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The subject of this policy is free care discounting or discounting of Hospital charges to uninsured patients. It is not the intent of this policy to require free or discounted care to patients who have health insurance coverage with high deductibles or coinsurance.

PURPOSE:

In accordance with Magee Rehabilitation Hospital’s mission, discounted rates or free care are provided to patients who are uninsured or underinsured and who do not qualify for Federal or State health care benefits.

Definitions:

Charity Care means the ability to receive free care.  Patients who are uninsured for the relevant, medically necessary service, who are ineligible for governmental or other insurance coverage, and who have family incomes not in excess of 200% of the Federal Poverty Level will be eligible to receive free care (See attached Schedule A).

Patients who are uninsured, are ineligible for free governmental coverage if available, and have family incomes in excess of 200% but not exceeding 300% of Federal Poverty Level (FPL), should be eligible to receive discounted care at no more than 30% of billed charges (i.e. at least a 70% allowance) or, to the extent the Patient Protection and Affordable Care Act (PPACA) limits amounts charged to such patients to less than 30% of billed charges, the PPACA limit, provided they cooperate as aforesaid.  Discounts or allowances against billed charges should also apply to eligible patients between 300% and 500% of FPL; provided however, to the extent the PPACA limit applies to such patients, the amounts charged to such patients shall not exceed the PPACA limit.  Additional discounts or allowances for prepayment, prompt payment, or agreement to a payment schedule may be offered, provided they are uniformly applied.  A member may decide by policy that patients who would otherwise be eligible for discounted care based on income between 200% and 500% of FPL but who have sufficient available assets to pay for services at full charges without becoming medically indigent are not eligible for discounts or allowances.( See Schedule A)
 
Uninsured Patient means an individual who does not have any third-party health care coverage by: (a) a third party insurer, (b) an ERISA plan, (c) a Federal Health Care Program (including without limitation Medicare, Medicaid, SCHIP and TRICARE), (d) Workers’ Compensation, Medical Savings Accounts or other coverage for all or any part of the bill, including claims against third parties covered by insurance to which Magee is subrogated, but only if payment is actually made by such insurance company.

POLICY:

All patients admitted to Magee Rehabilitation Hospital who are uninsured will have a state specific medical assistance application taken to determine if they are eligible for medical and hospital payment benefits. Patients will not be eligible for free or discounted care unless they cooperate in a timely manner with the application process and efforts to help secure available free governmental coverage.

At the same time the patient or patient representative will be interviewed to determine if the patient would qualify for a discounted self pay rate or free care.

The demographic information to be gathered should included but is not limited to names, birthdates and social security numbers of all family members for whom the patient has financial responsibility.

The financial information to be gathered should include but is not limited to W2s for all income earners in the household, tax returns, proof of residence, checking account and savings account statements and any other documentation required to help determine the patient’s eligibility for this program.

For the purpose of calculating the discount or free care the base daily per diem will be the most current Pennsylvania Medical Assistance daily per diem rate.  The amount of discount will be determined by using a sliding scale calculation based on the most current federal poverty guidelines found on the CMS web site.  See Schedule A.

The following collections guidelines should apply to all uninsured patients, whether or not the patient has established eligibility for free or discounted care.  All internal employees and outside vendors (including law firms) should be informed of and bound by the member’s specific collection policies.

a.    Payment will not be pursued in a manner that would make the patient indigent if successful.  Generally, absent significant available assets, annual patient payments toward billings that are unreasonable in relation to annual net family income (income less expenses) should not be sought.

b.    Lawsuits or other extraordinary collection actions such as the referral to third party debt collectors or reporting to credit agencies,  should not be instituted unless reasonable efforts to determine if a patient qualifies for free or discounted care under the member’s policies have been made and adequate written opportunity to resolve the unpaid amount have been ignored or rejected.  Member General Counsel pre-approval of all lawsuits should be required, and it is recommended that member counsel cooperate to establish uniform criteria with respect to collection litigation issues.

c.    The placing of a lien on or the seizure of property, or the garnishment of wages, should not be permitted for patients where there is no reasonable belief that there is either income or assets available to fulfill the payment obligation.

d.    The sale or foreclosure of a primary residence with a market value of less than $250,000 shall not be pursued except in special circumstances approved in writing by the member’s General Counsel.

e.    Where appropriate under applicable law, debt collection may be pursued against financially responsible family members.

Schedule A
Magee Rehabilitation Hospital Charity Care and Financial Assistance Table*
To apply for Charity Care and Financial Assistance, the patient must complete the Magee Charity Care Application and proof of income must be attached.

Size of Family Unit

2013
Poverty Guide

2xFPL

100%

3xFPL

70%



1

$ 11,490

        $ 22,980

        $ 34,470



2

$ 15,510

        $ 31,020

        $ 46,530



3

$ 19,530

        $ 39,060

        $ 58,590



4

$ 23,550

        $ 47,100

        $ 70,650



5

$ 27,570

        $ 55,140

        $ 82,710



6

$ 31,590

        $ 63,180

        $ 94,770



7

$ 35,610

        $ 71,220

        $106,830



8

$ 39,630

        $ 79,260

        $118,890



Add $4,020 for each family member over 8 members
*This Table shall be adjusted in accordance with annually released changes to the Federal Poverty Levels