PAGE: 1 f 7 PURPOSE: This plicy is intended t cmply with the financial assistance and emergency care plicies required by Internal Revenue Sectin 501(r) and shall be interpreted t s cmply. This plicy applies t all medically necessary care and emergency care prvided by the Hspital and any substantially related entity f the Hspital. This plicy supprts the charitable purpse and missin f Fri Reginal Hspital. I. POLICY Fri Reginal Hspital is cmmitted t prviding charity care t persns wh have healthcare needs and are uninsured, underinsured, ineligible fr a gvernment prgram, r therwise unable t pay, fr medically necessary care based n their individual financial situatin. Cnsistent with its missin t deliver cmpassinate, high quality, affrdable healthcare services and t advcate fr thse wh are pr and disenfranchised, Fri Reginal Hspital strives t ensure that the financial capacity f peple wh need health care services des nt prevent them frm seeking r receiving care. Fri Reginal Hspital will prvide, withut discriminatin, care fr emergency medical cnditins t individuals regardless f their eligibility fr financial assistance r fr gvernment assistance. Accrdingly, this written plicy: Includes eligibility criteria fr financial assistance free and discunted (partial charity) care Describes the basis fr calculating amunts charged t patients eligible fr financial assistance under this plicy Describes the methd by which patients may apply fr financial assistance Describes hw the hspital will widely publicize the plicy within the cmmunity served by the hspital Limits the amunts that the hspital will charge fr emergency r ther medically necessary care prvided t individuals eligible fr financial assistance t amunt generally billed (received by) the hspital fr cmmercially insured r Medicare patients Charity is nt cnsidered t be a substitute fr persnal respnsibility. Patients are expected t cperate with Fri Reginal Hspital s prcedures fr btaining charity r ther frms f payment r financial assistance, and t cntribute t the cst f their care based n their individual ability t pay. Individuals with the financial capacity t purchase health insurance shall be encuraged t d s, as a means f assuring access t health care services, fr their verall persnal health, and fr the prtectin f their individual assets. In rder t manage its resurces respnsibility and t allw Fri Reginal Hspital t prvide the apprpriate level f assistance t the greatest number f persns in need, the Bard f Directrs establishes the fllwing guidelines fr the prvisin f patient charity.
PAGE: 2 f 7 II. DEFINITIONS Fr the purpse f this plicy, the terms belw are defined as fllws: Charity Care: Healthcare services that have been r will be prvided but are never expected t result in cash inflws. Charity care results frm a prvider's plicy t prvide healthcare services free r at a discunt t individuals wh meet the established criteria. Family: Using the Census Bureau definitin, a grup f tw r mre peple wh reside tgether and wh are related by birth, marriage, r adptin. Accrding t Internal Revenue Service rules, if the patient claims smene as a dependent n their incme tax return, they may be cnsidered a dependent fr purpses f the prvisin f financial assistance. Family Incme: Family Incme is determined using the Census Bureau definitin, which uses the fllwing incme when cmputing federal pverty guidelines: Includes earnings, unemplyment cmpensatin, wrkers cmpensatin, Scial Security, Supplemental Security Incme, public assistance, veterans payments, survivr benefits, pensin r retirement incme, interest, dividends, rents, ryalties, incme frm estates, trusts, educatinal assistance, alimny, child supprt, assistance frm utside the husehld, and ther miscellaneus surces; Nncash benefits (such as fd stamps and husing subsidies) d nt cunt; Determined n a befre-tax basis; Excludes capital gains r lsses; and If a persn lives with a family, includes the incme f all family members (Nnrelatives, such as husemates, d nt cunt). Uninsured: The patient has n level f insurance r third party assistance t assist with meeting his/her payment bligatins. Underinsured: The patient has sme level f insurance r third-party assistance but still has ut-fpcket expenses that exceed his/her financial abilities.
