To provide access to government assistance applications and/or Financial Aid for the qualified uninsured.

Transcription

1 Financial Aid for the qualified uninsured. To provide accessible and affordable care to uninsured patients and to identify methods by which patients and/or family members are notified of the Jamaica Hospital Medical Center Financial Aid policy. Notification to Patients: Jamaica Hospital Medical Center developed and has publicly available a clear and understandable written summary of its financial assistance policies and ensures that every patient is made aware of the existence of the policies. The hospital has a 24-hour emergency department and notifies patients that financial assistance is available during the intake and registration process through the posting of conspicuous and language appropriate information, and through information on all bills and statements sent to patients. In addition, the hospital posts the financial assistance summary on its website. The summary of policies includes the specific income levels used to determine eligibility for financial assistance, a description of the primary service area of the hospital, and information about how patients can apply for assistance. Additionally, the hospital requires contracted outside collections agencies to, when appropriate; provide information to patients about how to apply for financial assistance. Refer to Appendix A for Patient Notification Documents Page 1 of 11

2 Financial Aid for the qualified uninsured. To provide accessible and affordable care to uninsured patients and to define their responsibility to contribute to their care based on their ability to pay. Eligibility: Jamaica Hospital Medical Center financial assistance policy ensures that any patient that has been deemed to be uninsured through basic financial screening will be entitled to a global charitable discount for emergent (NYS residents) and/or medically necessary services (resides in hospital s primary service area). The global charitable discount will be based on the current applicable Medicaid rate depending on the service provided. Additionally, for covered services there are no limits on financial assistance based on the medical condition of the applicant. The hospital also provides additional financial assistance to patients with incomes below 300% FPL. To be potentially eligible for additional financial assistance, a patient must be uninsured or have exhausted their health insurance benefits and must be deemed ineligible for any other government assistance program by the financial counseling office of the hospital. Those patients who are potentially eligible and provide proof that their income is below 300% FPL can qualify for additional financial assistance. The level of additional assistance would be dependent on how low their income is. There is no resource test for financial aid eligible patients. Page 2 of 11

3 Please note that certain elective services are excluded from this program such as non-medically necessary cosmetic services and self-improvement services. Patients with account balances deemed their responsibility may be subject to the Hospital asserting a lien against any and all rights of action, suits, claims, counterclaims, demands or settlements of any nature that may be relating to or a result of personal injuries sustained prior to receiving treatment, care, and/or services at the Hospital, pursuant to Section 189 of New York States Lien Law, and any other applicable laws, rules or regulations. Patient accounts to which a Hospital Lien has been filed are not eligible for coverage under this Program absent independent review, consideration, and subsequent settlement between the Hospital and the patient/guarantor. Co-pays and deductibles are not covered under the program. Patients who do not have insurance, and; choose not to file for additional charitable assistance; are uncooperative; or who are unable to be located will have the global charitable discount applied to their account(s). No further discounting will be made available to patients in these categories unless approved via the appeals process. Ancillaries are not included in discounting extended to these patients accounts. Jamaica Hospital Medical Center allows for all residents of New York State to be eligible for financial assistance for emergency hospital services. For any medically necessary, nonemergent medical care, the policy allows for residents of the hospital s primary service (as defined by the Commissioner of the Department of Health), to be eligible to receive financial assistance. Refer to Appendix B for Eligibility Documents Page 3 of 11

4 Financial Aid for the qualified uninsured. To define what services are covered under the Jamaica Hospital Medical Center Financial Aid policy based on New York State mandatory guidelines. Services Covered: Jamaica Hospital Medical Center provides financial assistance for all medically necessary and therapeutically beneficial services and procedures, and all emergency hospital services including emergency transfers pursuant to the federal Emergency Medical Treatment and Active Labor Act (EMTALA). Refer to Appendix C for Financial Aid Service and Payment Grid Page 4 of 11

5 Financial Aid for the qualified uninsured. To provide accessible and affordable care to uninsured patients and to define their responsibility to contribute to their care based on their ability to pay. Application, Approval, and Appeal: Jamaica Hospital Medical Center financial assistance policy allows patients to apply for additional financial assistance up to 90 days after inpatient discharge or receipt of outpatient services. The hospital requires applicants to submit financial documents to support their application. The policy allows 20 days for patients to submit additional documents and information needed to complete an application. Financial assistance applicants are not required to pay their hospital bill(s) while the application for assistance is being considered and a determination made. Designated hospital staff assists patients in the application process, including understanding the policies and procedures. Patients applying for financial assistance are required to cooperate with the requirements of the application, such as providing information and documentation necessary to render a decision on the application. To qualify for additional financial assistance, hospital policy requires a patient to first apply for Medicaid or another insurance program, if, in the judgment of the hospital, the patient may be eligible for Medicaid or another health insurance program. Page 5 of 11

