Title 31, Chapter 8, Section 41
( 31-8-41)
As used in this article, the term: (1) "Cost of care" means the cost of services rendered by a
hospital for care required to be provided thereby under this
article, and for services rendered by a physician in connection
therewith, at the lesser of the actual charges or the
reimbursement rate currently in effect for the hospital and
physician under the medical assistance program for the needy under
Title XIX of the Social Security Act (42 U.S.C.A. Section 1396, et
seq.), as amended, but shall not include any portion of such cost
which is paid by the indigent patient, by the spouse or a relative
of the indigent patient, by the father of the child, by insurance,
or by any governmental or other public agency pursuant to any
federal, state, or local program paying cost of health care for
indigent patients, other than the program established by this
article. The Medicaid reimbursement rate for services under this
article shall not be adjusted for outlier payment. Payments
actually received by a hospital or physician, when made by the
patient, the patient's spouse, family member, father of the
patient's child, or by insurance, the medical assistance program
for the needy, any similar federal, state, or local program, or
any other third-party payor other than a county, shall constitute
payment to the hospital or physician, respectively, of the payment
amount so received and exclude that amount from the definition of
"cost of care." When a hospital renders care to a woman who is
not a resident of the county in which that hospital is located and
that care is required to be provided under this article but there
is within the county of residence of that woman a hospital which
usually and customarily provides that care, "cost of care" means
the lesser of the actual charges for the care actually rendered or
the Medicaid reimbursement rate currently in effect for such care,
which Medicaid reimbursement rate shall be that Medicaid rate for
such care in the hospital of the woman's county of residence,
unless there is more than one such hospital, in which event the
rate shall be the average Medicaid rate for such care in all
hospitals of the woman's county of residence. (2) "Hospital" means a hospital which is permitted to operate by
the department pursuant to Article 1 of Chapter 7 of this title. (3) "Indigency" means the inability of a patient or other person to pay the entire cost of care determined in accordance with subsection (a) of Code Section 31-8-43. (4) "Patient" means a pregnant woman who receives services under
this article. (5) "Resident of the county" means a person who is domiciled in
the county as determined pursuant to Chapter 2 of Title 19. |