Health Care Responsibility Act (HCRA)
In 1977, the Legislature declared that it is inequitable for hospitals and taxpayers of one county to be expected to subsidize the care of out-of-county indigent persons. In order to assure that adequate and affordable health care is available to all Floridians, the Health Care Responsibility Act (HCRA) was enacted. The Act places the ultimate financial obligation for an indigent patients out-of-county emergency care on the county in which the indigent patient resides. The Health Care responsibility act can be found in Chapter 154, Sections .301 - .331, Florida Statutes, and Rule Chapter 59H-1.001-.015, Florida Administrative Code.
In 1998, the Legislature revised the Act to allow counties to use up to ½ of the HCRA funds to reimburse eligible in-county hospitals for indigent care. Currently there are 11 counties that elected to reimburse their in county hospital(S] for resident indigents under the HCRA. These counties are: Bradford, Calhoun, Hamilton, Hardee, Holmes, Levy, Madison, Suwannee, Taylor, Volusia and Washington.
In 2001, the Legislature revised the Act to allow a county with a population of 100,000 or less to reduce the maximum amount that it may be required to pay. The Agency must reduce the official state population estimates 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 Family Services, and by the number of active-duty military personnel residing in the county. A county is entitled to receive the benefit of the reduction only if the county accepts and does not require any re-verification of the documentation of financial eligibility and county residency provided to it by the participating hospital. The submitted documentation must be complete and in accordance with the requirements of Section 154.3105, F.S.Currently there are ten (10) counties that have elected to participate in the reduction. These counties are: Baker, Bradford, Gulf, Hardee, Holmes, Jefferson, Madison, Nassau, Union, and Wakulla.
Counties may pre-approve elective and non-emergency care for services (including follow-up care) when one of the two following conditions are present: 1.) if the funding and services are not available in the county of residence; OR 2.) if the participating hospital has obtained written prior authorization and pre-approval from the county of residence and that county has such procedures on file with the Agency. The following counties have written pre-authorization and pre-approval procedures on file with the Agency: Brevard, Flagler, Hernando, Nassau, St. Lucie, and Seminole.
Effective July 1, 2013, the Agency implemented a new hospital inpatient payment method utilizing Diagnosis-Related Groups (DRG) for Florida Medicaid. DRG transitions hospital inpatient reimbursement from a cost-based per diem to a per discharge, diagnosis-code payment. Participating hospitals must provide HCRA eligible inpatient UB 04 claim forms to the applicant's county of residence using the APR-DRG grouping method (not Medicare). If the DRG code provided in field 71 on the UB 04 claim form is not on the APR-DRG Inpatient Hospital Reimbursement Rates list posted on the HCRA website, it is not reimbursable through HCRA.
The following Health Care Assistance Application form is for use by HCRA Participating Hospitals only (see list below) . The Notification of Eligibility form is for use by designated HCRA county contact personnel only. Any modifications to either of these forms are prohibited.
- Health Care Assistance Application (AHCA Form 5220-0001) [171KB, PDF]
- Notification of Eligibility (AHCA Form 5220-0002) [113KB, PDF]
Please review this "Questions and Answers" [21.8 KB, PDF] document for the most often asked questions concerning the HCRA program. If you do not find the answer to your question(S] or for county or hospital training, please email the HCRA liaison at HCRA@ahca.myflorida.com.
For additional information and HCRA related forms, please visit the following:
- HCRA Rule - Chapter 59H-1, Florida Administrative Code [80KB, DOC]
- HCRA Overview Presentation [619KB,PDF] Updated 8/28/13
- Participating Hospital List [166KB, XLS] Updated: 12/4/13
- Hospital Per Diem Rates- July 2012 [350 KB, PDF] Effective for claims prior to July 1, 2013
Special Note: HB 7109 changed the posting of Medicaid hospital per diem from semiannual to annual, the next update will be July 2013.
- APR-DRG Inpatient Hospital Reimbursement Rates [564KB, PDF] Effective July 1, 2013
- APR-DRG Inpatient and Outpatient Hospital Reimbursement Rates Instructions (236KB, PDF) Effective 7/1/13
- Hospital Per Diem Outpatient Rates [228KB, PDF] Effective July 1, 2013
- Participating Hospitals Contact List [460KB, XLS] Updated: 11/20/13
- County Contact List [318KB, XLS] Updated: 12/4/13
- County Population & HCRA Liability [72KB, XLS] 2012-2013 - Updated 7/25/13
- 100% Federal Poverty Income Limits [137 KB, PDF] Updated: 03/5/13
- Spend-down Provision Income Limits [137 KB, PDF] Updated: 03/5/13
- Asset Limits (Medically Needy) [10.2 KB, PDF]
HCRA Forms and Templates:
- Applicant's Rights and Responsibilities [318KB, PDF]
- Designated Authorized Representative Form [84 KB, PDF] (voluntary use)
- Monthly Household Expense Calculation Form [14.5 KB, PDF] (voluntary use)
- Monthly Caseload & Appeals Automated Report [216 KB, XLS] 2013-2014
- Quarterly Expense Automated Report [43 KB, XLS] 2013-2014 Updated 12/4/13
- County Contact Change Form [122KB, PDF]
- Hospital Contact Change Form [154KB, PDF]