South Carolina Code of Regulations › Chapter 126 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › Article 5 - MEDICALLY INDIGENT ASSISTANCE PROGRAM (MIAP) › Subarticle 1 - ELIGIBILITY FOR THE MEDICALLY INDIGENT ASSISTANCE PROGRAM (MIAP) › Section 126-510 - Application Process

Current through Register Vol. 48, No. 6, June 28, 2024
When it is determined that an individual needs
				  hospitalization and that he may qualify for assistance through the MIAP, the
				  procedures stated below shall be followed.
A. For nonemergency admissions, the patient
				shall be referred to the designee in the county of residence for an eligibility
				determination. The designee shall notify the patient and the admitting hospital
				or physician of the outcome of the eligibility determination. Eligibility shall
				be determined prior to admission.
B. For emergency admissions, the hospital
				shall admit the patient and obtain a signed application from the applicant, his
				relative or other individual authorized to act on his behalf. The hospital
				shall collect information pertaining to the individual's eligibility. The
				hospital shall then forward the information to the designee in the individual's
				county of residence for processing. The county designee shall notify the
				patient and the hospital of the outcome of the eligibility determination in
				accordance with Section H of this subpart.
C. Eligibility shall be determined on an
				episodic basis. A new application is required for each period of
				hospitalization. Exception: If the patient is readmitted to the hospital within
				thirty (30) days of the date of discharge, he is not required to file another
				application; however, it must be determined that the patient's financial
				circumstances have not changed.
D.
				The application must be submitted by the patient or a responsible person acting
				on his behalf. If the applicant is not capable of submitting his own
				application and he has no one to act on his behalf, the hospital may submit the
				application.
E. A retroactive
				application may be filed only if an individual failed to apply at the time of
				hospitalization. The individual must be able to establish that he was eligible
				at the time of hospitalization. All retroactive applications must be filed
				within one (1) year after discharge from the hospital. Retroactive sponsorship
				by MIAP may be made only if the program had not sponsored $15 million in
				unreimbursed hospital care during the year in which the hospitalization
				occurred. These procedures also apply if an application is made on behalf of a
				deceased individual.
F. The
				applicant shall furnish required documentation to establish eligibility. The
				designee shall assist the applicant in obtaining needed documentation when the
				applicant is incapable of obtaining such documentation.
G. Disposition of applications for assistance
				through the MIAP shall be made within fifteen (15) working days unless an
				eligibility determination for other benefits such as Medicaid must be made
				prior to certification for payment or unless more time is needed to obtain
				adequate documentation. If disposition of an application is not made within
				fifteen (15) working days, the reason for delay must be documented. This time
				frame, is separate from the fifteen (15) working days that a county is allowed
				for the review of hospital claims, if it elects to do so.
For applicants who are potentially eligible for Medicaid, the
				  MIAP application cannot be approved until the applicant has applied for and
				  been denied Medicaid benefits for a reason other than those identified in the
				  MIAP Manual. The fifteen (15) day time frame does not apply in this
				  situation.
H. The designee
				shall provide written notification to applicants and providers of the decision
				on MIAP applications.
I. If an
				applicant disagrees with the decision made on his case, he may request a
				reconsideration at the county level. This reconsideration request must be made
				within thirty (30) days of the notification of the decision. The
				reconsideration decision shall be made by an individual(s), other than the
				person who made the eligibility determination, designated by the county's chief
				administrative officer. If the applicant disagrees with the reconsideration
				decision, he may request a fair hearing from the Appeals Unit of the
				Department. This request must be made in writing within thirty (30) days of the
				reconsideration decision. The fair hearing will be conducted in accordance with
				the Department Appeals and Hearing Regulations, R.
				126-150 et
				seq.