Charity CareCuidado Caritativo / Pago de asistencia Marcia Elstob
Southeast Colorado Hospital District (SECHD) is committed to providing charity care to persons who have healthcare needs and are uninsured, underinsured, ineligible for a government program, CICP, Medicaid, or otherwise unable to pay, for medically necessary care based on their individual financial situation. Consistent with our mission to deliver compassionate, high quality, affordable healthcare services SECHD strives to ensure that the financial capacity of people who need health care services does not prevent them from seeking or receiving care. SECHD will provide, without discrimination, care of emergency medical conditions to individuals regardless of their eligibility for financial assistance or for government assistance.
Accordingly, this written policy: Includes eligibility criteria for financial assistance -- free and discounted (partial charity) care
Describes the basis for calculating amounts charged to patients eligible for financial assistance under this policy
Describes the method by which patients may apply for financial assistance
Limits the amounts that the hospital will charge for emergency or other medically necessary care provided to individuals eligible
for financial assistance to amount generally billed (received by) the hospital for commercially insured or Medicare patients
Charity is not considered to be a substitute for personal responsibility. Patients are expected to cooperate with SECHD's procedures for obtaining other forms of payment or financial assistance, and to contribute to the cost of their care based on their individual ability to pay.
In order to manage its resources responsibility and to allow SECHD to provide the appropriate level of assistance to the greatest number of persons in need, the following guidelines for the provision of patient charity have been established.
II. DefinitionsFor the purpose of this policy, the terms below are defined as follows:
Charity Care: Healthcare services that have been or will be provided but are never expected to result in cash inflows. Charity care results from a provider's policy to provide healthcare services free or at a discount to individuals who meet the established criteria.
Family: Using the Colorado Indigent Care Program Definition and guidelines, if the patient claims someone as a dependent, they may be considered a dependent for purposes of the provision of financial assistance.
Family Income: Family Income is determined using the Colorado Indigent Care Program Definition and Guidelines.
Uninsured: The patient has no level of insurance or third party assistance to assist with meeting his/her payment obligations.
Underinsured: The patient has some level of insurance or third-party assistance but still has out-of-pocket expenses that exceed his/her financial abilities.
Gross Charges: The total charges of SECHD's full established rates for the provision of patient care services before deductions from revenue are applied.
Emergency Medical Conditions: Defined within the meaning of section 1867 of the Social Security Act (42 U.S.C. 1395dd).
Medically necessary: As defined by Medicare (services or items reasonable and necessary for the diagnosis or treatment of illness or injury).
III. ProceduresA. Services Eligible Under this Policy. For purposes of this policy, "charity" or "financial assistance" refers to healthcare services provided by SECHD without charge or at a discount to qualifying patients. The following healthcare services are eligible for charity:
Non-elective services provided in response to life-threatening circumstances in a non-emergency room setting; and
Medically necessary services, evaluated on a case-by-case basis at SECHD's discretion.
B. Eligibility for Charity. Eligibility for charity will be considered for those individuals who are uninsured, underinsured, ineligible for any government health care benefit program, and who are unable to pay for their care, based upon a determination of financial need in accordance with this Policy. The granting of charity shall be based on an individualized determination of financial need, and shall not take into account age, gender, race, social or immigrant status, sexual orientation or religious affiliation. Southeast Colorado Hospital District shall determine whether or not patients are eligible to receive charity for deductibles, co-insurance, or co-payment responsibilities.
C. Method by Which Patients May Apply for Charity Care. 1. Financial need will be determined in accordance with procedures that involve an individual assessment of financial need; and may
Include an application process, in which the patient or the patient's guarantor are required to cooperate and supply personal, financial
and other information and documentation relevant to making a determination of financial need;
Include reasonable efforts by SECHD to explore appropriate alternative sources of payment and coverage from public and private
payment programs, and to assist patients to apply for such programs;
Take into account the patient's available assets, and all other financial resources available to the patient; and
Include a review of the patient's outstanding accounts receivable for prior services rendered and the patient's payment history.
