28-13-27. Hospitalization of poor persons--Definition of terms.
Terms used in this chapter mean:
(1)"Actual cost of hospitalization," the actual cost to a hospital of providing hospital services to a medically indigent person, determined by applying the ratios of costs to charges appearing on the statement of costs required in §28-13-28 to charges at the hospital in effect at the time the hospital services are provided;
(2)"Emergency hospital services," treatment in the most appropriate hospital available to meet the emergency need. The physician, physician assistant, or certified nurse practitioner on duty or on call at the hospital must determine whether the individual requires emergency hospital care. The need for emergency hospital care is established if the absence of emergency care is expected to result in death, additional serious jeopardy to the individual's health, serious impairment to the individual's bodily functions, or serious dysfunction of any bodily organ or part. The term does not include care for which treatment is available and routinely provided in a clinic or physician's office;
(3)"Hospital," any hospital licensed as such by the state in which it is located;
(4)"Household," the patient, minor children of the patient living with the patient, and anyone else living with the patient to whom the patient has the legal right to look for support;
(5)"Nonemergency care," hospitalization which is medically necessary and recommended by a physician licensed under chapter 36-4 but does not require immediate care or attention;
(6)"Indigent by design," an individual who meets any one of the following criteria:
(a)Is able to work but has chosen not to work;
(b)Is a student at a postsecondary institution who has chosen not to purchase health insurance;
(c)Has failed to purchase or elect major medical health insurance or health benefits made available through an employer-based health benefit plan although the person was financially able, pursuant to §28-13-32.11, to purchase or elect the insurance or health benefits;
(d)Has failed to purchase available major medical health insurance although the individual was insurable and was financially able, pursuant to §28-13-32.11, to purchase the insurance. For purposes of this subdivision, an individual is presumed insurable unless the individual can produce sufficient evidence to show that the individual was declined major medical insurance by an insurance company and the individual did not qualify for any guarantees of major medical insurance available through any legal or contractual right that was not exercised; or
(e)Has transferred resources for purposes of establishing eligibility for medical assistance available under the provisions of this chapter. The lookback period for making this determination includes the thirty-six month period immediately prior to the onset of the individual's illness and continues through the period of time for which the individual is requesting services.
Source: SL 1953, ch 131, §1; SDC Supp 1960, §27.12B01; SL 1980, ch 202, §4; SL 1984, ch 203, §3; SL 1988, ch 225, §1; SL 1991, ch 227, §1; SL 1997, ch 170, §3; SL 2000, ch 134, §1; SL 2017, ch 171, §50.