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126–505. Responsibilities for Eligibility Determination. A. The Department shall develop uniform criteria and materials for statewide use. A detailed description of the criteria, procedures, and materials which include an application form and letter of notification may be found in the MIAP Manual. Each county is responsible for determining eligibility in accordance with the policies and procedures in the MIAP Manual. If a county fails to meet this responsibility, claims for the county’s residents may be suspended until it is determined that the county is fulfilling its responsibility. B. The county government shall make arrangements for the determination of eligibility for the MIAP for its residents. The county shall notify the Department of who is designated to determine eligibility in the county. The Department shall provide a listing of each county’s designee to each general hospital and to the Chief Administrative Officer and Clerk to County Council in each county. If a county intends to review claims prior to the submission of such claims for payment, the county must inform the Department of its intent to review claims. C. General hospitals shall inform patients of the existence of the MIAP and shall refer the patient for an application if it is determined that the patient has no means to pay for hospital services. General hospitals shall submit claims to the Department. If a county has elected to review claims prior to submission to the Department, it must review the claims within fifteen (15) working days from the date the claim is provided by the hospital. If no response is received from the county within fifteen (15) working days, the hospital shall forward the claim to the Department. HISTORY: Amended by SCSR42–5 Doc. No. 4746, eff May 25, 2018. 126–510. Application Process. When it is determined that an individual needs hospitalization and that he may qualify for assistance through the MIAP, the procedures stated below shall be followed. A. For nonemergency admissions, the patient shall be referred to the designee in the county of residence for an eligibility determination. The designee shall notify the patient and the admitting hospital or physician of the outcome of the eligibility determination. Eligibility shall be determined prior to admission. B. For emergency admissions, the hospital shall admit the patient and obtain a signed application from the applicant, his relative or other individual authorized to act on his behalf. The hospital shall collect information pertaining to the individual’s eligibility. The hospital shall then forward the information to the designee in the individual’s county of residence for processing. The county designee shall notify the patient and the hospital of the outcome of the eligibility determination in accordance with Section H of this subpart. C. Eligibility shall be determined on an episodic basis. A new application is required for each period of hospitalization. Exception: If the patient is readmitted to the hospital within thirty (30) days of the date of discharge, he is not required to file another application; however, it must be determined that the patient’s financial circumstances have not changed. D. The application must be submitted by the patient or a responsible person acting on his behalf. If the applicant is not capable of submitting his own application and he has no one to act on his behalf, the hospital may submit the application. E. A retroactive application may be filed only if an individual failed to apply at the time of hospitalization. The individual must be able to establish that he was eligible at the time of hospitaliza- tion. All retroactive applications must be filed within one (1) year after discharge from the hospital. Retroactive sponsorship by MIAP may be made only if the program had not sponsored $15 million in unreimbursed hospital care during the year in which the hospitalization occurred. These procedures also apply if an application is made on behalf of a deceased individual. F. The applicant shall furnish required documentation to establish eligibility. The designee shall assist the applicant in obtaining needed documentation when the applicant is incapable of obtaining such documentation. G. Disposition of applications for assistance through the MIAP shall be made within fifteen (15) working days unless an eligibility determination for other benefits such as Medicaid must be made prior to certification for payment or unless more time is needed to obtain adequate documentation. If