South Carolina Code 44-6-150. Medically Indigent Assistance Program; reporting of charges for sponsored patients; duties of commission; duty to provide unreimbursed medical care to indigent persons
(1) admit a patient sponsored by the program; and
Terms Used In South Carolina Code 44-6-150
- Department: means the State Department of Health and Human Services. See South Carolina Code 44-6-5
- General hospital: means any hospital licensed as a general hospital by the Department of Health and Environmental Control. See South Carolina Code 44-6-5
- Medically indigent: means :
(a) all persons whose gross family income and size falls at or below the federal Community Service Administration guidelines and who meet certain qualifying criteria regarding real property allowance, qualifying services, residency requirements, and other sponsorship, and migrant or seasonal farm workers who have no established domicile in any state; and
(b) all persons whose gross family income and size falls between one hundred percent and two hundred percent of the Community Service Administration guidelines who meet certain other qualifying criteria regarding real property allowance, qualifying services, residency requirements, and other sponsorship and whose medical bill is sufficiently large in relation to their income and resources to preclude full payment. See South Carolina Code 44-6-5 - Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
- Office: means the Revenue and Fiscal Affairs Office. See South Carolina Code 44-6-5
(2) accept the transfer of a patient sponsored by the program from a hospital which is not equipped to provide the necessary treatment.
In addition to or in lieu of an action taken affecting the license of the hospital, when it is established that an officer, employee, or member of the hospital medical staff has violated this section, the South Carolina Department of Health and Environmental Control shall require the hospital to pay a civil penalty of up to ten thousand dollars.
(B) Hospital charges for patients sponsored by the Medically Indigent Assistance Program must be reported to the Revenue and Fiscal Affairs Office pursuant to § 44-6-170.
(C) In administering the Medically Indigent Assistance Program, the department shall determine:
(1) the method of administration including the specific procedures and materials to be used statewide in determining eligibility for the program;
(a) In a nonemergency, the patient shall submit the necessary documentation to the patient’s county of residence or its designee to determine eligibility before admission to the hospital.
(b) In an emergency, the hospital shall admit the patient pursuant to § 44-7-260. If a hospital holds the patient financially responsible for all or a portion of the inpatient hospital bill, and if the hospital determines that the patient could be eligible for the program, it shall forward the necessary documentation along with the patient’s bill and other supporting information to the patient’s county of residence or its designee for processing. A county may request that all hospital bills incurred by its residents sponsored by the program be submitted to the county or its designee for review.
(2) the population to be served, including eligibility criteria based on family income and resources. Eligibility is determined on an episodic basis for a given spell of illness. Eligibility criteria must be uniform statewide and may include only those persons who meet the program’s definition of medically indigent;
(3) the health care services covered;
(4) a process by which an eligibility determination can be contested and appealed; and
(5) the program may not sponsor a patient until all other means of paying for or providing services have been exhausted. This includes Medicaid, Medicare, health insurance, employee benefit plans, or other persons or agencies required by law to provide medical care for the person. Hospitals may require eligible patients whose gross family income is between one hundred percent and two hundred percent of the federal poverty guidelines, to make a copayment based on a sliding payment scale developed by the department based on income and family size.
(D) Nothing in this section may be construed as relieving hospitals of their Hill-Burton obligation to provide unreimbursed medical care to indigent persons.