county will owe for the monthly billing. Screenshots of updated portal u .. ser cure rro. ".n Account c41ma e8plblllty Pnor Autbamatlan Re,.-1 Lrc aepam 1—.. rHes Pan.. Adm.. .� securer Admin Hosl 2 AR Number __.._ Recipient lD _..� Inuo4. —.b.r Kabul I—k. Namb.r - CataOary - - OpenStstus.I.N from Date J3: J1ZJ32 �. v.:< Da. 1 To Dal. � I R cords ; uw AR Count: 7 Total Paid: 587,180.06 County Share: $10,701.53 ssbu M _ a.�Mr sw Osw rrA zE 21157 1, __..- _ M1ar aN rises, �tl __� C•.,k cn a row t. v..w 1h. detail. — —.1-. talc[ row i:. Rtl out b.l—. and cn.n ,..r4 .eve t3 -DADE -Carry Blibp FLORIDA, _ MEDICAID A Division of the Agency for Heafth Care Administration I - i.j Mal - i Page - -r TO.6 , 'f v9y f°� Super User - ..secure Providers Account Claims Eilelbllity Prior Authorlia[lon Referral LTC Reports Trade flies Portal Admin Security Super User Admin Host - Z R AR Number Recipient [D Invoice Number I Status BILLED Rebill Invoice Number ! Category �'•. Open Status W From Data 07/31/2012 Past Due 1', To Date j 0 Records 100 �, cle AR Count:5 Total Paid: $25,310.34 County Shares:$7,218.13 AR Invoic. Rabill Prss.ss umMr Ilumb.r tnuWCa sb RMpi.at ID Prior VTD flbr 8111 Amount caumy pays Days Days Psid Slrr. atap naMdar ip - - 4 ' 2_2.39 HO . -SSCJ 3CC3�990 2C 1233 0 BILLED 7 = 5,551.9= 52._ .0 � 1Cv�53,C 2_.2 _ILLEC 13 7 46,561.94 42,295. HO C:D0 -53C0 2 52,812.26 - 555.:9 HO C:CC�52CC 3 _ ._..._2.26 5555..9 HC c4ar a0 � s.MCt ali Status" AD,/ REFUND REQUEST v Oenlal Reason- UO3 NOT COUNTr RESIDENT Comments He REQUESTING AN ADVANCE REFUND 1. Due Date The advance refund requests can be made up to the last day of the month in which the invoice was posted to the County Billing portal. After the end of the month the option to change the status on an AR will not be available. a. Determining an Advanced Refund Request Counties are responsible for participating in the cost of care and service provided to an eligible Medicaid recipient. Counties may request an advance refund request for charges that they believe are not their responsibility. The advance refund request will be reviewed by Agency staff within a 60 day period. In order for the AHCA county billing unit to research and provide the required information to substantiate a refund request, it is essential that each county indicate the reason for requesting the refund request. Please indicate the reason on the invoice with appropriate comment, or provide a separate list that includes the AR number, invoice number, amount and reason for the refund request. The advance refund requests that are approved by Agency staff will be transferred out of the county's billing. The charges may be transferred into another county's billing. The requests that are not approved will be marked certified and included with the certified charges in the subsequent month. 3. Marking an Advanced Refund Request in the Web Portal A county requests an advance refund request by checking the box to the left of the AR number (see screen shot above). Use the drop -down box to change the status code from "BILLED" to "ADV REFUND REQUEST ". Include the reason, which is also a drop -down box. Any additional information may be typed in the comment field. Click the SAVE button when done. If a charge is accidentally marked "ADV REFUND REQUEST" the county will have the ability to return it to a "BILLED" status. 01 County Billing Back -end Refund Request County: County Contact Name: County Contact Phone Number: Invoice # AR # County Share Amount Reason for Refund Request 11 DEFINITIONS AR Number — An identifying number assigned to a charge in the County Billing Subsystem Invoice Number — The four -digit year + two -digit month during which the claim was processed Provider ID — The Medicaid number of the provider who received payment for services rendered to the recipient Provider Name — The name of the provider who rendered care or service, and received payment Recipient ID — This is the Medicaid identification number specifically assigned to the recipient Recipient Name — Name of the recipient as it appears in the FLORIDA system Prior YTD Days: Hospital — The total number of days the recipient has been hospitalized for the current state fiscal year prior to the current charge Nursing Home — Not applicable Nbr Days: Hospital Invoice — The number of days hospitalized for the current charge Nursing Home Invoice — The number of days in the service month Bill Days — Number of days the county is responsible for on the current charge Service Month — The month in which the care was rendered Total Amount — The total paid to the provider for the designated recipient and service month County Share — The county portion of the total amount due Address History: Hospital Invoice — Current address - The address of the Medicaid recipient Nursing Home Invoice — Current address - The address of the nursing home Prior address - The address of the recipient prior to entering the nursing home 12 GLOSSARY OF TERMS AHCA — Agency for Health Care Administration Bill Days - The number of days that are to be billed to the county Date Of Service — The day service was obtained DCF — Department of Children and Family Fiscal Agent — The contractor responsible for administering FMMIS, processing payments to Medicaid providers, and generating the monthly county billing reports FLORIDA System — The DCF computer system which has the personal profile and eligibility information for a Medicaid recipient FMMIS System — The Florida Medicaid Management Information System, which is the system that processes Medicaid payments, and produces the monthly county billing invoice. Intermediate Facility — (ICF/DD) Intermediate Care Facility for the Developmentally Disabled; a State owned facility that provides care for mentally retarded or developmentally disabled individuals Per Diem — The daily rate paid to providers for rendering services to a Medicaid recipient Recipient — A person who has been determined eligible to receive Medicaid benefits Third Party — Any other insurance that pays on a claim for a Medicaid recipient; Medicaid is the payer of last resort 13