Summary and Hospital Financial Aid Policy

June 22, 2007

DPACS: 07-09

Dear Chief Executive Officer:

As you know, Subdivision 9-a of Section 2807-k of the Public Health Law required all hospitals to implement financial aid policies and procedures by the effective date of January 1, 2007. In addition, Section 9-a(c) requires general hospitals to develop a summary of its financial policies and procedures that must be made publicly available. This letter and its attachment will outline the Department´s expectations and provide a template that should be used in the creation of the summaries. The Department will collect the summary and the hospital´s financial aid policies and procedures by August 1, 2007.

A hospital´s summary must be clear and understandable and publicly available. At a minimum, the summary must include:

  • Specific information as to income levels used to determine eligibility for assistance,
  • A description of the primary service area of the hospital, and
  • The means of applying for assistance.

For all hospitals, the financial assistance summary must be publicly available in the Emergency Department and during the intake and registration process. In addition, for hospitals with 24-hour emergency departments, conspicuous posting of language appropriate information is required in public areas such as waiting rooms, outpatient clinics, billing and Medicaid offices. For specialty hospitals, posting of language appropriate information is strongly encouraged. To meet this posting requirement, the Department has developed a sign that announces the availability of financial aid in multiple languages. If a hospital has independently developed a sign for this purpose, the use of such sign does not need to be discontinued in favor of the Department’s, as long as it notifies the public of the availability of financial assistance in multiple languages and is displayed in public areas. For those hospitals who will use their own sign, the Department will request that the sign file be submitted to the Department with the financial assistance summary and policies and procedures by August 1, 2007. Hospitals that do not currently have a sign may use the Department’s version to notify the public of its available financial assistance. Signs should be posted within two weeks from the receipt of this letter. Hospitals are reminded that notifications must also be printed on bills and statements. A summary template has been attached to this letter that hospitals should use to create their hospital- specific financial assistance summary. If a hospital has already created a financial aid summary, there is no need to recreate another one using this template. For those hospitals without an existing template, it may be modified by replacing the red text with hospital-specific information about your financial assistance policies. It is also acceptable to add additional information, but the basic template should not be changed. Once the summary is complete, hospitals must submit it and a copy of its full financial aid policies and procedures to the Department by August 1, 2007. Please submit documents in .pdf format, if possible. Each summary will be posted as part of the financial assistance section of the Department´s enhanced Hospital Profile website. It is also required that the summary will be made available in the languages spoken by 1% or more of the population of the hospital´s service area, as identified by the hospital´s annual language needs assessment.

It has come to the Department´s attention that some hospitals are requiring all financial assistance applicants to receive a denial for Medicaid or other public insurance before allowing applicants to apply for financial assistance. While hospitals are within their rights under the statute to require patients who are potentially eligible for Medicaid or other publicly sponsored insurance programs to apply for such coverage as a condition of being considered for financial aid, the hospital must have a reasonable, good-faith basis for believing that the patient may be eligible for such coverage and should document the reason for that conclusion in the patient´s records. An across-the-board requirement that all applicants for financial aid apply for Medicaid or other programs, even when it is clear they will not qualify, is not an acceptable procedure.

Further, in any case where a hospital requires the patient to apply for Medicaid or other public insurance, the Department strongly encourages hospitals to process financial aid applications concurrently to minimize delays in making financial aid available.

Hospitals should use separate application forms and documentation checklists, if applicable, for Medicaid and financial assistance. In applying policies in this area, hospitals should recognize and take into account the fact that Medicaid will pay for services provided to Medicaid eligible patients for a period of ninety days prior to the patient´s enrollment in Medicaid. Under these circumstances, hospitals have the option of voiding the discounted bill, returning any money actually collected from the patient and billing Medicaid for the services provided.

The intent of the financial assistance law is to reduce the financial and socioeconomic barriers that deter uninsured individuals from receiving healthcare. In keeping with this goal, a hospital´s application and approval process should be reasonable and straightforward, so that the process itself does not become an obstacle to obtaining health care services. The following list of Performance Guidelines, while not mandated under law, should be considered by each hospital to assist in streamlining and improving its current process.

Performance Guidelines

  • If a hospital requires deposits prior to providing medical care, the hospital must take into consideration the income level of the applicant and adjust the deposit to be commensurate with the patient´s ability to pay;
  • To the extent possible, make information available on what patients can expect to pay, as this will encourage patients to seek preventative care;
  • Hospitals should notify patients about separate billing from various parties that patients may encounter in the hospital setting, i.e. providers, laboratory services, etc., if applicable.
  • Streamline documentation requirements for potential applicants to those that are necessary for the process e.g. one form of ID, one proof of residency, and one proof of income;
  • In requesting documentation, hospitals should take into account the patient´s individual circumstance and consider alternative forms of verification, which may include self-attestation;
  • Develop training for staff, particularly financial assistance staff, on the requirements and intent of the financial assistance law and a hospital´s specific policies and procedures;
  • Review the provisions of PHL 2807 (9-a)(d) to ensure that interest charges for unpaid hospital bills are consistent with this provision of law;
  • Consider a simplified, one page application form, such as the one enclosed in Attachment B;
  • To alleviate the potentially duplicative application process for repeat admissions within a defined period of time and eliminate undue burden on applicants for repeated application submissions, an approved application should be effective for a specified period of time. For example, if an approved application was in effect for a 12-month period, re-application would not be necessary for each patient contact with the hospital during that period, assuming patient income status remains the same;
  • Consider establishing a financial assistance hotline or work-friendly hours for the purposes of submitting a financial assistance application; and
  • Materials and discussions with prospective applicants should encourage, not discourage, patients to apply for financial assistance, if they meet income requirements. Patients cannot be denied medically necessary care because they are eligible for financial assistance.

Should you have any questions about the content of this letter or attachment, wish to submit a summary and policies and procedures, or request the financial aid sign file, please contact Ruth Leslie at 518-402-1003 or ruth.leslie@health.ny.gov.

Sincerely,

Martin J. Conroy Director
Division of Primary and Acute Care Services

attachments: Financial Assistance Summary and Sample Application