To recover funding for services from third party sources.

 

DEPARTMENT OF HEALTH

Division of Children’s Medical Services

RULE NO.:RULE TITLE:

64C-3.002Recovery of Third Party Payments

PURPOSE AND EFFECT: To recover funding for services from third party sources.

SUMMARY: The proposed rule language deletes references to Section 381.785, F.S., and the description of liability as it pertains to the recovery of funded services.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: Based on the SERC checklist completed by the Division of Children's Medical Services, the regulatory costs for the implementation of the new third party collections does not exceed the $200,000 threshold in the aggregate within one year after the implementation of the rule.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 402.24(2)(h) FS.

LAW IMPLEMENTED: 391.026(9), 402.24 FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: December 5, 2013, 1:00 p.m. − 3:00 p.m.

PLACE: Florida Department of Health, 2585 Merchants Row Blvd., Conference Rm. 210AA, Tallahassee, Florida

Participation in this hearing will be available via conference call at the following conference call number and code: Conference number: 1(888)670-3525; Passcode: 8211431221

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 5 days before the workshop/meeting by contacting: Bonnie Dorman at [phone], Ext. 2221 or via email at [e-mail]. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Bonnie Dorman at [phone], Ext. 2221 or at [e-mail]

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

64C-3.002 Recovery of Third Party Payments

(1) Except as otherwise provided in subsection (2) below, the Department shall recover in full on its rights under Sections 381.785, 391.047, and 402.24, Florida Statutes, and this rule, for payment for funded services and medical services.

(2) Where undue financial hardship would result to the individual who received funded services or medical services as a result of the Department recovering in full on its rights under subsection (1) above, a request may be made to the Department to accept less than full recovery in satisfaction of its rights thereunder. Undue financial hardship does not exist where the dollar amount of such services for the relevant individual is less than 5 percent of the dollar amount of relevant judgments, settlements, or awards, net of attorney’s fees, costs, and the actual amount paid or to be paid to satisfy other valid liens for medical or rehabilitation services. Such request must be based upon the following factors:

(a) The amount of relevant judgments, settlements, or awards;

(b) The lien amount of funded services and medical services;

(c) The nature of funded services and medical services;

(d) Employment status of the individual;

(e) Cost to the individual of living independently, if applicable;

(f) The amount paid or to be paid to satisfy other valid liens for medical or rehabilitation services provided to such individual;

(g) The amount by which such other lienors have reduced their liens;

(h) The amount of attorney’s fees and costs to generate the relevant judgments, settlements, or awards;

(i) The amount by which the attorney’s reduced their fees or absorbed their costs; and

(j) Other sources of income available to the individual.

(3) The phrase “becomes liable for” in Sections 381.785 and 402.24, Florida Statutes, means the non-speculative amount of future expenditures for funded services or medical services. “Non-speculative” includes all future expenditures for funded services or medical services that can be reasonably expected to be made on behalf of the individual based upon that individual’s current and expected needs by the Department. “Non-speculative” excludes future expenditures for unexpected, emergency, or extraordinary funded services or medical services; for such future expenditures the Department retains all its rights under Sections 381.785, 391.047, and 402.24, Florida Statutes, and this rule.

(3)(4) The Department’s rights under Sections 381.785, 391.047, and 402.24, Florida Statutes, and this rule are continuing in nature and survive beyond the date of any judgment, settlement, or award, or court approval thereof. Judgments, settlements, or award amounts funded in whole or in part from claims bills or other acts of local, state, federal or foreign established under 42 U.S.C. Section 1396p(d)(4), for the benefit of recipients of funded services or medical services, remain subject to the Department’s rights under Sections 381.785, 391.047, and 402.24, Florida Statutes, and this rule.

Rulemaking Specific Authority 381.785(9), 402.24(2)(h) FS. Law Implemented 381.785, 391.026(9), 402.24 FS. History–New 3-11-87, Amended 6-22-94, 3-28-96, Formerly 10J-3.007, Amended 1-20-03,_________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Ann Filloon

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: John H. Armstrong, M.D., FACS

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: October 22, 2013

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: October 02, 2013