Charity Care Policy


I. Policy

Delta County Memorial Hospital (DCMH) is committed to providing charity care to persons who have healthcare needs and are uninsured, underinsured or otherwise unable to pay for medically necessary care based on their individual financial situation.

Accordingly, this written policy:

   *Includes eligibility criteria for financial assistance - free and discounted (partial charity) care

   *Describes the method by which patients may apply for financial assistance

   *Describes how the hospital will widely publicize the policy within the community served by the hospital
   *Limits the amounts that the hospital will charge for emergency or other medically necessary care provided to individuals eligible for financial assistance to the amount generally billed (received by) the hospital for commercially insured patients.

Charity is not considered to be a substitute for personal responsibility. Patients are expected to cooperate with DCMH's 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.

In order to manage its resources responsibly and to allow DCMH to provide the appropriate level of assistance to the greatest number of persons in need, the Board of Directors establishes the following guidelines for the provision of patient charity.

II. Definitions

For purposes of this policy, the terms below are defined as follows:

Charity Care: 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 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: Family income is determined using the Census Bureau definition, which uses the following income when computing federal poverty guidelines:

   *Includes earnings, unemployment compensation, worker's compensation, Social Security, Supplemental Security Income, public assistance, veteran's pay, survivor benefits, pension or retirement income, interest, dividends, royalties, income from estates, trusts, educational assistance, child support, assistance from outside the household, and other miscellaneous sources;

   *Noncash benefits (such as food stamps and housing subsidies) do not count;

   *Determined on a before-tax basis;

   *Excludes capital gains or losses; and

   *If a person lives with a family, includes the income of all family members (Non-relatives, such as housemates, do not count).

Uninsured: 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.

Gross Charges: 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 of illness or injury).

III. Procedures

A. Services Eligible Under this Policy For purposes of this policy, "charity" or "financial assistance" refers to healthcare services provided by DCMH without charge or at a discount to qualifying patients. The following healthcare services are eligible for charity:

   *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 a life-threatening circumstances in a non-emergency room setting; and

   *Medically necessary services, evaluated on a case-by-case basis at DCMH's discretion.

B. Eligibility for Charity. Eligibility for charity will be considered for those individuals who are uninsured, underinsured and who are unable to pay for their care, based upon determination of financial need in accordance with this Policy. The granting of charity shall be based on an individualized determination of financial need.

C. Methods by Which Patients May Apply for Charity Care.

   1. Financial need will be determined in accordance with procedures that involve an individual assessment of financial need; and may

     *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 publically available data sources that provide information on a patient's or a patient's guarantor's ability to pay (such as credit scoring);

     *Include reasonable efforts by DCMH 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.

   2. It is preferred but not required 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 at each subsequent time of services if the last financial evaluation was completed more than a year prior, or at any time additional information relevant to the eligibility of the patient for charity becomes known.

   3. DCMH'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 DCMH shall notify the patient or applicant in writing 30 days of receipt of a completed application.

D. Communication of the Charity Program to Patients Within the Community. Notification about charity available from DCMH, which shall include a contact number, shall be disseminated by DCMH's various means, which may include but are not limited to, the publication of notices in patient bills, and by posting notices in emergency rooms, in the Conditions of Admission form, admitting and registration departments, hospital business office, and patient financial services offices that are located on facility campuses. DCMH also shall publish and widely publicize a summary of this charity care policy on facility websites and at other places within the community served by the hospital as DCMH may elect. 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 DCMH staff, or medical staff, including physicians, nurses, financial counselors, social workers, case managers and chaplains. 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.

E. Relationship to Collection Polices. DCMH 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 DCMH, and a patient's good faith effort to comply with his or her payment agreements with DCMH. For patients who qualify for charity and who are cooperating in good faith to resolve their discounted hospital bills, DCMH may offer extended payment plans, will not send unpaid bills to outside collection agencies, and will cease all collection efforts. DCMH will not impose extraordinary collections actions such as wage garnishments; liens on primary residences, or other legal actions for any patient without first making reasonable efforts to determine whether that patient is eligible for charity car under the financial assistance policy.
Reasonable efforts shall include:

   1. Validating that the patient owes the unpaid bills and that all sources of third-party payments have been identified by the hospital;

   2. Documentation that DCMH 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;

   3. Documentation that the patient has been offered a payment plan but has not honored the terms of that plan.

F. Regulatory Requirements. In implementing this Policy, DCMH management shall comply with all other federal, state, and local laws, rules, and regulations that may apply to activities conducted pursuant to this Policy.

Charity Care Application