Colorado Plains Medical Center Charity Care Policy - 2012
Colorado Plains Medical Center (CPMC) 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. Committed in its mission to deliver compassionate, high quality, affordable healthcare services CPMC strives to ensure that the financial capacity of people who need health care services does not prevent them from seeking or receiving care. CPMC will provide, without discrimination, care of emergency medical conditions to individuals regardless of their eligibility for financial assistance or for government assistance.
Accordingly, this written policy:
- Includes eligibility criteria for financial assistance.
- Describes the method by which patients may apply for financial assistance.
- Describes how the hospital will publicize the policy within the community served by the hospital.
Charity is not considered to be a substitute for personal responsibility. Patients are expected to cooperate with CPMC procedures for obtaining charity or other forms of payment or financial assistance, and to contribute to the cost of their care based on their individual ability to pay. Individuals with the financial capacity to purchase health insurance shall be encouraged to do so, as a means of assuring access to health care services, for their overall personal health, and for the protection of their individual assets.
Anyone wanting more information on CPMC’s charity policy or wanting to apply for charity needs to contact the Financial Counselor at 970-542-4363.
For the purpose of this policy, the terms below are defined as follows:
Charity care results from a provider's policy to provide healthcare services at a discount to individuals who meet the established criteria.
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 Internal Revenue Service 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 is determined using the Census Bureau definition, which uses the following income when computing federal poverty guidelines:
- Includes earnings, unemployment compensation, workers’ compensation, Social Security, Supplemental Security Income, veterans’ payments, survivor benefits, pension or retirement income, interest, dividends, rents, royalties, income from estates, trusts, alimony, assistance from outside the household, and other miscellaneous sources;
- Non-cash benefits (such as food stamps and housing subsidies) do not count;
- Determined on a before-tax basis;
- If a person lives with a family, includes the income of all family members (Non-relatives, such as housemates, do not count).
The patient has no level of insurance or third party assistance to assist with meeting his/her payment obligations.
Underinsured: The patient has some level of insurance or third-party assistance but still has out-of-pocket expenses that exceed his/her financial abilities.
The total charges at the organization's full established rates for the provision of patient care services before deductions from revenue are applied.
Emergency medical conditions:
Defined within the meaning of section 1867 of the Social Security Act (42 U.S.C. 1395dd).
Medically necessary: As defined by Medicare (services or items reasonable and necessary for the diagnosis or treatment of illness or injury).
A. Services Eligible under this Policy.
For purposes of this policy, “charity” or "financial assistance" refers to healthcare services provided by CPMC at a discount to qualifying patients. The following healthcare services are eligible for charity:
B. Eligibility for Charity.
- Emergency medical services provided in an emergency room setting
- Services for a condition which, if not promptly treated, would lead to an adverse change in the health status of an individual
- Non-elective services provided in response to life-threatening circumstances in a non-emergency room setting; and
- Medically necessary services, evaluated on a case-by-case basis at Colorado Plains Medical Center’s discretion.
Eligibility for charity will be considered for those individuals who are uninsured, underinsured, ineligible for any government health care benefit program, and who are unable to pay for their care, based upon a determination of financial need in accordance with this Policy. The granting of charity shall be based on an individualized determination of financial need, and shall not take into account age, gender, race, social or immigrant status, sexual orientation or religious affiliation. [CPMC shall determine whether or not patients are eligible to receive charity for deductibles, co-insurance, or co-payment responsibilities.]
C. Method by Which Patients May Apply for Charity Care.
D. Eligibility Criteria and Amounts Charged to Patients.
- Financial need will be determined in accordance with procedures that involve an individual assessment of financial need; and will
- Include an application process, in which the patient or the patient’s guarantor are required to cooperate and supply personal, financial and other information and documentation relevant to making a determination of financial need;
- Include the use of external publicly available data sources that provide information on a patient’s or a patient’s guarantor’s ability to pay;
- Include reasonable efforts by CPMC to explore appropriate alternative sources of payment and coverage from public and private payment programs, and to assist patients to apply for such programs;
- Take into account the patient’s available assets, and all other financial resources available to the patient; and
- Include a review of the patient’s outstanding accounts receivable for prior services rendered and the patient’s payment history.
- It is preferred that a request for charity and a determination of financial need occur prior to rendering of non-emergent medically necessary services. However, the determination may be done at any point in the collection cycle. The need for financial assistance shall be re-evaluated yearly or at any time additional information relevant to the eligibility of the patient for charity becomes known.
- Colorado Plains Medical Center’s values of human dignity and stewardship shall be reflected in the application process, financial need determination and granting of charity. Requests for charity shall be processed promptly and CPMC shall notify the patient or applicant in writing within 45 days of receipt of a completed application.
Services eligible under this Policy will be made available to the patient at a discounted rate, in accordance with financial need, as determined in reference to Federal Poverty Levels (FPL) in effect at the time of the determination. Once a patient has been determined by CPMC to be eligible for financial assistance, CPMC will charge patients qualifying for financial assistance as follows:
E. Communication of the Charity Program to Patients and Within the Community.
- Patients whose family income is at or below 250% of the FPL are eligible to receive discounted care.
Notification about charity available from CPMC, which shall include a contact number, shall be disseminated by CPMC 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, hospital business offices, and patient financial services offices that are located on facility campuses, and at other public places as CPMC may elect. CPMC also shall publish and publicize a summary of this charity care policy on facility websites. Such notices and summary information shall be provided in English and Spanish. Referral of patients for charity may be made by any member of the CPMC staff. A request for charity may be made by the patient or a family member, close friend, or associate of the patient, subject to applicable privacy laws.
F. Relationship to Collection Policies.
CPMC management shall develop policies and procedures for internal and external collection practices (including actions the hospital may take in the event of non-payment, including collections action and reporting to credit agencies) that take into account the extent to which the patient qualifies for charity, a patient’s good faith effort to apply for a governmental program or for charity from CPMC, and a patient’s good faith effort to comply with his or her payment agreements with CPMC. For patients who qualify for charity and who are cooperating in good faith to resolve their discounted hospital bills, CPMC may offer extended payment plans. CPMC will make reasonable efforts to determine whether that patient is eligible for charity care under this financial assistance policy. Reasonable efforts shall include:
G. Regulatory Requirements.
- Validating that the patient owes the unpaid bills and that all sources of third-party payments have been identified and billed by the hospital
- Documentation that CPMC has or has attempted to offer the patient the opportunity to apply for charity care pursuant to this policy and that the patient has not complied with the hospital's application requirements
- Documentation that the patient has been offered a payment plan but has not honored the terms of that plan.
In implementing this Policy, CPMC 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.