Hospital Financial Assistance Under The Fair Patient Billing Act

Transcription

1 Hospital Financial Assistance Under The Fair Patient Billing Act Final Rule as Published in the Illinois Register August 2, 2013 On August 2, 2013, the final financial assistance rule was released by the Illinois Office of Attorney General (OAG). The final rule leaves intact the basic framework and elements of the financial assistance application form, development of presumptive eligibility policy and hospital reporting as outlined in the proposed rule. Changes between Proposed Rule and Final Rule The major changes made from the proposed rule include: January 1, 2014 Effective date for hospital compliance for application and presumptive eligibility. Corrected the reference that applications are to be returned within 60 days from service date, rather than date of receipt. Allows extensions at hospital s discretion. The application now includes family information. A new section that states if a patient meets presumptive eligibility criteria, the patient does not need to complete the application s monthly expense section. One presumptive eligibility category for rural and CAH hospitals has been shifted from the mandated list to the consideration list. The presumptive eligibility policy needs to be applied to an uninsured patient as soon as possible and before issuance of a bill. Effective Date The hospital financial assistance application requirements (Section ) and the presumptive eligibility criteria (Section ) are to be implemented no later than January 1, Statement on Application Form As part of the required Opening Statement, the sentence that provided instruction that the form was to be returned within 60 days after receipt of the form has been corrected to reference 60 days following date of discharge or receipt of outpatient care. Hospitals may increase the timeframe for return of the form, but may not decrease it. An additional sentence is to be added to the form: Patient acknowledges that he or she has made a good faith effort to provide all information requested in the application to assist the hospital in determining whether the patient is eligible for financial assistance. 1

2 Family Information In the application form s Patient Information section, the name, address and telephone numbers of the spouse, partner, parent or guardian can be listed in cases where they are a guarantor for the patient. The hospital may choose not to include this information. Gross family income includes cases where a spouse or partner is guarantor for the patient or where a parent or guardian is guarantor for a minor. The Hospital Uninsured Patient Discount Act (HUPDA) requires free care and discounts to uninsured patients with family incomes at varying levels of the federal poverty level (FPL), so all family income may be considered for application of that mandated requirement. Presumptive Eligibility The financial assistance application shall contain a note that if a patient meets the presumptive eligibility criteria or is otherwise presumptively eligible by virtue of the patient s family income, the patient shall not be required to complete the application s section on monthly expenses. For rural and Critical Access Hospitals only: One of the previously mandated presumptive eligibility categories, enrollment in an organized community-based program, has now been moved to the list of criteria that could be considered. The reasoning was that some programs could have eligibility thresholds greater than the HUPDA free care threshold of 125% FPL. The presumptive eligibility criteria set forth in a hospitals policy needs to be applied to an uninsured patient as soon as possible after receipt of health care services from the hospital by the patient and prior to the issuance of any bill for such service by the hospital. Additional Agreement During the Joint Committee on Administrative Rule (JCAR) meeting, the OAG agreed to consult with affected organizations concerning the billing processes and application of presumptive eligibility criteria and revisit this topic as needed in the future. 2

3 Final Rule Requirements Financial Assistance Application Form The rule requires that by January 1, 2014, all Illinois hospitals must develop a financial assistance application form that conforms to the parameters outlined in the rule. The form should be in English as well as any other language that is the primary language of at least 5% of the patients serviced by the hospital. The Financial Assistance Application Form shall include the following: 1. The following opening statement: Important: YOU MAY BE ABLE TO RECEIVE FREE OR DISCOUNTED CARE: Completing this application will help Hospital determine if you can receive free or discounted services or other public programs that can help pay for your healthcare. Please submit this application to the hospital. IF YOU ARE UNINSURED, A SOCIAL SECURITY NUMBER IS NOT REQUIRED TO QUALIFY FOR FREE OR DISCOUNTED CARE. However, a Social Security Number is required for some public programs, including Medicaid. Providing a Social Security Number is not required, but will help the hospital determine whether you qualify for any public programs. Please complete this form and submit it to the hospital in person, by mail, by electronic mail, or by fax to apply for free or discounted care within 60 days following the date of discharge or receipt of outpatient care. Patient acknowledges that he or she has made a good faith effort to provide all information requested in the application to assist the hospital in determining whether the patient is eligible for financial assistance. (OAG has indicated that nothing prohibits a hospital from providing additional information regarding to which staff member or hospital department a Form should be returned.) 2. Patient Information, limited to: Patient name Patient date of birth Patient address Whether patient was an Illinois resident when care was rendered by the hospital Whether patient was involved in an alleged accident Whether patient was a victim of an alleged crime Patient Social Security Number (not required if you are uninsured) Patient telephone number or cell phone number Patient address 3

