Section 400.7033. Payment for inpatient or outpatient hospitalization of migrant families.

(1) Inpatient hospitalization or outpatient   services  for migrant families may be provided for a period of up to 30 consecutive days in any 12-month period if all of the following provisions are satisfied:

(a)     Members of the migrant family have not received migrant hospitalization services from the SER program in the 12-month period preceding the date of hospital admission.

(b)   The person applying for inpatient hospitalization or outpatient services is ineligible for medicaid, and medicaid ineligibility did not result from any of the following:

(i)   Excess income.

(ii)   The applicant’s failure to meet a   procedural   requirement   of medicaid.

(iii)   The applicant's entrance into this state for  reasons  other   than employment.

(c)   No member of the household quit or refused employment or training without good cause within the 30 days prior to application.

(2)  A migrant family is a family that meets all  of   the  following requirements:

(a)  Works primarily in agriculture or a related seasonal industry.

(b)   Moves from place to place to find work.

(c)   Lives in a temporary residence during the work season.

(d)   Has a child who is less than 21-years-old and who is living with, or has lived with, a specified relative during the last 6 months.

(e)   The household members are nonresidents of this state.

(3)      Exclusions, payment rates, and conditions of coverage for inpatient hospitalization shall be based on medicaid payment rates and covered services. Elective hospitalization is not a covered service.

(4)    Exclusions, payment rates, and conditions of coverage for outpatient services shall be based on medicaid payment rates and covered services subject to the following provisions:

(a)   Services which are a follow-up to inpatient services and which are performed within 30 days of the hospital admission will be covered.

(b)   Services which are normally performed as inpatient services, but which the attending physician and the client have decided to have performed on an outpatient basis will be covered.

History: 1993 AACS; 2015 AACS.