Current through 2024-38, September 18, 2024
A.
Application
(1) Each hospital
shall provide an opportunity for each person seeking free care to make
application on forms provided by the hospital.
(2) A hospital may require an applicant to
furnish any information that is reasonably necessary to substantiate the
applicant's income or the fact that the individual is not covered by insurance
or eligible for coverage by state or federal programs of medical
assistance.
B.
Determination
(1) Upon receipt
of an application, a hospital shall determine that an individual seeking free
care qualifies for such care if:
(a) the
individual meets the income guidelines specified in Section 1.02;
(b) the individual is not covered by any
insurance nor eligible for coverage by state or federal programs of medical
assistance; and,
(c) services
received were medically necessary.
(2) If the hospital determines that the
individual seeking free care meets the income guidelines but is covered by
insurance or by state or federal programs of medical assistance, it shall
determine that any amount remaining due after payment by the insurer or medical
assistance program will be considered free care.
(3) A hospital may allow the determination of
qualification for outpatient free care services to remain valid for up to six
months following the date of determination.
If a hospital adopts the policy of allowing qualification for
outpatient free care services to remain valid for six months, such policy shall
apply to all individuals determined qualified for outpatient free care
services. A determination of qualification for inpatient free care services
shall be made with each admission.
C.
Deferral of Determination
(1) Under the conditions specified in
paragraphs (2) and (3) below, a determination of qualifications for free care
may be deferred up to 60 days, for the purpose of requiring the applicant to
obtain the present evidence of ineligibility for medical assistance programs or
to verify that the services in question are not covered by insurance.
(2) If an applicant for free care, who meets
the income guidelines in section 1.02 and who is not covered under any state or
federal program of medical assistance, meets any of the following criteria,
qualification for free care shall be deferred:
(a) age 65 or over;
(b) blind,
(c) disabled;
(d) an individual is a member of a family in
which a child is deprived of parental support or care due to one of the
following causes, and the individual's income is less than the guidelines in
section 1.02:
(i) death of a
parent;
(ii) continued absence of
the parent(s) from the home due to incarceration in a penal institute,
confinement in a general, chronic or specialized medical institution,
deportation to a foreign country, divorce, desertion or mutual separation of
parents, or unwed parenthood;
(iii)
disability of a parent; or
(iv)
unemployment of a parent who is the principal wage earner;
(3) If an individual does not meet
any of the criteria specified in (2) above, but the hospital is unable to
determine the coverage of the individual and has a reasonable basis for
believing that the individual may be covered by insurance or eligible for
federal or state medical assistance programs, it may defer the determination
concerning free care.
D.
Content of Favorable Determination. A determination that an
applicant qualifies for free care must indicate:
(1) That the hospital will provide care at no
charge;
(2) The date on which the
services were requested;
(3) The
date on which the determination was made; and
(4) The date on which services were or will
be first provided to the applicant.
E.
Reasons for Denial
Each hospital shall provide each applicant who requests free
care and is denied it, in whole or in part, a written and dated statement of
the reasons for the denial when the denial is made. When the reason for denial
is failure to provide required information during a period of deferral under
subsection 1.05(C), the applicant shall be informed that she or he may reapply
for free care, if the required information can be furnished. Additionally, the
notice must state that the patient has a right to a hearing; how to obtain a
hearing; and name and telephone number of the person who should be contacted,
should the provider/patient have questions regarding the notice.
F.
Reasons for
Deferral
(1) When an application for
free care under paragraph 1.05 (C) (2) is deferred, the applicant shall be
notified as follows:
A free care determination has not yet been made. There is
reason to believe that you [the applicant] may be eligible for coverage by
state or federal medical assistance programs. If you can show that you are not
eligible for coverage by these programs within 60 days of the date of this
notice by obtaining a letter or other statement from __________ [insert name of
state or federal agency to which applicant has been referred], then you will be
considered qualified for free care. Even if you are eligible for coverage, free
care will be available for any portions of the bills that medical assistance
programs (or any insurance that you have) will not pay.
(2) When an application is deferred under
paragraph 1.05 (C) (3), the applicant shall be notified of the reason for
deferral, including the basis for the hospital's belief that coverage or
eligibility may exist and the nature of the evidence that should be provided to
complete the determination. The notice shall be in substantially the form
specified in paragraph (1) above and shall include the last sentence of that
form.