4 In cases in which a spouse or partner is guarantor for the patient or in which a parent or guardian is guarantor for a minor, the name, address and telephone number of the guarantor. Family/Household Information, limited to: Number of persons in the patient s family/household Number of person who are dependents of the patient Ages of patient s dependents Patient s family income and employment information, limited to: Whether patient or patient s spouse or partner is currently employed If patient is a minor, whether patient s parents or guardians are currently employed If patient or patient s spouse or partner is employed, name, address and telephone number of all employers If minor patient s parents or guardians are employed, name, address and telephone number of all employers If patient is divorced or separated or was a party to a dissolution proceeding, whether the former spouse or partner is financially responsible for patient s medical care per the dissolution of separation agreement Gross monthly family income, including cases in which a spouse or partner is guarantor for the patient or in which a parent or guardian is guarantor for a minor, from sources, such as: o Wages o Self-employment o Unemployment compensation o Social Security o Social Security disability o Veterans pension o Veterans disability o Private disability o Workers Compensation o Temporary Assistance for Needy Families (TANF) o Retirement income o Child support, alimony or other spousal support o Other income Documentation of family income from paycheck stubs, benefit statements, award letters, court orders, federal tax returns, or other documentation provided by the patient. 5. Insurance/benefit information, including but not limited to: Health insurance Medicare Medicare Part D Medicare supplement 4

5 Medicaid Veterans benefits 6. Asset and estimated asset value information, limited to: Checking Savings Stocks Certificates of deposit Mutual funds Automobiles or other vehicles Real property Health savings/flexible Spending Account 7. Monthly expense information and estimated expense figures, limited to: Housing Utilities Food Transportation Child care Loans Medical expenses Other expenses 8. Certification Statement: I certify that the information in this application is true and correct to the best of my knowledge. I will apply for any state, federal or local assistance for which I may be eligible to help pay for this hospital bill. I understand that the information provided may be verified by the hospital, and I authorize the hospital to contact third parties to verify the accuracy of the information provided in this application. I understand that if I knowingly provide untrue information in this application, I will be ineligible for financial assistance, any financial assistance granted to me may be reversed, and I will be responsible for the payment of the hospital bill. Patient or Applicant Signature and Date Presumptive Eligibility Criteria By January 1, 2014, every hospital must develop a presumptive eligibility policy outlining the criteria it will use to determine if a patient is eligible for hospital financial assistance without further scrutiny by the hospital. Several categories of criteria are mandatory, and a hospital may consider other categories, depending on the facility s location. The mandatory categories are intended to reflect the new free care mandate included in the 2012 amendment to the Hospital Uninsured Patient Discount Act (HUPDA) legislation for uninsured patients at up to 200% of the federal poverty level (FPL) at urban hospitals and up to 125% of FPL at rural and critical access hospitals. 5

6 OAG has indicated that a hospital could have a separate presumptive eligibility section within the hospital s financial assistance policy that would meet the requirement for a presumptive eligibility policy. The presumptive eligibility policy shall be applied to an uninsured patient as soon as possible after receipt of hospital services by the patient and prior to issuing any bill for those hospital services. Presumptive eligibility policy is defined as the criteria used to deem a patient eligible for financial assistance, and the criteria is defined as the categories identified as demonstrating financial need. ALL HOSPITALS - Mandated Categories: Homelessness Deceased with no estate Mental incapacitation with no one to act on patient s behalf Medicaid eligibility, but not on date of service or for non-covered service URBAN HOSPITALS - Additional Mandated Categories: Enrollment in the following programs with criteria at or below 200% FPL: Women, Infants and Children Nutrition Program (WIC) Supplemental Nutrition Assistance Program (SNAP) Illinois Free Lunch and Breakfast Program Low Income Home Energy Assistance Program (LIHEAP) Enrollment in an organized community-based program providing access to medical care that assesses and documents limited low-income financial status as criteria Receipt of grant assistance for medical services ALL HOSPITALS Optional Additional Criteria: Recent personal bankruptcy Incarceration in a penal institution Affiliation with a religious order and vow of poverty Enrollment in the following assistance programs for low-income individuals: o Temporary Assistance for Needy Families (TANF) o Illinois Housing Development Authority s Rental Housing Support Program CAH AND RURAL HOSPITALS - Optional Additional Criteria: Enrollment in an organized community-based program providing access to medical care that assesses and documents limited low-income financial status as criteria Reporting Hospitals must submit a report to the OAG annually regarding compliance with this rule either when submitting the Community Benefits Report (if subject to that requirement) or when submitting its Medicare cost report Worksheet C pursuant to that requirement under HUPDA. 6

7 The OAG submitted a report form to the Joint Committee on Administrative Rules (JCAR) with the final rule, and IHA is seeking clarification if this is the final report form hospitals will utilize. The report shall include: Financial Assistance Application Form Presumptive Eligibility Policy, including each criteria used Financial Assistance Statistics on form OAG will develop o Applications submitted (complete and incomplete) o Applications approved (including number approved using presumptive eligibility) o Applications denied o Dollar amount of financial assistance at cost Description of electronic and information technology used Hospitals are allowed to utilize electronic and information technology in both the financial assistance application form process and presumptive eligibility requirements. If a hospital utilizes such electronic and information technology, the annual report shall also include a description of the type and source used. The hospital shall also certify that the electronic system includes the requirements for the application and presumptive eligibility in the rule. If you have any questions, please contact Sandy Kraiss at or skraiss@ihastaff.org. 7