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3200-3400-3600-4600-Appendix: Florida Medicaid Manual

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

·        Relatives

·        Friends

·        Agency representative/nursing home staff (other than nursing home administrator).

3240.0118. Liability of the Designated Representative.


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 over payments.

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.


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