---
kind: "section"
citation: "42 C.F.R. § 124.507"
title: "42"
number: "124.507"
heading: "Written determinations of eligibility."
url: "https://uscodex.org/cfr/42/124.507"
---

# §124.507. Written determinations of eligibility.

- (a) 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.
- (b) **Content of determinations—**
  - (1) **Favorable determinations.** A determination that an applicant is eligible must indicate:
    - (i) That the facility will provide uncompensated services at no charge or at a specified charge less than the allowable credit for the services;
    - (ii) The date on which services were requested;
    - (iii) The date on which the determination was made;
    - (iv) The applicant's individual or family income, as applicable, and family size; and
    - (v) The date on which services were or will be first provided to the applicant.
  - (2) **Conditional determinations.**
    - (i) **As a condition to providing uncompensated services, a facility may—**
      - (A) Require the applicant to furnish any information that is reasonably necessary to substantiate eligibility; and
      - (B) 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.
    - (ii) **A conditional determination must—**
      - (A) Comply with [paragraph (b)(1)](#b-1) of this section; and
      - (B) State the condition(s) under which the applicant will be found eligible.
    - (iii) 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.
  - (3) **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.
- (c) **Timing of determinations—**
  - (1) **Preservice determinations.**
    - (i) 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;
    - (ii) 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.
  - (2) **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

[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]