PAGE: 3 f 7 Grss charges: The ttal charges at the rganizatin s full established rates fr the prvisin f patient care services befre deductins frm revenue are applied. Emergency medical cnditins: Defined within the meaning f sectin 1867 f the Scial Security Act (42 U.S.C. 1395dd). Medically necessary: As defined by Medicare (services r items reasnable and necessary fr the diagnsis r treatment f illness r injury). III. PROCEDURES A. Eligible Under This Plicy. Fr purpses f this plicy, charity r financial assistance refers t healthcare services prvided by Fri Reginal Hspital withut charge r at a discunt t qualifying patients. The fllwing healthcare services are eligible fr charity: 1. Emergency medical services prvided in an emergency rm setting; 2. fr a cnditin which, if nt prmptly treated, wuld lead t an adverse change in the health status f an individual; 3. Nn-elective services prvided in respnse t life-threatening circumstances in a nn-emergency rm setting; and 4. Medically necessary services, evaluated n a case-by-case basis at Fri Reginal Hspital s discretin. B. Eligibility fr Charity. Eligibility fr charity will be cnsidered fr thse individuals wh are uninsured, underinsured, ineligible fr any gvernment health care benefit prgram, and wh are unable t pay fr their care, based upn a determinatin f financial need in accrdance with this Plicy. The granting f charity shall be based n an individualized determinatin f financial need, and shall nt take int accunt age, gender, race, scial r immigrant status, sexual rientatin r religius affiliatin. C. Methd by Which Patients May Apply fr Charity Care. 1. Financial need will be determined in accrdance with prcedures that invlve an individual assessment f financial need; and may a. Include an applicatin prcess, in which the patient r the patient s guarantr are required t cperate and supply persnal,
PAGE: 4 f 7 financial and ther infrmatin and dcumentatin relevant t making a determinatin f financial need; b. Include the use f external publicly available data surces that prvide infrmatin n a patient s r a patient s guarantr s ability t pay (such as credit scring); c. Include reasnable effrts by Fri Reginal Hspital t explre apprpriate alternative surces f payment and cverage frm public and private payment prgrams, and t assist patients t apply fr such prgrams; d. Take int accunt the patient s available assets, and all ther financial resurces available t the patient; and e. Include a review f the patient s utstanding accunts receivable fr prir services rendered and the patient s payment histry. 2. It is preferred but nt required that a request fr charity and a determinatin f financial need ccur prir t rendering f nn- emergent medically necessary services. Hwever, the determinatin may be dne at any pint in the cllectin cycle. The need fr financial assistance shall be re-evaluated at each subsequent time f services if the last financial evaluatin was cmpleted mre than a year prir, r at any time additinal infrmatin relevant t the eligibility f the patient fr charity becmes knwn. 3. Fri Reginal Hspital s values f human dignity and stewardship shall be reflected in the applicatin prcess, financial need determinatin and granting f charity. Requests fr charity shall be prcessed prmptly and Fri Reginal Hspital shall ntify the patient r applicant in writing within 30 days f receipt f a cmpleted applicatin. D. Presumptive Financial Assistance Eligibility. There are instances when a patient may appear eligible fr charity care discunts, but there is n financial assistance frm n file due t a lack f supprting dcumentatin. Often there is adequate infrmatin prvided by the patient r thrugh ther surces, which culd prvide sufficient evidence t prvide the patient with charity care assistance. In the event there is n evidence t supprt a patient s eligibility fr charity care, Fri Reginal Hspital culd use utside agencies in determining estimate incme amunts fr the basis f determining charity care eligibility and ptential discunt amunts. Once determined, due t the inherent nature f the presumptive
PAGE: 5 f 7 circumstances, the nly discunt that can be granted is a 100% write ff f the accunt balance. Presumptive eligibility may be determined n the basis f individual life circumstances that may include: 1. State-funded prescriptin prgrams; 2. Hmeless r received care frm a hmeless clinic; 3. Participatin in Wmen, Infants and Children prgrams (WIC); 4. Fd stamp eligibility; 5. Subsidized schl lunch prgram eligibility; 6. Eligibility fr ther state r lcal assistance prgrams that are unfunded (e.g., Medicaid spend-dwn); 7. Lw incme/subsidized husing is prvided as a valid address; and 8. Patient is deceased with n knwn estate. E. Eligibility Criteria and Amunts Charged t Patients. eligible under this Plicy will be made available t the patient n a sliding fee scale, in accrdance with financial need, as determined in reference t Federal Pverty Levels (FPL) in effect at the time f the determinatin. Once a patient has been determined by Fri Reginal Hspital t be eligible fr financial assistance, that patient shall nt receive any future bills based n undiscunted grss charges. The basis fr the amunts Fri Reginal Hspital will charge patients qualifying fr financial assistance is as fllws: 1. Patients whse grss mnthly family incme is at r belw 100% f the Federal Pverty guidelines fr the husehld s size may be eligible fr the Fri Hspital District s Indigent Health Care prgram. 