Presentation Minutes


Hospital Charity Care Policies and Practices

  • Al Ratcliffe, City of Tacoma Human Rights Commission - alratcliffe@gmail.com
  • Presentation - https://coalitionfiles.blob.core.windows.net/files/HospitalCharityCare.pptx
  • Worked with CHI and Multicare to find out what we can do
  • Clients should always ask for charity care – there is no penalty for asking (you can’t win if you don’t play… -ed)
  • The Human Rights Commission – coming soon, folks experiencing rental discrimination can seek remedy with the Tacoma Human Rights Commission
  • We asked organizations who work with people who do not speak English as a primary language, and we learned:
    • Most do now know charity care is offered
    • Many do not know how to apply for financial assistance (especially English language learners)
    • English language learners avoid medical care early, so they may have a condition that could have been treated much more easily earlier.
  • Charity Care
    • Definition: hospitals are supposed to provide free or reduced cost care for folks that can’t pay full freight – to make sure folks who can’t pay get needed care
    • Why –
      • It is a good exchange
      • Hospitals get tax breaks and such – exempt from taxes at all levels – this is a way they pay that back
      • Have to provide care to indigent persons – those who have exhausted all financial assistance and are under 200% of the federal poverty level
    • Multicare health System – Pierce County facilities
      • Tacoma General Hospital
      • Mary Bridge Children’s Hospital
      • Allenmore Hospital (used to have the best parking of any local hospital, but sadly, no longer. –ed)
      • Primary care clinics and urgent care clinics
    • Catholic Health Initiatives (CHI) Pierce County facilities
      • Saint Joseph’s Hospital (want some fun facts about St Joseph’s? I know you do.  I learned all this when I was a kid and I’ve never had it verified, so take it all with a grain of salt.  Anyway, St. Joe’s was built to withstand a nuclear blast – they figured the windows would blow out, so they have spares stored in the basement.  The building is built on springs, so it can handle powerful earthquakes.  I’m pretty sure the spare windows and the springs are myths, but the reinforced concrete “shell wall” does provide excellent strength and a lovely, open interior.  Because of superstitious patients, the building doesn’t have a 13th floor – it goes from 12th to 14th.  Doesn’t that make the 14th floor actually the 13th?  Apparently not.  There is a room 13 – it is the morgue.  Each floor has 4 quadrants, which were designed for 10 beds in each quadrant.  Each quadrant had a nursing station – and no bed was designed to be further than 5 feet from a nursing station.    
      • Rehabilitation hospital
      • Several Primary care and urgent care clinics
    • New Welfound Behavioral Health hospital, a partnership between CHI and Multicare, probably will follow CHI charity care policies, but not sure
    • Substitute Senate Bill 6273 (https://app.leg.wa.gov/billsummary?BillNumber=6273&Initiative=false&Year=2017 ) – now in effect
      • Requires hospitals to asses eligibility for charity care instead of waiting for the patient to apply
      • Must perform screening for charity care prior to attempting to collect payment
      • Provide written notice that free or reduced cost care may be available
      • Interpret charity care info so patients have better understanding
      • Ensure charity care application process is not burdensome
    • Hospital must post charity care information around patient areas and on the website.  Need plain language summaries (https://www.chifranciscan.org/billing-insurance-and-finances/financial-assistance-discounts-for-patients.html and https://www.multicare.org/financial-assistance/ )
    • Must provide translation for languages that are used by more than 10% of the population (only Spanish meets that criteria here).
    • All hospital bills must notify of eligibility for charity care and how to contact about it.
    • Establishing Eligibility
      • Screening for charity care is part of admission. Screening is completed before payment of deposits.
      • Needed documentation
        • W-2 or pay stuff or income tax return or forms approving or denying Medicaid eligibility
        • Income documentation can be submitted later
        • Hospital can also waive the documentation requirements and provide charity care.
      • Final decision has to be made within 14 days – no collections can be done prior to determination.
      • No sending patients to collections
      • Screening happens immediately (or nearly immediately)
      • Application links – (https://www.chifranciscan.org/content/dam/chi-franciscan/website-files/billing-and-finances/financial-assistance/English2018.07.25.pdf and https://www.multicareorg/financial-assistance-forms/ )
      • If you are very low income and go to SeaMar or Pierce County Project Access or Community Health Care, they can do the screening for charity care ahead of time and get application assistance from those organization.
      • CHI - You must reapply every 6 months. Multicare – annually, or after 6 months if income variers
    • If you are found to be eligible and paid a fee, the hospital will issue a refund.
    • Doctor Billing –
      • Multicare has a list of doctors that will accept charity care. Charity care qualification covers both hospital and doctors
      • CHI does not list the doctors, so you have to ask as the Doctor’s office. Also, doctors offices have a separate financial assistance application, qualification for hospital care does not carry over, you have to apply separately.
    • Urgent Care clinics
      • Multicare has urgent care in the same facility as doctor offices. Urgent care clinics do not provide financial assistance.  Doctor offices sometimes provide charity care.
    • Of concern to immigrants – HIPAA laws and hospital policies are very clear that they do no release information to ICE or law enforcement. If an ICE official has a court order signed by a judge identifying records for a named individual, the records must be provided.
  • Patricia – there is a lot on there about language. What about cognitive impairments that make filling out forms?  Al – I don’t know.  It is the hospitals problem to communicate with them.  Carrie – a care giver can help them fill that information out – at Molina, our navigators would assist.  At multicare, the link to information is on the bill.  Al – yes, they can get help with the forms. It is not supposed to be burdensome.
  • CHI – charity care starts with folks under 300% of federal poverty line. Multicare has a sliding scale from 500% to 300%, and charity care below 300%.  (see grid here: https://www.multicare.org/file_viewer.php?id=11807&title=Financial+Assistance+Eligibility+Grid )
  • Language Services
    • Have bilingual staff
    • Telephone access to interpretation
    • Video-remote – my accessible real time trusted interpreter (MARTTI)
  • Maureen – Thanks. We’ve talked about this in terms of clients – I am a recipient as is my husband.  You have got to go on-line and take a look.  The form is confusing – seems to be for a one-time event – it isn’t.  This is an amazing program, especially if you have high co-pays.  Those co-pays are covered at the level of charity care you are receiving.  Don’t assume you are not eligible – the income levels are much higher than you think.    Use this and tell all your friends.  Al – and remember, if you received a service and you did not apply at the time and you paid the bill and now you have income within the guidelines, you can apply retroactively. 
  • Carrie – for the Medicaid side, everything is probably already covered.
  • Martha – what about dental? We have lots of clients with Medicaid with a spend down, so they can’t afford dental.  Al – we didn’t look at dental.  Carrie- if it is a spend down, then it is Medicare. 
  • Theresa – anyone who is on the hilltop – the Tacoma Houing Authority (THA) is asking for help to design the hilltop – it is a chance to talk about affordable housing
  • Maureen – the state released the list of applicants for the next two years of housing trust fund projects. It is a huge file – let me know and I’ll send it to you. 

 

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