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Updated August 2010
STANDARD OPERATING PROCEDURE FINANCIAL ASSISTANCE/CHARITY CARE
Virginia Gay Hospital is committed to providing charity care 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 compassionate, high quality, affordable healthcare services and to advocate for those who need assistance, VGH strives to ensure that the financial capacity of people who need health care services does not prevent them from seeking or receiving care.
In order to allow VGH to provide the appropriate level of assistance to the greatest number of persons in need guidelines have been established. Charity is not considered to be a substitute for personal responsibility. Patients are expected to cooperate with VGH's procedures for obtaining charity care or other forms of payment of financial assistance, and to contribute to the cost of their care based on their individual ability to pay.
For purposes of this policy, the terms below are defined as follows: Charity care Healthcare services that have or will be provided but are never expected to result in cash inflows, charity care results from a provider's policy to provide healthcare services free or at a discount to individuals who meet the established criteria. Family Using the Census Bureau definition, a group of two or more people who reside together and who are related by birth, marriage or adoption. According to the IRS rules, if the patient claims someone as a dependent on their income tax return, they may be considered a dependent for purposes of the provision of financial assistance.
Family Income Family income is determined using the Census Bureau definition, which uses the following income when computing the federal poverty guidelines: Includes earnings, unemployment compensation, workers' compensation, Social Security, Supplemental Security income, public assistance, veterans' pymts, survivor benefits, pension ore retirement income, interest, dividends, rents, royalties, income from estates, trusts, educational assistance, alimony, child support, assistance from outside the household, and other misc sources.
If a person lives with a family, includes the income of all family members (non-relatives do not count) Noncash benefits such as food stamps do not count. Excludes capital gains or losses.
This policy will include all departments of the facility, including the Vinton Family Medical Clinic, the Urbana Family Medical Clinic, the Van Horne Family Medical Clinic and the Nursing and Rehab.
The VGH Home Health Agency has a separate financial assistance procedure, due to their Public Health role in the community.
PATIENT DOCUMENTATION GUIDELINES:
To be considered for charity care/financial assistance, the patient/family must furnish VGH with a completed application provided by VGH, or documentation to support the presumptive eligibility criteria (as described in this policy).
In the event the patient does not initially qualify for charity care after providing the requested information, the patient may re-apply if there is a change in their income or assets.
A patient who qualifies for partial discounts must cooperate with VGH to establish a reasonable payment plan that will take in to account the patient's available income and assets.
To maintain compliance with the "limitation on charges" for patients who qualify for financial assistance, if a person qualifies for partial financial assistance, VGH will discount the Emergency room charges to ensure individuals receive the same amount billed to Medicare patients.
Patients who qualify for partial discounts must make a good faith effort to honor the payment plan for their discounted healthcare bills. They are responsible for communicating to VGH any change in their financial situation which may impact their ability to pay their discounted healthcare bills or to honor the provisions of their payment plans. Failure to do this will be perceived as their intention to not pay their outstanding balance, and the account may then be turned over to bad debt collections.
1. Financial Assistance Guidelines: Charity Care/financial assistance discounts will be available for healthcare services provided to persons who meet the financial and documentation criteria defined in this policy. Discounts will be based on the Following Federal Poverty Income guidelines:
|Discount||Current Year's Federal FPI for Family size|
|100%||Family income is less or equal to 200% of FPIG|
|80%||Family income is 201% to 225% of FPIG|
|60%||Family income is 226% to 250% of FPIG|
|40%||Family income is 251% to 300% of FPIG|
|20%||Family income is 301% to 350% of FPIG|
|0%||Family income is greater than 350% of FPIG|
Patients who meet presumptive eligibility criteria may be granted financial assistance without completing the financial assistance application. Documentation supporting the patient's qualification for or participation in a program should be obtained and kept on file. Documentation may include a copy of a government issued card or other documentation listing eligibility, or a print screen of a web page listing the patient's eligibility. An individual who is presumed eligible under these presumptive criteria will continue to remain eligible for six months following the date of the initial approval, unless facility personnel have reason to believe the patient no longer meets the presumptive criteria. The following programs are acceptable: The U.S. Dept of Agriculture Food and Nutrition (Food Stamp program). Mothers and Children (MAC) Medicaid available to pregnant women and children under the age of 19. (42 CFR 435.116,441). Iowa Family Planning Network (IFPN), a 90% federal/10% state Medicaid Waiver providing free reproductive healthcare services to low and moderate Income women by approved providers. Medically Needy Program, a state optional eligibility program under the Iowa Dept of Human Svs Medical Assistance Program (Iowa Code Chapter 249A) Limited eligibility illegal alien 3-day emergency window. The Iowa dept of Human svs allows for up to three days of Medicaid benefits to pay for the cost of emergency svs for aliens who do not meet citizenship, alien status or social security number requirements. The emergency services must be provided in a facility such as a hospital, clinic or office that can provide the required care after the emergency medical condition has occurred. County relief programs This is a financial assistance program designed to provide emergency short term assistance to persons lacking the resources to meet their basic needs for food, shelter, fuel, utilities, clothing, medical, dental, hospital care and burial. Patient is deceased, with no known estate. OTHER PROGRAMS MAY BE ADDED AT THE DISCRETION OF THE FACILITY.
COMMUNICATION OF THE CHARITY PROGRAM TO PATIENTS AND THE PUBLIC:
Notification about charity available form VGH shall include a contact number, and shall be displayed by VGH by various means, which may include, but are not limited to, the publication of notices in patient bills, and by posting notices in emergency rooms, admitting and registration departments, the Business Office and other public places the Hospital may elect. Information shall also be included on the facility website, and in the Patient information packets. A request for charity may be made by the patient or a family member, close friend or associate of the patient, subject to the applicable privacy laws.
RELATIONSHIP TO COLLECTION POLICIES
VGH policy and procedure for collection practices will take in to account the extent to which the patient qualifies for charity, if a patient enters in to an extended payment plan, VGH will not impose wage garnishments, or liens on primary residences, and will not send unpaid bills to outside collection agencies, and will cease all collection efforts, as long as the patient complies with their payment agreement, or contacts VGH with changed financial information.
In implementing this Policy, VGH management and facilities shall comply with all other federal, state, and local laws, rules and regulations that may apply to activities conducted pursuant to this Policy.