2. Patients whse grss mnthly family incme is abve 100% but n mre than 200% f the FPL are eligible t receive free care; 3. Patients may be qualified as Medically Indigent if the amunt wed by the patient after payment by all third-party payers must exceed ten percent (10%) f the patient s yearly grss incme and the patient must be unable t pay the remaining bill. If the
PAGE: 6 f 7 patient meets the initial assessment criteria and whse yearly grss family incme is abve 200% but nt mre than 500% f the FPL are eligible t receive free care; and 4. Patients whse family incme exceeds 500% f the FPL may be eligible t receive discunted rates n a case-by-case basis based n their specific circumstances, such as catastrphic illness, at the discretin f Fri Reginal Hspital; hwever, the discunted rates shall nt be greater than the amunts generally billed t (received by the hspital fr) Medicare patients. F. Cmmunicatin f the Charity Prgram t Patients and Within the Cmmunity. Ntificatin abut charity available frm Fri Reginal Hspital, which shall include a cntact number, shall be disseminated by Fri Reginal Hspital by varius means, which may include, but are nt limited t, the publicatin f ntices in patient bills and by psting ntices in emergency rms, in the Cnditins f Admissin frm, at urgent care centers, admitting and registratin departments, hspital business ffices, and patient financial services ffices that are lcated n facility campuses, and at ther public places as Fri Reginal Hspital may elect. Fri Reginal Hspital als shall publish and widely publicize a summary f this charity care plicy n facility websites, in brchures available inpatient access sites and at ther places within the cmmunity served by the hspital as Fri Reginal Hspital may elect. Such ntices and summary infrmatin shall be prvided in the primary languages spken by the ppulatin serviced by Fri Reginal Hspital. Referral f patients fr charity may be made by any member f the Fri Reginal Hspital staff r medical staff, including physicians, nurses, financial cunselrs, scial wrkers, case managers, chaplains, and religius spnsrs. A request fr charity may be made by the patient r a family member, clse friend, r assciate f the patient, subject t applicable privacy laws. G. Relatinship t Cllectin Plicies. Fri Reginal Hspital management shall develp plicies and prcedures fr internal and external cllectin practices (including actins the hspital may take in the event f nn-payment, including cllectins actin and reprting t credit agencies) that take int accunt the extent t which the patient qualifies fr charity, a patient s gd faith effrt t apply fr a gvernmental prgram r fr charity frm Fri Reginal Hspital, and a patient s gd faith effrt t cmply with his r her payment agreements with Fri Reginal Hspital. Fr patients wh qualify fr charity and wh are cperating in gd faith t reslve their discunted hspital bills, Fri Reginal Hspital may ffer extended payment plans, will nt send unpaid bills t utside cllectin agencies, and will cease all cllectin effrts. Fri Reginal Hspital will nt impse extrardinary cllectins actins such as wage garnishments; liens n primary residences, r ther legal actins fr any patient withut first making reasnable effrts t determine whether that patient is eligible fr charity care under this financial assistance plicy. Reasnable effrts
PAGE: 7 f 7 shall include: 1. Validating that the patient wes the unpaid bills and that all surces f third-party payment have been identified and billed by the hspital; 2. Dcumentatin that Fri Reginal Hspital has r has attempted t ffer the patient the pprtunity t apply fr charity care pursuant t this plicy and that the patient has nt cmplied with the hspital s applicatin requirements; 3. Dcumentatin that the patient des nt qualify fr financial assistance n a presumptive basis; 4. Dcumentatin that the patient has been ffered a payment plan but has nt hnred the terms f that plan. H. Regulatry Requirements. In implementing this Plicy, Fri Reginal Hspital management and facilities shall cmply with all ther federal, state, and lcal laws, rules, and regulatins that may apply t activities cnducted pursuant t this Plicy.