59G-7.003: Medicaid Third Party Liability Responsibility and Notices
59G-7.004: Forms
59G-7.023: Probable Existence of Third-Party Liability Established
59G-7.032: Recovery of Reimbursement - General
59G-7.0322: Conflicting Claims by Medicare and Medicaid
59G-7.0331: Small Claim Exception under Paragraph (11)(f) of the MTPLA
59G-7.0332: All Medical Assistance; Medicaid Program Repaid First
59G-7.034: Settlement Agreements
59G-7.035: Fees of Recipient's Attorney
59G-7.051: Required to Seek Reimbursement
59G-7.053: Hospital Third-Party Liability Plan
59G-7.054: Prompt Repayment
59G-7.056: Benefits under Certain Plans
59G-7.057: Provider Third-Party Liability Audits
59G-7.058: Billing Statement and Medical Records
59G-7.0581: Statements as Notice
59G-7.060: Cooperation Required
59G-7.0601: Non-cooperation
59G-7.061: Duty to Inform
59G-7.062: Notice of Proceedings or Claim
59G-7.063: Settlement and Notice
59G-7.064: Appearance to Provide Information
59G-7.073: Proceeds of Tort Recovery Required to Be Held in Trust
PURPOSE AND EFFECT: Repeal rules associated with Medicaid Third Party Liability Program.
SUMMARY: The proposed repeal eliminates certain repetitive or obsolete rules. The rules are either repetitive as the language is in the Medicaid Third-Party Liability Act, Section 409.910, F.S. or reflect obsolete programs. Repeal of these rules will not negatively impact the Medicaid Third Party Liability Program; current operation of the program will not change as a result of these repeals.
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: The rules are either repetitive as the language is in the Medicaid Third-Party Liability Act, Section 409.910, F.S. or reflect obsolete programs. The Agency determined that the repeal of these rules will not impose regulatory costs and will not have an adverse impact on the public.
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: 20.05, 120.53,(1)(b), (c), 409.026(1), (6), (8), 409.285, 409.910(21), (22), (23), 409.919 FS.
LAW IMPLEMENTED: 120.52(16), 120.53(1),(1)(b),(c), 120.57, 120.58, 120.68, 409.257, 409.901, 409.902, 409.907, 409.908, 409.910,(1), (3), (20), 409.912, 409.913, 409.920,(2)(a), (c), 409.285, 624.424(9), 641.261, 641.411, FS. 447.15, 447.20, 447.21 FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN THE FAW.
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Lee Peacock, Agency for Health Care Administration, Division of Operations, Third Party Liability, Telephone No. (850)412-4139, email lee.peacock@ahca.myflorida.com
THE FULL TEXT OF THE PROPOSED RULE IS:
59G-7.003 Medicaid Third Party Liability Responsibility and Notices.
Rulemaking Specific Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.910 FS. History–New 11-13-91, Formerly 10C-35.003, Amended 10-3-96, Repealed________.
59G-7.004 Forms.
Rulemaking Specific Authority 120.53(1)(b), (c), 409.026(1), (6), (8), 409.910(23), 409.919 FS. Law Implemented 120.52(16), 120.53(1), 409.910 FS. History–New 11-13-91, Formerly 10C-35.004, Amended 10-3-96, Repealed________.
59G-7.023 Probable Existence of Third-Party Liability Established.
Rulemaking Specific Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.910(1), (3) FS. History–New 11-13-91, Formerly 10C-35.023, Amended 10-3-96, Repealed________.
59G-7.032 Recovery of Reimbursement – General.
Rulemaking Specific Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.910 FS. History–New 11-13-91, Formerly 10C-35.032, Amended 10-3-96, Repealed________.
59G-7.0322 Conflicting Claims by Medicare and Medicaid.
Rulemaking Specific Authority 409.919 FS. Law Implemented 120.53(1)(b), (c), 409.910 FS. History–New 11-13-91, Formerly 10C-35.0322, Amended 10-3-96, Repealed________.
59G-7.0331 Small Claim Exception under Paragraph (11)(f) of the MTPLA.
Rulemaking Specific Authority 120.53(1), 409.026(8), 409.910(23), 409.919 FS. Law Implemented 120.53(1), 409.910 FS. History–New 11-13-91, Formerly 10C-35.0331, Amended 10-3-96, Repealed________.
59G-7.0332 All Medical Assistance; Medicaid Program Repaid First.
Rulemaking Specific Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.910 FS. History–New 11-13-91, Formerly 10C-35.0332, Amended 10-3-96, Repealed________.
59G-7.034 Settlement Agreements.
