Policy Statement. Scope

Transcription

1 Metro Health FINANCIAL ASSISTANCE ELIGIBILITY Section PFS Former Policy Number PFS-D151 Policy Number PFS-03 Original Date June 2004 Effective Date July 2016 Next Review February 2017 Policy Statement Scope General Metro Health will reduce patient financial responsibility for necessary and appropriate treatment in situations where individuals requiring treatment qualify under the financial hardship guidelines of this policy and cooperate in the administration of the Financial Assistance procedures. Good faith evaluations of need by appropriate Metro Health representatives will determine the level of financial assistance offered. Patient Registration, Pre Arrival Services, Michigan Department of Human Services, Patient Financial Services, Customer Service, Professional Billing. (For all locations of Metro Health Corporation and Metro Health Hospital.) Metro Health is committed to providing financial assistance to persons who have healthcare needs and are uninsured, underinsured, ineligible for a government program, or otherwise unable to pay, for medically necessary care based on their individual financial situation. Consistent with its mission to deliver affordable healthcare services, we make no differentiation between an individual s ability to meet the costs of healthcare and the quality of services provided regardless of race, creed, color, sex, national origin, sexual orientation, handicap or age. Metro Health strives to ensure that the financial capacity of people who need health care services does not prevent them from seeking or receiving care Procedure STEP ACTION 1 Eligibility Determination: The determination of Financial Assistance should be made before providing services, except in the case of emergency care services. If complete information on the patient s insurance or financial situation is unavailable at the time of service, or if the patient s financial condition changes, the designation of Financial Assistance may be done at any point in the billing and collection cycle. Patients identified in need of Financial Assistance will be referred to Customer Service Representatives and asked to complete a financial assessment form. For patients who are experiencing or may be experiencing an emergency medical condition, Hospital Policy RM-04 should be followed before any financial information is collected or an evaluation of eligibility for assistance performed. Emergency care is provided irrespective of a patient s ability to pay. The Customer Service Representatives will refer those patients who may qualify for financial assistance from a governmental program such as Medicaid to the hospital-based MDHS worker. Consideration for assistance will not be given if applicant qualifies for Medicaid or other indigent health care programs until other such qualification evaluation has been completed; consideration for assistance will not be given for services related to experimental/ research studies and elective cosmetic services. There will be no refunds done on prior payments made on approved Financial Assistance applications, unless such payments were made for care provided during the process when an application for Financial Assistance was outstanding or within 240 days of the date of care, if a favorable determination of eligibility has been made. FINANCIAL ASSISTANCE ELIGIBILITY POLICY Page 1 of 5

2 Importantly: Medically necessary and/or emergency care may be provided by physicians or other health care providers who are not covered or obligated by this Financial Assistance Policy including those listed on Exhibit. 2 Application Process: Metro Health s application for Financial Assistance may be found on Metro Health s website ( under Financial Assistance. Patients who do not have insurance are automatically qualified for a percentage discount off Metro s Health s standard charge for services and may qualify for Financial Assistance based on their income, expenses, assets, and their family size. Patients having insurance may also be eligible for Financial Assistance for the portion of their bill that is not covered by insurance, including deductibles, coinsurance, and non-covered services. Application Assistance: Translation services and assistance will be offered to all patients. Metro attempts to make application information available in a patient s first language whenever possible. Requests for Information: Any patient requesting Financial Assistance will be sent the Financial Assistance packet that includes the Financial Assistance letter and application form. Financial Assistance requests may be proposed by sources other than the patient s. Timing: Metro Health s values of human dignity and stewardship shall be reflected in the application process, financial need determination and granting Financial Assistance. Requests for Financial Assistance shall be processed promptly and Metro Health shall notify the patient or applicant in writing within 30 days of receipt of a completed application. No collection efforts will be pursued until a determination is made. Patients may request Financial Assistance at any time before or after receiving care. If Financial Assistance is requested prior to care, Metro Health will be able to determine the percentage of discount off of charges that the patient is eligible for but may not be able to determine exactly what the patient s total financial obligation will be until after care is provided. If Financial Assistance is requested after care is provide and an initial bill for the patient responsible amount has been determined, Metro Health will determine the percentage of discount off of charges that the patient is eligible for and will apply that discount against the total of the patient s responsible amount. Patients may apply for Financial Assistance at any time and with whatever frequency they choose. Patients who have been denied Financial Assistance in the past may re-apply at any time if they believe that circumstances have changed that may make them eligible. A determination that a patient is eligible for Financial Assistance will remain in effect for 90 days follow the date of most recent determination. 3 Application/Eligibility Criteria Review Process: The following factors are to be considered in determining the eligibility of the patient for Financial Assistance: a. Individual or family income ( as defined by the Census Bureau ) b. Family size c. Employment status and future earning capacity d. Other financial resources e. Other financial obligations f. The amount and frequency of hospital/medical bills g. Individual or family net worth (assets), excluding residence, automobiles used to transport patients to and from work, food stamps, and housing subsidies. Documentation provided in connection with an application for Financial Assistance will be maintained by Metro Health for 240 days after submission but if a patient makes an new application for Financial Assistance after the 90 days of a prior determination has runout, Metro Health will require that the patient provide updated documentation if it is available. FINANCIAL ASSISTANCE ELIGIBILITY POLICY Page 2 of 5

