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Item D2 AGENDA ITEM SUMMARY La:z:e~:::':ecto BOARD OF COUNTY COMMISSIONERS Louis Meeting Date: August 15,2001 Division: Community Services Bulk Item: Yes ~ No Department: Social Services AGENDA ITEM WORDING: Health Care Responsibility Act (HCRA) In-County Hospital Reimbursement ITEM BACKGROUND: Since the recent discussions concerning the Trauma District, the issue was raised as to whether HCRA funds could be used for In-County Hospital Reimbursement. See attached documentation. PREVIOUS RELEVANT BOCC ACTION: None CONTRACT/AGREEMENT CHANGES: NIA STAFF RECOMMENDATION: Staff (Social Services Director and County Legal Department, Suzanne Hutton), reviewed the obligation ofHCRA funds for In-County Hospital Reimbursements. Staff strongly recommends that it is in the best interest of the County that funds that are currently allocated for HCRA be utilized for use of out-of-County HCRA cases. It is in the best interests of the County and in-county hospitals using these funds for medical cases that cannot be handled in Monroe County. TOTAL COST: $(One-half of $353.840 Legal Obligation) BUDGETED: Yes lL No _ (Only $100,000) COST TO COUNTY: $176.920.00 REVENUE PRODUCING: YES NO~ AMT. PER MONTH APPROVED BY: County Atty. ment DIVISION DIRECTOR APPROVAL: JameS . Malloch, Division Director/Community Services DOCUMENTATION: Included: 2L- To Follow: Not Required: _ DISPOSITION: Agenda Item #: /-Z)~ Effective Date: hnuary 28. 2000 RECAP OF POLICY AND PROCEDURE FOR IN-COUNTY HOSPITAL REIMBURSEMENTS All current policIes and procedures governing out-of-county HCRA reimbursement will be utilized to govern in-county HCRA reimbursement. All participating hospitals must meet the 2% charity care obligation unless there is no other hospital(s) within the county to provide tJldigent care or if no other hospital(s) within the county meets the 2% charity care obligation. Under those circumstances, the county must provide the Agency with a written statement that no hospital within the county meets the 2% requirement. In all cases, there must be a written agreement between the county and the in-county hospital accepting the HCRA or other negotiated reimbursement standards. A copy of the letter from the county to the hospital and a copy of the letter from the hospital to the county accepting the HCRA standards, or a copy of a signed contract, must be filed with the Agency. Upon receipt of the aforementioned letters or contract, the Agency will provide the in-county designated hospital(s) with the necessary forms and a copy of the HCRA Handbook. There is no limit to the number of HCRA qualified in-county hospitals that a county may elect to contract with. The county is then responsible for completing the In-County information on the Monthly Caseload and Appeals Reports and the Quarterly Financial Reports. The applicant must be a resident of the county where the hospital is located and services were provided and the county must have elected to reimburse its in-county hospitals. All in-county HCRA applicants must meet the same HCRA eligibility requirements used for out-of-county eligibility determination. If the county has established less restrictive requirements, the applicant would be required to meet the county's requirements on file with the Agency. The HCRA would not apply to persons active with a county medical assistance plan if the treating hospital is a participating facility under the county's medical assistance plan. The HCRA is the payor of last resort. The maximum amount of HCRA funds that a county can allocate for in-county reimbursement is up to Yz of its total HCRA funds, i.e., if a county must designate $500,000 for the fiscal year, it can only use a maximum of $250,000 for in-county hospital reimbursements. No county has the statutory authority to use out-of-county designated funds to supplement its in-county reimbursement amount above the aforementioned one half. Should a county exceed its designated in-county reimbursement limit, the additional funds must be provided through other funding sources from the county's budget and the amount exceeded shall not reduce the out-of- county obligation. All counties must notify the Agency of its decision to provide in-county reimbursement starting with the county fiscal year 1999-2000. Any changes to its decision must be filed with the Agency along with copies of notifications to the affected in-county hospitals no later than 45 days following the start of the new county fiscal year in which the change takes effect (on or around November 14). All HCRA funds, whether in-county or out-of-county, are only to be used to reimburse hospitals for qualified indigent emergency or pre-approved non-emergency care. Please refer to the current HCRA Handbook, page 3-8 for services and care NOT covered by HCRA. Page I of I "~.;. .,~"f.....~'!:";'~'.':.'~I\-'--:'""::~""r"";--"-""-:J'." -:"'~~'~"'-"'::"~~~.;r'"";r-':''''".~ ;.. ...::0'_" ,-_' ., C' ".- 'r= r ""-1>1"" -. _.-.~......~:.I - -,. '''-.:( ,"'c.'~., --.'. e.., "- .. '. :,.r~;~~'~~,' t~'~ .' " <.,~ .~'. - ".,"0"" ff~. ~~,ri'" .;; ~~.~ \..~~~~:~;..~::.r-. ~', ~.~'. _'. -,,: -' HEALTH.. CARE;;' RESPONS:IBIIILTY:;"iACT ~::;:, ~~'i.!:.~ :':,."':1:,-'!- . . . ,.,;-,~,:>;.: ., ....-;;_,..,:.)~.~~:~:i~_t::~;>;:.::~r/,5.,-?-"'.. ,-. .-: . . ........j . :..-...._.-..-... . ,', . '_.-~u.:'I'.~?>-.-:i:' '~ "~;.i~~"k~'~...r.:.:~~ .. - -' ~ - -'.~..~:,: - .;~ ,~-r -, HISTORY: ~he ~ealth Ca=e Responsibility Act (HCRA) was first enacted =evised by the 1988 Legislature to place the financial obligation for hospitals :0:- er..e=gency in-patient and out-patient services provided county indigent patients on the counties in which the patients reside. in 1977 and reimburSing to Ol..:.t-of- The 1991 Legislature amended the Act to increase the number of eligible applicants ch=ough the c=eation of a spend-down program and to increase hospital reimbursement rates. Both of these measures pertained ONLY to counties that 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 residents. 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 hospi tals 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 Need/Financial its overall charity care was provided Analysis that at 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-county indigent care; · 8e 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 ae 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 other federally or state reimbursement program (such as Medicaid or Medicare) ; funded hospital · Not live in a public institution; HeRA Summary Page 2 of 2 Revised February 15.2000 . Have assets less than the Medicaid medically needy ~evels; . Have no or inadequate private insurance; and . Be a C.S. citizen or lawfully admitted alien. APPLICATION PROCESSING RESPONSIBILITIES FOR THE HOSPITAL: The hospita~ providing emergency services to the indigent lS respons ible for submi t ting an appl ication (.Wc.; E='orm 5220-000ll by certifled mall to the indigene applicane's county of residence '""ithin 30 days of the date that the emergency inpatient or ouepatiene services were provided. APPLICATIONS PROCESSING RESPONSIBILITIES FOR THE COUNTY: The couney of residence is responsible for determining residency and eligibility. If the county is unable to determine residency, ehe .:'\gency will determine residency for ehe couney. The county has the right of refusal in determining HC~; eligibility. If the county so chooses, the eligibility function will be performed by the Agency for Health Care Administration office in Tallahassee. The county must notify the hospital and ehe 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 hospi tal 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 hospitals 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 HC~; handbook, and lists of all eligible hospi tals, spend-down provision eligible counties, Medicaid per diem rates (sene each January and July), and county and hospital contacts. HeRA Summary Page 2 of 2 Revised February 15. 2000