(1) Except as provided for in section 31-3503E, Idaho Code, an applicant or third party applicant requesting assistance under this chapter shall complete a written application. The truth of the matters contained in the completed application shall be sworn to by the applicant or third party applicant. The completed application shall be deemed consent for the providers, the hospital, the department, respective counties and board to exchange information pertaining to the applicant’s health and finances for the purposes of determining medicaid eligibility or medical indigency. The completed application shall be signed by the applicant or third party applicant, an authorized representative of the applicant, or, if the applicant is incompetent or incapacitated, someone acting responsibly for the applicant and filed in the clerk’s office. If the clerk determines that the patient may be eligible for medicaid, within one (1) business day of the filing of the completed application in the clerk’s office, the clerk shall transmit a copy of the application and a written request for medicaid eligibility determination to the department.
(a) If, based on its medicaid eligibility review, the department determines that the patient is eligible for medicaid, the department shall act on the application as an application for medicaid.
(b) If, based on its medicaid eligibility review, the department determines that the patient is not eligible for medicaid, the department shall notify the clerk of the denial and the reason therefor, in accordance with section 31-3503E, Idaho Code. Denial of medicaid eligibility is not a determination of medical indigence.
(2) If a third party completed application is filed, the application shall be presented in the same form and manner as set forth in subsection (1) of this section.
Terms Used In Idaho Code 31-3504
- Applicant: means any person who is requesting financial assistance under this chapter. See Idaho Code 31-3502
- Application: means the combined application for state and county medical assistance pursuant to sections 31-3504 and 31-3503E, Idaho Code. See Idaho Code 31-3502
- Board: means the board of the catastrophic health care cost program, as established in section 31-3517, Idaho Code. See Idaho Code 31-3502
- Clerk: means the clerk of the respective counties or his or her designee. See Idaho Code 31-3502
- Completed application: shall include at a minimum the cover sheet requesting services, applicant information including diagnosis and requests for services and signatures, personal and financial information of the applicant and obligated person or persons, patient rights and responsibilities, releases and all other signatures required in the application. See Idaho Code 31-3502
- County commissioners: means the board of county commissioners in their respective counties. See Idaho Code 31-3502
- Department: means the department of health and welfare. See Idaho Code 31-3502
- Hospital: means a facility licensed and regulated pursuant to sections 39-1301 through 39-1314, Idaho Code, or an out-of-state hospital providing necessary medical services for residents of Idaho, wherein a reciprocal agreement exists, in accordance with section 31-3503B, Idaho Code, excluding state institutions. See Idaho Code 31-3502
- Lien: A claim against real or personal property in satisfaction of a debt.
- Medicaid eligibility review: means the process used by the department to determine whether a person meets the criteria for medicaid coverage. See Idaho Code 31-3502
- Necessary medical services: means health care services and supplies that:
Idaho Code 31-3502
Obligated person: means the person or persons who are legally responsible for an applicant including, but not limited to, parents of minors or dependents. See Idaho Code 31-3502 person: includes a corporation as well as a natural person;
Idaho Code 73-114
Personal property: includes money, goods, chattels, things in action, evidences of debt and general intangibles as defined in the uniform commercial code — secured transactions. See Idaho Code 73-114 Property: includes both real and personal property. See Idaho Code 73-114 Provider: means any person, firm or corporation certified or licensed by the state of Idaho or holding an equivalent license or certification in another state, that provides necessary medical services to a patient requesting a medically indigent status determination or filing an application for financial assistance. See Idaho Code 31-3502 Real property: Land, and all immovable fixtures erected on, growing on, or affixed to the land. Resources: means all property, for which an applicant and/or an obligated person may be eligible or in which he or she may have an interest, whether tangible or intangible, real or personal, liquid or nonliquid, or pending, including, but not limited to, all forms of public assistance, crime victims compensation, worker’s compensation, veterans benefits, medicaid, medicare, supplemental security income (SSI), third party insurance, other insurance or apply for section 1011 of the medicare modernization act of 2003, if applicable, and any other property from any source. See Idaho Code 31-3502 State: when applied to the different parts of the United States, includes the District of Columbia and the territories; and the words "United States" may include the District of Columbia and territories. See Idaho Code 73-114 Third party applicant: means a person other than an obligated person who completes, signs and files an application on behalf of a patient. See Idaho Code 31-3502
(3) Follow-up necessary medical services based on a treatment plan, for the same condition, preapproved by the county commissioners, may be provided for a maximum of six (6) months from the date of the original application without requiring an additional application; however, a request for additional treatment not specified in the approved treatment plan shall be filed with the clerk ten (10) days prior to receiving services. Beyond the six (6) months, requests for additional treatment related to an original diagnosis in accordance with a preapproved treatment plan shall be filed ten (10) days prior to receiving services and an updated application may be requested by the county commissioners.
(4) Upon application for financial assistance pursuant to this chapter an automatic lien shall attach to all real and personal property of the applicant and on insurance benefits to which the applicant may become entitled. The lien shall also attach to any additional resources to which it may legally attach not covered in this section. The lien created by this section may be, in the discretion of the county commissioners and the board, perfected as to real property and fixtures by recording a document entitled: notice of lien and application for financial assistance, in any county recorder’s office in this state in which the applicant and obligated person own property. The notice of lien and application for financial assistance shall be recorded as provided herein within thirty (30) days from receipt of an application, and such lien, if so recorded, shall have a priority date as of the date the necessary medical services were provided. The lien created by this section may also be, in the discretion of the county commissioners and the board, perfected as to personal property by filing with the secretary of state within thirty (30) days of receipt of an application, a notice of application in substantially the same manner as a filing under chapter 9, title 28, Idaho Code, except that such notice need not be signed and no fee shall be required, and, if so filed, such lien shall have the priority date as of the date the necessary medical services were provided. An application for assistance pursuant to this chapter shall waive any confidentiality granted by state law to the extent necessary to carry out the intent of this section.
(5) In accordance with rules and procedures promulgated by the department or the board, each hospital and provider seeking reimbursement under this chapter shall submit all medical records and medical claims relevant to necessary medical services provided for an applicant in a standard or uniform format to the county clerk of the obligated county within ten (10) days after receiving a request from the county clerk; provided that, within the ten (10) day period if a provider presents a written request for suspension of the investigation, the investigation of the application shall be suspended for up to thirty (30) days. Upon receipt of the requested documentation, the investigation shall resume. A copy of the results of the reviewed medical records and medical claims shall be transmitted by the department’s or the board’s contractor to the clerk of the obligated county. Failure to provide the medical records and medical claims within the initial ten (10) day period and the suspension period, if any, shall result in denial of the application.