The purpose of the amendment to Rule 59G-1.020, F.A.C., is to provide implementation guidelines for Medicaid County billing processes per Section 409.915, F.S.

AGENCY FOR HEALTH CARE ADMINISTRATION
Medicaid

RULE NO.: RULE TITLE:
59G-1.020: Definition of County of Residence
PURPOSE AND EFFECT: The purpose of the amendment to Rule 59G-1.020, F.A.C., is to provide implementation guidelines for Medicaid County billing processes per Section 409.915, F.S.
SUMMARY: The implementation guidelines will result in improvements to the Medicaid County billing process.
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: A checklist was prepared by the Agency to determine the need for a SERC. Based on this information at the time of the analysis and pursuant to Section 120.541, F.S., the rule will not require legislative ratification.
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: 409.919 FS.
LAW IMPLEMENTED: 409.915 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: Thursday, July 26, 2012, 1:00 p.m. – 3:00 p.m.
PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room A, Tallahassee, Florida 32308-5407
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 48 hours before the workshop/meeting by contacting: Debbie Smith at the Division of Operations, [phone]. 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: Tonya Kidd, Deputy Secretary of Operations, 2727 Mahan Drive, Mail Stop 2, Tallahassee, Florida 32308-5407, telephone: [phone], e-mail: [e-mail].

THE FULL TEXT OF THE PROPOSED RULE IS:

59G-1.020 Definition of County of Residence.

For the purpose of county financial participation in the Medicaid Program, the county of residence for inpatient hospital care and nursing home care is determined by the recipient’s address information contained in the federally approved Medicaid eligibility system defined as follows.:

(1) For hospital claims, whether through fee-for-service or managed care, the address is based on the current living or residential address, with the exception of when the resident lives in a nursing home. When an individual lives in a nursing home, the address is based on the prior address. A person is considered to be residing in a county when they establish or maintain a physical living arrangement, outside of a medical facility, which they or someone responsible for them, consider to be home. A visit to another county does not make a person a resident of that county, nor does a planned temporary living arrangement prior to admission in a medical facility. Except in unusual situations related to an extended visit, it makes no difference how long a person has been physically located in the county if they maintain a primary residence in another county, and intend to return to that county. In all instances the person’s intent to reside in a county is the determining factor, regardless of the length of time involved.

(2) For nursing home claims, whether through fee-for-service or managed care, the address is based on the prior address, except when an individual is admitted to a nursing home directly from a place of residence outside of the State of Florida. If the individual is admitted to a nursing home from another state, the nursing home address will be used for county billing purposes. When an applicant has been admitted to a nursing home directly from a place of residence outside of the State of Florida, so that no Florida residency has been established, the certified county of residency will be considered as that county in which the nursing home is located.

(3) Since address information for children in custody is unavailable, counties are not responsible for these payments. In situations that are not clear cut, or otherwise unusually complicated, the determination of residency should be made on the basis of the preponderance of evidence. If a decision is not possible on this basis, the case should be referred to the Office of Social and Economic Services for determination

Rulemaking Authority 409.919 FS. Law Implemented 409.915 FS. History–New 1-1-77, Formerly 10C-7.31, 10C-7.031, Amended________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Tonya Kidd
NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Elizabeth Dudek
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: June 20, 2012
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: May 11, 2012