Fla. Admin. Code R. 59H-1.011

Current through Reg. 50, No. 235-239, December 10, 2024

Section 59H-1.011 - Coordination of Third Party Payments

(1) The hospital shall pursue all third party payors prior to submitting a claim to a county. This requirement shall not preclude submission of the application within time frames established in Rule 59H-1.008, F.A.C. The county, through the HCRA, shall serve as payor of last resort in regard to third party insurance, federally funded and state-funded hospital programs which may be available to the applicant.

(2) If a third party payment is less than 80 percent of the Medicaid per diem rate or less than a negotiated rate, total payment to the hospital by a third party payor, other government program and the county shall not exceed the Medicaid reimbursement rate or the negotiated rate.

(3) In cases where a hospital is reimbursed by a third party payor or other government program, after the county has paid the hospital under this program, the hospital shall reimburse the county up to the amount paid by the county, with in 30 days of receipt of such payment.

(4) In cases where a hospital is reimbursed by a third party payor or other government program and a share of cost is involved for a spend-down provision eligible applicant, total payment to the hospital by a third party payor or other government program, combined with the applicant's share of cost, shall not exceed the Medicaid reimbursement rate or other negotiated rate.

(5) In cases where patients are dually eligible for the Shared County and State Health Care Program and the Health Care Responsibility Act, the county may choose from which program to reimburse the hospital. The choice exercised by the county shall not reduce the amount of payment to the hospital. Reimbursement shall not exceed 45 days of service per county fiscal year through the act and the Shared County and State Health Care Program (SCS).

Fla. Admin. Code Ann. R. 59H-1.011

Rulemaking Authority 154.3105 FS. Law Implemented 154.304(9) FS.

New 3-29-89, Amended 12-24-90, 2-24-92, Formerly 10C-26.011, Amended 6-7-00.