providers in the past twelve( 12) months exceeds 25 % of the patient’ s family income. Guarantors who are above 400 % FPL but have large medical bills due to catastrophic illness, may be considered for the FAP. Income will be determined using the same criteria as non-catastrophic FAP. To calculate the adjustment for qualifying cases, 25 % of the income will be subtracted from the total open medical expenses and the remaining balance will be adjusted. The 25 % can be paid on a payment plan if needed. iii. In rare cases where the patient is unable to comply with the eligibility requirements, the hospital CFO will have the authority to review special circumstances and make determinations on eligibility.
5. Presumptive Eligibility( no application is required): Guarantors may be deemed indigent under the following circumstances, and a FAP application is not needed for FAP approval. a. Patients covered by Out-of-State Medicaid where the hospital is not an authorized provider and where the out of state Medicaid enrollment or reimbursement makes it prohibitive for the hospital to become a provider( Medicaid coverage verification required) i. The hospital may submit verification of Medicaid coverage as proof of qualification. b. Medicaid patients whose services deny or exhaust their benefits c. Deceased guarantors with no known estate d. Guarantors who are determined to be homeless, identified by 2 sources( qualified generic or shelter address, medical record diagnosis, clinical provider notation, public records, credit bureau records, patient attestation and other related sources) or with the approval of or acknowledgement from a homeless shelter. i. Accounts occurring in the 3 months preceding and following a service that has been qualified as homeless will also be considered homeless and eligible for adjustment( under adjustment code 5045). ii. State and local data sources representing indigence or credit evaluation tools may be used as sources to approve a guarantor for FAP. iii. In no case will these sources be solely used to disqualify an applicant. e. Guarantors eligible for assistance programs( i. e., food stamps, welfare, etc.), or who are deemed medically indigent may not be required to complete a FAP application to be considered for the program. i. State and local data sources representing indigence or credit evaluation tools may be used as sources to approve a guarantor for FAP. ii. In no case will these sources be solely used to disqualify an applicant. However, if a patient is non-cooperative for government assistance, the patient may be denied Financial Assistance as well. f. Medicare patients covered by the Qualified Medicare Beneficiary( QMB) program or the Specified Low-Income Medicare Beneficiary( SLMB) program. g. Undocumented: Indigent guarantors residing in the United States without legal immigration status. Approval for emergency Medicaid or an attestation from a charitable organization may be used as proof of indigency. Other forms of indigency may be approved by the Director or Vice President. h. Total or partial disability per Social Security, VA or other government agency documentation
6. Determination