S.C. Code Regs. § § 126-500

Current through Register Vol. 48, No. 11, November 22, 2024

Section 126-500 - Definitions

A. "Department" means the South Carolina Department of Health and Human Services.

B. "County resident" means an individual who is a state resident and who lives in a particular county. For the purpose of determining eligibility for the MIAP, an individual who does not have an established residence in a particular county is considered a resident of the county in which the admitting hospital is located. For the purpose of computing the county assessment pursuant to 44-6-146(B), Code of Laws of South Carolina (1976), as amended, an individual with no established residence shall be excluded from the computation.

C. "Designee" means the entity with which the county government has arranged to determine eligibility for the MIAP.

D. "Family" means the applicant and legally responsible relatives who live in the same household. If the applicant is legally or financially dependent upon another person, the applicant, the responsible person, and all persons related to the applicant by birth, marriage, or adoption who are also legally or financially dependent upon the responsible person and who reside in the same household as the responsible person are considered members of the same family. If the applicant is not legally or financially dependent upon another person, the applicant and all persons related to the applicant by birth, marriage, or adoption who are also legally or financially dependent upon the applicant and who reside in the same household as the applicant are considered members of the same family.

E. "General hospital" means any hospital licensed as a general hospital by the South Carolina Department of Health and Environmental Control.

F. "Gross annual income" means the total yearly income, before deductions, of the applicant and his family.

G. "Hospital bill" means the allowable payment under the Medicaid program for inpatient hospital services.

H. "Inpatient hospital services" are those items and services ordinarily furnished by a hospital for the care and treatment of in patients. Such services must be medically justified, documented by the physician's records, and comply with the requirements of the Professional Review Organization. Services covered, non-covered and restricted are defined in the MIAP Manual.

I. "Poverty guidelines" are the federal poverty income guidelines which are issued by the United States Department of Health and Human Services.

J. "State resident" means a person who is domiciled in South Carolina. A domicile once established is lost or changes only when an individual moves to a new locality with the intent to abandon his old domicile and the intent to live permanently or indefinitely in the new location. For the purposes of the MIAP, a migrant or seasonal farm worker is a resident of the State provided he has not established a domicile in another State.

K. "Third party payor" means any individual, entity, or program that is or may be liable to pay all or part of the medical cost of injury, disease, or disability of the individual. It includes Medicare, insurance, employee benefit plans, Medicaid, any other State or Federal program, or other persons or agencies required by law or a court order to provide medical care for an individual.

L. "Liquid assets" are those assets which are in cash or payable in cash on demand. Liquid assets also include financial instruments convertible into cash within twenty workdays.

M. "Financially dependent" means an individual who meets the federal criteria of "dependent" for income tax purposes.

S.C. Code Regs. § 126-500

Replaced and amended by State Register Volume 42, Issue No. 05, eff. 5/25/2018.