D.C. Mun. Regs. tit. 22, r. 22-B4408

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 22-B4408 - WRITTEN DETERMINATION OF ELIGIBILITY FOR UNCOMPENSATED CARE

4408.1

Each CON holder shall give written notice of its determination of eligibility for uncompensated care in response to each request for uncompensated care to the person requesting care. The CON holder shall give notice in person at the time uncompensated care is requested or by regular mail to the address the person requesting services provided. If the person requesting care has not provided an address and is not available to receive notice in person, the CON holder may post at the facility, in a conspicuous place such as the admissions office or the emergency services department, a notice that the person's eligibility status is available in the administrative office within that facility.

4408.2

Each CON holder shall communicate the contents of the written determination to any person requesting uncompensated care that the CON holder has reason to believe cannot read the determination.

4408.3

Each determination of eligibility for uncompensated care shall include the following statements:

(a) That the CON holder will, will with conditions, or will not provide uncompensated care;

(b) That there will be no charge for uncompensated care;

(c) The date on which the person requested care;

(d) The date on which the CON holder made the determination;

(e) The annual individual or family income, as applicable, and family size of the person who requested uncompensated care;

(f) The date on which services were, or will be, provided; and

(g) The reason for denial, if applicable.

4408.4

As a condition of providing uncompensated care, a CON holder may:

(a) Require the person requesting uncompensated care to furnish any information that is reasonably necessary to substantiate eligibility; and

(b) Require each person requesting uncompensated care to apply for any benefits under third party insurer or governmental programs to which the person requesting uncompensated care is, or could be, entitled upon application.

4408.5

A conditional eligibility determination shall state the conditions that the person requesting uncompensated care must satisfy to be eligible.

4408.6

CON holders shall make eligibility determinations as follows:

(a) Each hospital shall make an eligibility determination for uncompensated care within five (5) business days of a request for an outpatient service or before discharge for an inpatient service;

(b) Each ambulatory surgical facility shall make an eligibility determination for uncompensated care within five (5) business days of a request for an outpatient service; and

(c) Any other CON holder shall make a determination of eligibility for uncompensated care within ten (10) business days following the date of admission or delivery of services.

D.C. Mun. Regs. tit. 22, r. 22-B4408

Final Rulemaking published at 36 DCR 5819 (August 11, 1989); as amended by Final Rulemaking published at 52 DCR 8258 (September 2, 2005); as amended by Final Rulemaking published at 53 DCR 4808 (June 16, 2006)

Authority: This chapter was originally enacted under the authority of the District of Columbia Certificate of Need Act of 1980, effective September 16, 1980 (D.C. Law 3-99; D.C. Official Code, §§ 44-1801 to 44-1817 (2001 ed.)), and amended by the District of Columbia Certificate of Need Act of 1980 Amendment Act of 1987, effective March 16, 1988 (D.C. Law 7-90; 35 DCR 710 (February 5, 1988)). Subsequent to the enactment of this chapter, the District of Columbia Certificate of Need Act of 1980 was repealed by § 22 of the Health Services Planning Program Act of 1992, effective March 16, 1993 (D.C. Law 9-197; 39 DCR 9195 (December 11, 1992)). Later authority for the regulation of Certificates of Need was found at D.C. Official Code §§ 44-401 to 44-421 (2001 ed.); Mayor's Reorganization Plan No. 3 of 1986; and Mayor's Order 95-162, dated December 4, 1995.