Chapter 3200. Coverage Groups.
3240.0100. REPRESENTATIVES AND PAYEES. Individuals may designate anyone to make application and/or receive benefits on behalf of an assistance group.
3240.0115. Designated Representative. A designated representative is someone who assumes responsibility for acting on behalf of the individual or assistance group by providing information for the eligibility determination.
If individual is incapable of selecting a representative, the designated representative may be self-appointed.
3240.0116. Self-Designated Representative.
The following guide presents an order of preference for selection of designated representative:
· Legal guardian
· Power of attorney
· Agency representative/nursing home staff (other than nursing home administrator).
3240.0118. Liability of the Designated Representative.
3240.0400. THIRD PARTY PAYMENTS.
Chapter 3400. Notices and Forms.
3440.0200. TYPES OF NOTICES.
Notifications of case action, approvals/denials, adverse actions, etc…
3440.0504. Law/Rules Citations.
Rule citations for Medicaid are found in Florida Administrative Code 65A-1. Florida Administrative Code citations much be given on any notice regarding:
· Increase in patient responsibility
· Increase of share/cost
· Termination of Medicaid for a recipient who is no longer enrolled.
Chapter 3600. Benefit Recovery.
3640.0101. Legal Basis. Legal basis for fraud and recovery of overpayments.
3640.0200. Statute of Limitations. 24 months for non-fraud. 36 months for fraud.
3640.0300. Types of Overpayment: agency error, client error, fraud/intentional violation, or any combination of above.
Chapter 4600. Glossary / Definitions.
Florida Medicaid ESS Policy Manual Appendices
Scroll down for Appendix A-1 through A-35.