Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-3 - MEDICAL ASSISTANCE › Subject 111-3-6 - INDIGENT CARE TRUST FUND › Rule 111-3-6-.03 - Use of Funds

Current through Rules and Regulations filed through June 27, 2024
(1) Funds appropriated by the General
				Assembly to the Department pursuant to O.C.G.A. §
									31-8-156 shall be used for the
				purposes stated in Rule
				111-3-6-.02(5) and
				shall be used to match federal funds which are available for such
				purposes.
(2) The Department shall
				provide for public notice of the manner of disbursement of the Trust Fund
				appropriation as provided in Rule
				350-1-.02(3) and
				350-2-.08. Such funds may be
				transferred to disproportionate share hospitals by electronic funds
				transfer.
(3) The Department shall
				issue a manual of policies and procedures and other instructions for
				disproportionate share hospital programs (the "Manual"), and shall adopt the
				Manual as an appendix to Part II of the Department's Policies and Procedures
				for Hospital Services. The Manual shall contain policies, procedures,
				instructions, public notification plan requirements, forms and other items for
				hospitals' use in operating their programs consistent with these Rules. The
				Manual shall contain a procedure for accepting and resolving complaints
				concerning a hospital's compliance with these Rules. The Department may approve
				a plan for the operation of a disproportionate share hospital to coordinate its
				program with an existing program of care for the medically indigent sponsored
				by a local government, provided that the program is operated in a manner
				consistent with these Rules and further provided that the program is operated
				in a manner consistent with these Rules and further provided that no patients
				are rendered ineligible for services without charge or at a reduced charge who
				would have been eligible if the variance had not been granted.
(4) As a condition of receipt of such funds,
				providers of medical assistance must:
(a)
				continue participation in the Medicare program;
(b) comply with the Rules and the
				Department's Policies and Procedures, including specifically Part II of the
				Department's Policies and Procedures for Hospital Services and the
				Manual;
(c) comply with the
				Department's requests for reports on the use of funds;
(d) use the funds to provide health care
				services to Medicaid recipients and medically indigent citizens of the
				state;
(e) use the funds during the
				fiscal year in which the payment is disbursed; and
(f) if the provider is a disproportionate
				share hospital, meet the following additional conditions:
1. continue participation in the Medicare
				program;
2. make available its
				services to Medicaid and Medicare recipients without discrimination;
3. continue to provide obstetrical care
				services if such services are presently provided;
4. comply with the patient transfer
				requirements provided in the Emergency Medical Treatment and Active Labor Act
				of 1986, as amended;
5. ensure that
				patients are not transferred or denied services based solely or in significant
				part on economic reasons;
6. make
				arrangements with sufficient numbers of physicians on each service to assure
				that Medicaid patients have full access to the facility's services without
				being required to pay physicians for Medicaid covered services;
7. make arrangements with physicians to
				ensure Medicaid and medically indigent patients are not required to have a
				physician with staff privileges as a condition of admission or treatment when
				such admission or treatment is determined to be medically necessary and within
				the scope of service capability of the hospital;
8. document which physicians with staff
				privileges accept and will treat Medicaid patients in their offices, and assist
				Medicaid patients with referrals to such physicians. The hospital shall
				encourage full provider participation in the Medicaid program;
9. ensure that preadmission deposits are not
				required on demand as a condition of treatment of Medicaid eligible persons or
				medically indigent persons;
10. for
				treatment of medically indigent patients, ensure that ability to pay does not
				act to deny or substantially delay receipt of medically necessary services. The
				hospital shall provide assistance to medically indigent patients by operating a
				program under which such patients may receive care without charge or at a
				reduced charge, except that no hospital shall be required to provide services
				without charge or at a reduced charge once the hospital's medical indigency
				services expenditures equals the amount described in Rule
				111-3-6-.03(4)(e)12.
				(iii). Consistent with the Rules and the
				Manual, the hospital shall:
(i) provide
				services for no charge to persons with incomes below 125 percent of the federal
				poverty level; and
(ii) provide
				services for no charge or adopt a sliding fee scale for persons with incomes
				between 125 percent and, at a minimum, 200 percent of the federal poverty
				level;
11. as more
				specifically set forth in the Manual, effectively advise the public of the
				hospital's participation in the program, the availability of services provided,
				the terms of eligibility for free and reduced charge services, the application
				process for free and reduced charge services, and the person or office to whom
				complaints or questions about the hospital's participation in or operation of
				the program may be directed; The hospital shall comply with such other
				provisions as may be reasonably established by the Department in the Manual.
				Upon request by the Department, the hospital shall demonstrate its compliance
				with the public notification requirements of this section and with the
				Manual.
12. submit to the
				Department a report on the use of Trust Fund payment adjustments each calendar
				year. Such reports shall:
(i) be in a format
				established by the Department;
(ii)
				be available to the public for examination; and
(iii) include a report of the number of
				medically indigent persons served without charge in both inpatient and primary
				care settings and the dollars expended for such services. Hospitals shall
				report dollars expended using a cost-to-charges ratio of 65 percent. Over a
				twelve month period, each hospital will be expected to report a medical
				indigency services expenditure of an amount equal to no less than 100 percent
				of the hospital's total Trust Fund payment adjustments minus the amount
				transferred or deposited to the Trust Fund by or on behalf of the hospital.
				Failure to provide such reports in the format prescribed and within the time
				periods established by the Department, or to demonstrate timely accessibility
				to Trust Fund supported services, may result in a withholding or recoupment of
				Trust Fund payment adjustments.
13. sign a letter of Agreement which
				incorporates the provisions of these Rules, the Department's Policies and
				Procedures and the Manual.
14.
				comply with the requirements of the Certificate of Need program under the
				Division of Health Planning of the Department, as set forth more specifically
				in O.C.G.A. §§
											31-6-40
et seq.
,
				and the rules promulgated thereunder, and the annual reporting requirements
				under O.C.G.A. §
											31-6-70.