6 The hospital provides application forms in the primary languages of patients served by the hospital. Decisions regarding financial assistance applications are made by the hospital within 30 days of receipt of a completed application. Whenever a Medicaid application is also being submitted on behalf of the financial aid applicant, a financial aid decision will be rendered within 30 days of a Medicaid denial. The decision is provided to the patient in writing and includes the method by which the patient can appeal a denial. The financial assistance denial letters explains the appeals process to re-evaluate denied applications; if, or when, an appeal is requested. Refer to Appendix D for Application, Approval, Denial and Appeal Documents Page 6 of 11

7 Financial Aid for the qualified uninsured. To provide accessible and affordable care to uninsured patients and to define their responsibility to contribute to their care based on their ability to pay. Billing and Collections: Jamaica Hospital Medical Center provides information about the availability of a financial assistance program on all bills and statements sent to patients. Additionally, the hospital requires outside contracted collections agencies to provide to patients information about the financial assistance programs when appropriate. Any accounts referred to collection for which a patient is applying for financial assistance will be referred back to the hospital for application. The hospital may require a deposit before providing nonemergent, medically necessary care, and it will be included as part of any financial assistance consideration. For individuals whose incomes are at or below 100% FPL, the hospital collects no more than a nominal payment amount, consistent with guidelines established by the New York State Commissioner of Health. The current guidelines the maximum amount that can be charged to eligible patients are: $150/discharge for inpatient services, $150/procedure for ambulatory surgery, $150/procedure for MRI testing, $15/visit for adult ER/clinic services, and no charge for prenatal and pediatric ER/clinic services. Page 7 of 11

8 For individuals with incomes between 101% and 150% FPL, the hospital collects no more than a proportional sliding fee schedule that increases from the nominal payment amount up to 20% of the amount that would have been paid for the same services by Medicaid depending on the service. For individuals with incomes between 151% and 250% FPL, the hospital collects no more than a proportional sliding fee schedule that increases from 20% in equal increments up to the maximum of the greater of the amount that would have been paid for the same services by either Medicaid. For individuals with incomes between 251% and 300% FPL, the hospital collects no more than the greater amount that would have been paid for the same services by Medicaid. The hospital may offer a discount to individuals with incomes above 300% FPL. Where Medicaid does not provide a reimbursement methodology for medically-necessary service rendered, financial assistance recipients will be billed at a percentage of the hospital charges based on financial aid discounting increments. Please note that if the Medicaid rate is greater than the hospital s total charges for the service, the patient will be billed the hospital charge. The hospital offers installment plans for the payment of outstanding balances for patients approved for financial aid. The hospital does not mandate that the monthly installment payment arrangement exceed 10% of the applicant s gross monthly income or an interest rate that exceeds the rate for a 90-day security issued by the US Department of Treasury, plus 0.5%. There is no accelerator or similar clause under which a higher rate of interest is triggered when a patient misses making a payment. The hospital includes a written notice on patients bills and statements at least 30 days prior to referring the account to collection. The hospital requires that any collections agencies with which they contract follow the financial assistance policies of the hospital. The hospital does not force the sale or foreclosure of a patient s primary residence to collect on an outstanding bill. Collection is prohibited against any patient who was eligible for Medicaid at the time services were rendered. Finally, the contracted collections agencies must obtain the hospital s written consent before commencing a legal action. Refer to Appendix E for Billing and Collections Documents Page 8 of 11

9 Jamaica Hospital Medical Center will provide its uninsured patient population with access to government assistance applications and evaluate patient eligibility for financial assistance. To specify the method by which Jamaica Hospital Medical Center certifies its Financial Aid policy. Reporting and Compliance: Jamaica Hospital Medical Center, as a condition for participation in the Indigent Care Pools, certifies via attestation by an independent licensed public accountant that the hospital is in compliance with reporting laws. The financial aid reports that the hospital submits to the state will include the following: The hospital will provide the costs incurred and the uncollected amounts in providing services to eligible patients without insurance; including the amount of care provided for a nominal payment amount; the hospital costs incurred and uncollected amounts for deductibles and coinsurance for eligible patients with insurance or other third-party payor coverage; the number of patients organized by zip code, who applied for financial assistance; the number of applications approved, and the number denied; the reimbursement received for indigent care from the Indigent Care Pool; the amount of funds that have been expended on charity care from charitable bequests made or trusts established for the purpose for providing financial assistance to Page 9 of 11

10 patients who are eligible in accordance with the terms of such bequests or trusts; the number of applications for eligibility under Medicaid that the hospital assisted patients in completing and the number denied and approved; the hospital s financial losses resulting from services provided under Medicaid, and; the number of liens placed on the primary residences of patients through the collections process used by the hospital. Page 10 of 11

11 Financial Aid for the qualified uninsured To ensure that all staff that interact with patients have a basic knowledge of the Jamaica Hospital Medical Center Financial Aid policy so that they can disseminate the information accordingly. Staff Education: All Jamaica Hospital Medical Center staff that interacts with patients or has responsibility for billing and collections has been trained in the hospital s financial assistance policy. Hospital staff trained includes, but is not limited to, registration staff, nursing staff, admitting staff, billing staff, information staff, and security staff. Page 11 of 11