Compilation of Rules and Regulations of the State of Georgia › Department 290 - RULES OF DEPARTMENT OF HUMAN SERVICES › Chapter 290-2 - FAMILY AND CHILDREN SERVICES › Subject 290-2-26 - EMERGENCY MEDICAL SERVICES TO PREGNANT WOMEN › Rule 290-2-26-.07 - Eligibility Criteria and Determination

Current through Rules and
				Regulations filed through June 27, 2024
(1) When a woman receives services from a
				hospital, hospitals, or physicians under the provisions of the law, and claims
				indigency, the Chief Administrative Officer of the hospital shall determine
				whether any portion of the cost of services may be paid by the medical
				assistance program for the needy, or by insurance, or by any other governmental
				or public agency with a federal, state, or local program, and provide written
				notification of determination to the Health Care Advisory Officer of the
				woman's county of residence. Such notification shall include a certification by
				the Chief Administrative Officer on the Certification and Acknowledgment Form
				that an appropriate investigation has been made and the results of such
				determination, the amount to be paid if the determination shows that a portion
				of the cost of services is available from such sources as identified above, and
				a request for a determination of indigency on the woman. Such request shall be
				made on a form entitled "Request for a Determination of Indigency". If the
				woman receives services in more than one hospital because of transfer, each
				hospital must submit a request in order to seek reimbursement under this
				program.
(2) The Health Care
				Advisory Officer of the woman's county of residence shall complete a
				determination of indigency in accordance with these rules and regulations and
				notify the hospital, the governing authority of the patient's county of
				residence, and the patient of the results of the determination not later than
				60 days after receipt of the request. Notifications shall be made on a standard
				form designated by the Department. If the Health Care Advisory Officer fails to
				respond to a request for determination within the 60 day time limitation, the
				county of residence of the patient is liable for the payment of cost of care of
				the woman. The Health Care Advisory Officer shall establish and maintain files
				showing names of county residents who the Officer has determined to be
				indigent. These records are required to the end that certification of indigency
				may be expedited. The Health Care Advisory Officer should develop standards to
				protect the confidentiality of these records consistent with the "Open Records
				Act", O.C.G.A. §
				50-18-70,
et seq.
The fact that the patient has obtained prenatal care or any treatment
				whatsoever relating to the pregnancy will not, in and of itself, preclude such
				patient from utilizing the benefits of this program, nor will such prenatal
				care or any treatment whatsoever relating to the pregnancy preclude the
				delivery from being characterized as an emergency.
(3) Eligibility is based on family income and
				family size. The gross family income is used to determine eligibility and in
				order to be considered indigent, the family income must be less than 125% of
				the federal poverty level. Only the income of the patient and legally liable
				adult family members is considered in making the eligibility
				determination.
(4) The Request for
				Determination of Indigency Form (Sections A and B) and the Certification and
				Acknowledgment Form are completed before a patient is discharged from the
				hospital, and are forwarded by the Hospital Administrative Officer to the
				Health Care Advisory Office of the patient's county of residence. The Health
				Care Advisory Officer completes a determination of indigency on the patient,
				and returns the Request for Determination of Indigency to the Hospital
				Administrative Officer within 60 days of the date received. The Health Care
				Advisory Officer also notifies the patient of the outcome of the determination.
				The county governing authority is notified of only those persons determined to
				be indigent.
(5) In order to do an
				eligibility determination, the Health Care Advisory Officer must have contact
				with the patient and complete an Indigency Worksheet. The completed worksheet
				provides the total family income and family size which are basic to using the
				Eligibility Determination Scale. The scale is designed to simplify the process
				of determining whether a patient's family income is less than 125% of the
				federal poverty level. Individuals whose income is less than 125% of the
				federal poverty level are eligible for this program. A copy of the Eligibility
				Determination Scale is attached here to and reflected as "Annex A".
(6) In addition to establishing the
				eligibility of a pregnant woman for the Emergency Medical Services Program, it
				is the responsibility of the Health Care Advisory Officer to determine the
				amount of repayment to the county for which the patient, and each other legally
				responsible person, is liable. This amount can range from a minimum of $100 to
				a maximum of 65% of the actual cost.
O.C.G.A. §
				  31-8-43.