Health Care Responsibility Act (HCRA)

HCRA Handbook
Available in PDF format.

Table of Contents (19.6 KB, PDF)

Chapters

  1. Background and Overview (287 KB, PDF)
  2. County, Hospital, and Agency Program Administration (35.9 KB, PDF)
  3. Covered Services Emergency Care (177 KB, PDF) Updated June 2003
  4. Application Process (25.1 KB, PDF)
  5. Eligibility Determination Process (135 KB, PDF)
  6. Claims Processing (148 KB, PDF)  Updated August 2010
  7. Appeal Process (87.3 KB, PDF)

Appendices

  1. Definitions (29.6 KB, PDF)
  2. Monthly Caseload and Appeals Report (30.4 KB, PDF)
  3. HCRA Quarterly Financial Report (57.8 KB, PDF)
  4. Out-of-County Charity Care Report - Page 1 (116 KB, PDF) and Page 2 (44.6 KB, PDF)
  5. Sample Participation Agreement (52.1 KB, PDF)
  6. Sterilization Consent Form (108 KB, PDF)
  7. Elective Surgery Procedure Codes (6.21 KB, PDF)
  8. Procedures Exempt from the $1,500 Reimbursement Limits (72.3 KB, PDF)
  9. Application/Notification of Eligibility Order Form (no longer applicable)
  10. Notification of Eligibility, AHCA Form 5220-0002 (23.3 KB, PDF)
  11. Health Care Assistance Application, AHCA Form 5220-0001 (90.0 KB, XLS)
  12. UB-04 (CMS-1450) Claim Completion Instructions (47.6 KB, PDF)  Update: 5/31/07
              UB-04 Claim Form (pdf)  (262 KB, PDF)
              UB-04 CMS Manual (pdf) (1.80 MB, PDF)
  13. List of Counties Not at Their 10 Mill Cap (55.7 KB, PDF)
  14. List of Counties at Their 10 Mill Cap (48.8 KB, PDF)
  15. Revenue Codes for Inpatient Claims (1.20 MB, PDF)  Updated: 2/26/08
  16. Outpatient Revenue Center Codes  (896 KB, PDF)   Updated: 2/26/08
  17. Pathology/Laboratory Fees  (175 KB, XLS) Updated: 6/08/10
  18. Itemized Paid Claims  (48.3 KB, PDF)
  19. HCRA Income Limits (100% FPL)  (1328 KB, PDF)   Updated:02/16/12
  20. HCRA Spend-down Provision Income Limits (150%)   (1192 KB, PDF)   Updated:02/16/12
  21. HCRA Asset Limits  (10.2 KB, PDF)


Reporting Medicaid Fraud