3 Financially Indigent Guidelines: The Federal Poverty Guidelines are included in this policy (Attachment B). A person who is uninsured, underinsured or low income and is accepted for care with no obligation or a discounted obligation to pay for services rendered, based on the hospital s criteria as set forth in this policy, may be considered financially indigent is eligible to apply for Financial Assistance. To be eligible for full Financial Assistance as a financially indigent patient, a person s income shall be at or below 175% of the Federal Poverty Guidelines. A person not qualifying for full Financial Assistance may still be approved for a discount (ranging from a total of 60% to 95%) if their income is between 176% and 250% of the most current Federal Poverty Guidelines. (Attachment A) 4 Approval Notification: The patient shall be notified in writing within (30) working days after receipt of a completed Financial Assistance application and supporting materials as to whether the patient qualifies for the Financial Assistance Program. Each applicant will receive a letter of approval with the specific percentage amount of discount that the patient has been determined eligible for and, if care has already been provided, patient will also be provided with the new patient responsible payment amount following the application of the discount. If the patient has applied and qualified for Financial Assistance and the patient s financial circumstances have not changed, the notice shall also inform the patient that he/she is eligible for Financial Assistance for any patient balances still held in open accounts receivables for the past 90 days without having to submit a new Financial Assistance application. If a determination is made that the patient has the ability to pay all or a portion of the bill, such a determination does not prevent reassessment for the following circumstances: a. Subsequent rendering of services b. Change in income c. Increase in family size and the Patient may submit an application for redetermination at any time. 5 Denial Notification Each patient who does not qualify for Financial Assistance will receive a letter of denial within (30) working days after receipt of a completed Financial Assistance application. Denied patients can file a petition within (30) days for reconsideration based on extenuating circumstances, and may reapply for Financial Assistance at any time. Failure to provide information necessary to complete a financial assessment may delay a determination but will not serve as the only basis to deny an application. In the event there is no evidence to support a patient s eligibility for Financial Assistance, Metro Health may use outside agencies in determining estimate income amounts for the basis of determining ability to pay, Financial Assistance eligibility and potential discount amounts. A patient s clinical, behavioral, and/or social history shall not be considered in assessing one s ability to pay or in determining eligibility for Financial Assistance. In addition, a credit bureau report may be obtained to validate information. 6 Publication/Notice of Financial Assistance: It is the goal of Metro Health Hospital to communicate to patients and the public of the availability of Financial Assistance, including a plain language summary of its Financial Assistance Eligibility Policy to those who qualify. This is achieved through various methods including, but not limited to, A Patient s Guide, Metro Health s website ( patient billing statements, word of mouth, community publications, signage in the Emergency/Admissions area and other public locations. Financial Assistance applications will be translated into languages appropriate to the hospital s community. 7 Alternative Payment Arrangements: In cases in which the patient is not eligible for Financial Assistance, Metro Health will extend to the patient the following option: Care Payment: FINANCIAL ASSISTANCE ELIGIBILITY POLICY Page 3 of 5

4 The Care Payment program features an interest free finance card that is available to our patients, regardless of employment or credit history. Minimum payments are for twenty five months; is $25 or 4% of balance. 8 External Reporting: The hospital or its designee shall report the amount of Financial Assistance provided for each fiscal year in its annual financial statements and on the hospital s Medicare cost report, form CMS Approving Committee(s) Metro Health Corporation Board of Directors Committee(s) 7/26/2016 Date FINANCIAL ASSISTANCE ELIGIBILITY POLICY Page 4 of 5

5 METRO HEALTH HOSPITAL FINANCIAL ASSISTANCE GUIDELINES EFFECTIVE JANUARY 25, 2016: THE 2016 NATIONAL POVERTY GUIDELINES AS PUBLISHED IN THE FEDERAL REGISTER WILL BE THE GENERAL STANDARD USED TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY HHS POVERTY GUIDELINES FEDERAL METRO INCOME LIMIT METRO INCOME LIMIT SIZE OF FAMILY POVERTY LIMIT 175% 250% 1 $11, $20, $29, $16, $28, $40, $20, $35, $50, $24, $42, $60, $28, $49, $71, $32, $57, $81, $36, $64, $91, $40, $71, $102, FOR FAMILY UNITS WITH MORE THAN EIGHT MEMBERS, ADD $4, FOR EACH ADDITIONAL MEMBER POVERTY LEVELS REFER TO ALL INCOME SOURCES BEFORE TAXES. INCOME DATA FOR PART OF A YEAR MAY BE ANNUALIZED TO DETERMINE ELIGIBILITY FINANCIAL ASSISTANCE ELIGIBILITY POLICY Page 5 of 5