Rulemaking Specific Authority 20.05, 120.53(1)(b), (c), 409.026(8), 409.285, 409.910(23), 409.919 FS. Law Implemented 120.53(1)(b), (c), 120.57, 120.58, 409.285, 409.902, 409.910 FS. History–New 11-13-91, Formerly 10C-35.034, Amended 10-3-96, Repealed________.
59G-7.035 Fees of Recipient’s Attorney.
Rulemaking Specific Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.910 FS. History–New 11-13-91, Formerly 10C-35.035, Amended 10-3-96, Repealed________.
59G-7.051 Required to Seek Reimbursement.
Rulemaking Specific Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.902, 409.907, 409.908, 409.910, 409.912, 409.913, 409.920 FS. History–New 11-13-91, Formerly 10C-35.051, Amended 10-3-96, Repealed________.
59G-7.053 Hospital Third-Party Liability Plan.
Rulemaking Specific Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.902, 409.907, 409.908, 409.910, 409.912, 409.913, 409.920 FS. History–New 11-13-91, Formerly 10C-35.053, Amended 10-3-96, Repealed________.
59G-7.054 Prompt Repayment.
Rulemaking Specific Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.902, 409.907, 409.908, 409.910, 409.912, 409.913, 409.920 FS. History–New 11-13-91, Formerly 10C-35.054, Amended 10-3-96, Repealed________.
59G-7.056 Benefits under Certain Plans.
Rulemaking Specific Authority 409.026(8), 409.910(21), 409.919 FS. Law Implemented 409.902, 409.907, 409.908, 409.910, 409.912, 409.913, 409.920 FS.; 42 U.S.C. ss. 1396a(a)(25), (a)(27), (a)(45), 1396k (Social Security Act ss. 1902(a)(25), (a)(27), (a)(45), 1912); 42 C.F.R. ss. 433.135-433.140, 447.15, 447.20, 447.21. History–New 11-13-91, Formerly 10C-35.056, Repealed________.
59G-7.057 Provider Third-Party Liability Audits.
Rulemaking Specific Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.902, 409.907, 409.908, 409.910, 409.912, 409.913, 409.920 FS. History–New 11-13-91, Formerly 10C-35.057, Amended 10-3-96, Repealed________.
59G-7.058 Billing Statement and Medical Records.
Rulemaking Specific Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.902, 409.907, 409.908, 409.910, 409.912, 409.913, 409.920 FS. History–New 11-13-91, Formerly 10C-35.058, Amended 10-3-96, Repealed________.
59G-7.0581 Statements as Notice.
Rulemaking Specific Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.902, 409.907, 409.908, 409.910, 409.912, 409.913, 409.920 FS. History–New 11-13-91, Formerly 10C-35.0581, Amended 10-3-96, Repealed________.
59G-7.060 Cooperation Required.
Rulemaking Specific Authority 120.53, 409.026(8), 409.910(23), 409.919 FS. Law Implemented 120.57, 120.58, 120.68, 409.901, 409.902, 409.910, 409.920(2)(a), (c) FS. History–New 11-13-91, Formerly 10C-35.060, Amended 10-3-96, Repealed________.
59G-7.0601 Non-cooperation.
Rulemaking Specific Authority 120.53, 409.026(8), 409.910(23), 409.919 FS. Law Implemented 120.57, 120.58, 120.68, 409.901, 409.902, 409.910, 409.920(2)(a), (c) FS. History–New 11-13-91, Formerly 10C-35.0601, Amended 10-3-96, Repealed________.
59G-7.061 Duty to Inform.
Rulemaking Specific Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.901, 409.902, 409.910, 409.920(2)(a), (c) FS. History–New 11-13-91, Formerly 10C-35.061, Amended 10-3-96, Repealed________.
59G-7.062 Notice of Proceedings or Claim.
Rulemaking Specific Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.901, 409.902, 409.910, 409.920(2)(a), (c) FS. History–New 11-13-91, Formerly 10C-35.062, Amended 10-3-96, Repealed________.
59G-7.063 Settlement and Notice.
Rulemaking Specific Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.901, 409.902, 409.910, 409.920(2)(a), (c) FS. History–New 11-13-91, Formerly 10C-35.063, Amended 10-3-96, Repealed________.
59G-7.064 Appearance to Provide Information.
Rulemaking Specific Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 120.58, 409.257, 409.901, 409.902, 409.910, 409.920(2)(a), (c) FS. History–New 11-13-91, Formerly 10C-35.064, Amended 10-3-96, Repealed________.
59G-7.073 Proceeds of Tort Recovery Required to be Held in Trust.
Rulemaking Specific Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.910 FS. History–New 11-13-91, Formerly 10C-35.073, Amended 10-3-96,, Repealed________.