§124.507. Written determinations of eligibility.
42 C.F.R. § 124.507
Determinations of eligibility must be in writing, be made in accordance with this section, and a copy of the determination must be provided to the applicant promptly.
Content of determinations—
Favorable determinations. A determination that an applicant is eligible must indicate:
That the facility will provide uncompensated services at no charge or at a specified charge less than the allowable credit for the services;
The date on which services were requested;
The date on which the determination was made;
The applicant's individual or family income, as applicable, and family size; and
The date on which services were or will be first provided to the applicant.
Conditional determinations.
As a condition to providing uncompensated services, a facility may—
Require the applicant to furnish any information that is reasonably necessary to substantiate eligibility; and
Require the applicant to apply for any benefits under third party insurer or governmental programs to which he/she is or could be entitled upon proper application.
A conditional determination must—
Comply with paragraph (b)(1) of this section; and
State the condition(s) under which the applicant will be found eligible.
When a facility determines that the condition(s) upon which a conditional determination was made has been met, or will not be met, it shall make a favorable determination or denial on the request, as appropriate, in accordance with this section.
Denials. A facility must provide to each applicant denied the uncompensated services requested, in whole or in part, a dated statement of the reasons for the denial.
Timing of determinations—
Preservice determinations.
Facilities other than nursing homes shall make a determination of eligibility within two working days following a request for uncompensated services which is made before receipt of outpatient services or before discharge for inpatient services;
Nursing homes shall make a determination of eligibility within ten working days, but no later than two working days following the date of admission, following a request for uncompensated services made prior to admission.
Postservice determinations. All facilities shall make a determination of eligibility not later than the end of the first full billing cycle following a request for uncompensated services which is made after receipt of outpatient services, discharge for inpatient services, or admission for nursing home services.
Notes, amendments, and revision history
Amendments
[52 FR 46031, Dec. 3, 1987; 52 FR 48362, Dec. 21, 1987]
Authority
Authority: 42 U.S.C. 216; 42 U.S.C. 300s(3).
Source
Source: 52 FR 46031, Dec. 3, 1987, unless otherwise noted.
Authority
Authority: Secs. 215, 1602, 1625, Public Health Service Act (42 U.S.C. 216, 300o-1, 300r), unless otherwise noted.
Source
Source: 42 FR 62270, Dec. 9, 1977, unless otherwise noted.
Amendments
[52 FR 46031, Dec. 3, 1987; 52 FR 48362, Dec. 21, 1987]