2. It is preferred but not required that a request for charity and a determination of financial need occur prior to rendering of non-emergent medically necessary services. However, the determination may be done at any point in the collection cycle. The need for financial assistance shall be re-evaluated at each subsequent time of services if the last financial evaluation was completed more than a year prior, or at any time additional information relevant to the eligibility of the patient for charity becomes known.
3. SECHD's values of human dignity and privacy shall be reflected in the application process, financial need determination and granting of charity. Requests for charity shall be processed promptly and SECHD shall notify the patient or applicant in writing within 30 days of receipt of a completed application.
D. Eligibility Criteria and Amounts Charged to Patients. Services eligible under this Policy will be made available to the patient on a sliding fee scale, in accordance with financial need, as determined in reference to Federal Poverty Levels (FPL) in effect at the time of the determination. Once a patient has been determined by SECHD to be eligible for financial assistance, that patient shall not receive any future bills based on undiscounted gross charges. The basis for the amounts SECHD will charge patients qualifying for financial assistance is as follows:
Patients whose family income exceeds 250% of the FPL may be eligible to receive discounted rates on a case-by-case basis based on
their specific circumstances, such as catastrophic illness or medical indigence, at the discretion of SECHD, however the discounted
rates shall not be greater than the amounts generally billed to (received by the hospital for) commercially insured [or Medicare]
Patients who pay their bill in full within 30 days will receive a 20% discount.
Patients who cannot pay their bill within the 30 days or 60 days are offered a loan through Peoples Credit Union.
4. Who is automatically eligible for charity care:
A qualified patient, as defined in the law, must meet the following criteria:
A. The individual must be uninsured.
B. Family income must be 250 percent of the Federal Poverty Level (FPL) or less. For a family of four, this is equal to an annual
household income of $57,625 for 2012.
C. The services provided must not be eligible for discount under the Colorado Indigent Care Program (CICP).
E. Communication of the Charity Program to Patients and Within the Community. Notification about charity available from SECHD which shall include a contact number, shall be disseminated by SECHD by various means, which may include, but are not limited to, the publication of notices in patient bills and by posting notices in emergency rooms, in the Conditions of Admission form, admitting and registration departments, hospital business offices, and patient financial services offices that are located on the facility campus, and at other public places as SECHD may elect. SECHD also shall publish and widely publicize a summary of this charity care policy on facility websites, in brochures and at other places within the community served by the hospital as SECHD may elect. Such notices and summary information shall be provided in the primary languages spoken by the population serviced by SECHD. Referral of patients for charity may be made by any member of the SECHD staff or medical staff. A request for charity may be made by the patient or a family member, close friend, or associate of the patient, subject to applicable privacy laws.
F. Relationship to Collection Policies. SECHD shall develop policies and procedures for internal and external collection practices (including actions the hospital may take in the event of non-payment, including collections action and reporting to credit agencies) that take into account the extent to which the patient qualifies for charity, a patient's good faith effort to apply for a governmental program or for charity from SECHD and a patient's good faith effort to comply with his or her payment agreements with SECHD. For patients who qualify for charity and who are cooperating in good faith to resolve their discounted hospital bills, SECHD may offer extended payment plans, will not send unpaid bills to outside collection agencies, and will cease all collection efforts. SECHD will not impose extraordinary collections actions such as wage garnishments; liens on primary residences, or other legal actions for any patient without first making reasonable efforts to determine whether that patient is eligible for charity care under this financial assistance policy. Reasonable efforts shall include:
Validating that the patient owes the unpaid bills and that all sources of third-party payments have been identified and billed by the
Documentation that SECHD has or has attempted to offer the patient the opportunity to apply for charity care pursuant to this policy
and that the patient has not complied with the hospital's application requirements;
Documentation that the patient has been offered a payment plan but has not honored the terms of that plan.
G. Regulatory Requirements. In implementing this Policy, SECHD shall comply with all other federal, state, and local laws, rules, and regulations that may apply to activities conducted pursuant to this Policy.