Rule 111-3-12-.05 - Criteria for Determining Indigency(1) General Statement on Determining Financial Eligibility:(a) The Department of Community Health desires that each county have as much freedom as possible in determining the eligibility of its residents under the provisions of this Program.(b) Recognizing the differences in the socio-economic level of the several counties, there shall be no rigid state-wide formula devised for determining indigency and medical indigency.(2) A Local Policy or Standard Required:(a) The County Board of Health shall develop a policy or standard which shall be used in determining indigency and medical indigency under the Program for the residents of that county.(b) The local policy or standard shall be established in such a manner as to satisfy the following provisions: 1. It must contain reasonable assurance of a uniform basis of review for all requests for financial assistance under the Program for residents of that county.2. It must contain specified standards of eligibility relative to family income, family assets, hospitalization insurance, and number of dependents.3. It must contain a procedure which requires and specifies an inventory of economic resources on persons for whom assistance is requested.4. It must recognize the need for a higher priority in those instances where an indigent or medically indigent resident is hospitalized outside of the county.(3) Investigation of Individual Applicants: (a) There shall be an investigation or review of the economic condition of each applicant to determine eligibility.(b) Each applicant shall be required to certify that he is unable to pay for the full cost of hospital care as deemed necessary by a physician.(c) Each applicant, from family resources or hospitalization insurance, shall be required to pay as large a share as possible of the cost of his hospitalization.(4) Payment from Other Sources: (a) For days of hospitalization authorized under the Program, there may be a supplemental county payment above the amount based on the official per diem rate, provided such action is based upon a contract agreement between the hospital and the governing authority of the county. There shall be no State participation in a supplemental county payment.(b) When payment is made or expected to be made to the hospital on behalf of the patient from hospitalization insurance or family resources, the amounts so collected by or due to the hospital shall be deducted from that sum which would otherwise be payable to the hospital under the Program, except as stated in 111-3-12-.05(4)(c).(c) When the patient's stay in the hospital is greater than the days of hospitalization authorized under the Program, payment to the hospital from hospitalization insurance or family resources may be applied, according to the hospital's normal business practice, to those days of hospital care not authorized under the Program.(d) After payment has been made for days of hospital care not authorized under the Program, any balance of hospitalization insurance or family resources shall be applied to days of authorized hospital care in accordance with 111-3-12-.05(4)(b).Ga. Comp. R. & Regs. R. 111-3-12-.05
Ga. L. 1933, p. 7.; O.C.G.A. § 31-8-1et seq.
Original Rule entitled "Criteria for Determining Indigency" adopted. F. Oct. 9, 2020; eff. Oct. 29, 2020.