Rule 111-3-12-.06 - Criteria for Hospitalization(1) Certification of Hospital Care: (a) This Program shall provide essential hospitalization for the acutely ill or injured who are eligible otherwise under Program requirements and who are certified by the county of residency.(b) Each Participating County has the option of including or excluding normal obstetrics as eligible under the Program.(c) A standard application form shall be required for all patients who receive services under the Program.(d) All applications for hospitalization under the Program must be initiated by a physician.(e) Hospitalization under the Program for any one patient shall not exceed thirty days in any twelve-month period.(f) The applicant's attending physician, in recommending hospitalization shall certify the following: 1. That the applicant is acutely ill or injured;2. That in his professional judgment intensive care normally provided by a hospital is required;3. That there is likelihood of substantial benefit from hospitalization;4. That he has reason to believe that the applicant is indigent;5. That he has reason to believe the applicant is NOT eligible for care under any other program.(g) The applicant's attending physician in recommending hospitalization shall indicate, to the best of his judgment, the number of days of hospitalization required and the hospital providing the type of care needed by the applicant.(h) The County Board of Health, or its authorized agent, shall make the final decision on the following matters: 1. Selection of the Hospital to be used by the applicant.2. The number of hospitalization days which will be authorized.(i) The County Board of Health, or its authorized agent, shall promptly notify the Georgia Department of Community Health regarding all hospital care authorized under the Program.(2) Relationship with Other Medical Care Programs: (a) The Program shall not be construed as replacing existing Federal, State or local hospital and medical care programs for the indigent but may supplement such programs.(b) The Program may supplement other Federal or State programs in the following manner: 1. On proper local certification, a person who is acutely ill or injured may receive hospital care under the Program even though the person is currently eligible for or receiving care under another program for a different type of disability or illness.2. After exhausting eligibility under another program and on proper local certification, a person who is acutely ill or injured may receive hospital care under the Program for an acute illness or injury normally cared for under the program of prior sponsorship.3. On proper local certification, persons with diagnosed tuberculosis, who because of the critical degree of their condition cannot be safely transported to Battey State Hospital may be temporarily hospitalized under provisions of the Program.(c) When a person receives hospitalization under both this Program and another program, the authorization under this Program shall be prepared in such a manner as to avoid an overlapping payment for hospital care received.(3) Out-of-County Hospital Care: (a) There shall be free movement of patients and funds between counties so that the location of hospital care may become a medical determination and that payment for such hospital care may become void of artificial barriers.(b) Out-of-county hospital care may be a medical referral in which the patient goes from the county of residence to an out-of-county hospital after it is determined that care is needed. In this instance, the county of residency shall determine both the need for hospitalization and whether the person is eligible as indigent or as medically indigent.(c) Out-of-county hospital care may be an emergency wherein neither the patient nor his physician would have advanced plans regarding hospitalization. In this instance, the medical staff of the hospital shall determine the need for hospitalization relating to the emergency condition, and the county of residency shall determine whether the person is eligible as indigent or medically indigent.(d) In emergency cases, the hospital and the attending physician shall complete the appropriate parts of the application form, and such application shall be received by the patient's county of residency within five days after admission of the patient. In such instances, the hospital shall indicate its approved per diem rate when transmitting the application.(e) In the event there is an absence of negotiations between the parties concerned regarding the financial aspect of out-of-county hospital care, the Georgia Department of Community Health may earmark and reserve that sum of State funds which it deems advisable for the purpose of payment for out-of-county hospital care.Ga. Comp. R. & Regs. R. 111-3-12-.06
Ga. L. 1933, p. 7; O.C.G.A. § 31-8-1et seq.
Original Rule entitled "Criteria for Hospitalization" adopted. F. Oct. 9, 2020; eff. Oct. 29, 2020.