HACKENSACK UNIVERSITY MEDICAL CENTER Administrative Policy ...

HACKENSACK UNIVERSITY MEDICAL CENTER

Administrative Policy Manual

Financial Assistance Policy (Charity Care/Kid Care/Medicaid)

Policy No.: 1846

Effective Date: January 2016

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GENERAL

Policy All scheduled uninsured or underinsured patients who indicate payment is a financial hardship will be preliminarily screened for Charity Care/Kid Care/Medicaid. All patients who appear to meet the guidelines will be referred to Outpatient Intake for a screening appointment.

Purpose To screen all patients during the pre-registration process for Charity Care/Kid Care/Medicaid who state they do not have any insurance.

Administration The Executive Vice President for Finance and The Vice President of Patient Financial Services are responsible for the administration, maintenance and subsequent revisions of this policy.

PROCEDURE

1. All patients who during the pre-registration process indicate they do not have insurance and need financial assistance will be screened for the following. Refer to Attachment A for preliminary screening definitions. a. New Jersey Residency for Charity Care b. Marital Status c. Family Size d. Family yearly income e. Family asset amount f. Is patient employed? g. Is spouse employed? h. Has patient worked in the last 3 months? i. Has spouse worked in the last 3 months?

PROCEDURE

1. The patient will be preliminarily screened based on his/her income and asset criterion per family size. Refer to the following for: a. Charity Care and Reduced Charity Care Eligibility ? Attachment B

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b. Medicaid/Kid Care ? please see:

c. Patients who appear to meet the guidelines will be referred to Outpatient Intake for a screening appointment. Refer to "Documenting referral to Outpatient Intake Department."

d. Please note that in accordance with the Emergency Medical Treatment & Active Labor Act (EMTALA) of 1986, persons with emergency medical conditions will be screened and stabilized regardless of their ability to pay. Such services will not be delayed, denied, or otherwise qualified for any reason, including but not limited to inquiries related to payment. See Administrative Policy 558-1, Patient Transfer and Emergency Medical Treatment & Active Labor Act (EMTALA).

e. Please note that not all services provided within the Medical Center's hospital facilities are covered under this policy. Please refer to Attachment C for a list of providers by department that provide emergency or other medically necessary healthcare services within the hospital facility. This attachment specifies which providers are covered under this policy and which are not. The provider listing will be reviewed quarterly and updated, if necessary.

2. Amounts Generally Billed ("AGB") Calculation for Emergency or Other Medically Necessary Care a. In accordance with Internal Revenue Code ?501(r)(5), in the case of emergency or other medically necessary care, patients eligible for financial assistance under this Policy will not be charged more than an individual who has insurance covering such care. b. An individual deemed eligible for financial assistance that requires emergency or other medically necessary care will be charged the lesser of: i. The amount as calculated per sections (1)(a)(b) above; or ii. AGB. c. The AGB is calculated utilizing the look-back Medicare fee for service plus private health insurers. The current AGB percentages are as follows: i. Inpatient: 26% ii. Outpatient: 32% iii. Outpatient ER: 22%

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Financial Assistance Policy (Charity Care/Kid Care/Medicaid) _______________________________________________________________________

3. Methods for Applying for Financial Assistance a. View information on the Medical Center Website i. Website: An individual can view information about financial assistance online at the following website:

b. Application i. Available Languages a. The Medical Center's FAP, Application and PLS are available in English and in the primary language of populations with limited proficiency in English ("LEP") that constitute the lesser of 1,000 individuals or 5% of the Medical Center's primary service area. These documents are available free of charge upon request. ii. An individual can apply for financial assistance by filling out a paper copy of the application. The paper application is available free of charge by any of the following methods: b. By Mail: By writing to the following address and requesting a paper copy of the financial assistance application: 1) 100 First Street - Suite 300 Hackensack, NJ 07601 c. In Person: By stopping by the Financial Assistance Department in person (Monday thru Friday, 8:00AM4:00 PM), located at the following address: 1) 100 First Street - Suite 300 Hackensack, NJ 07601 d. By Phone: The Financial Assistance Department can be reached at (551)996-4343.

iii. Application Period: a. An individual has three hundred sixty five (365) days from the date of service to submit an Application for Charity Care. b. Incomplete applications are not considered, but applicants are notified and given an opportunity to furnish the missing documentation/information.

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iv. Completed Applications: a. Please mail all completed Applications to the Financial Assistance Department (refer to address above).

Please refer to Attachment D of this policy for HackensackUMC's Patient Collections Timeline for information regarding the billing/collection process and compliance with Internal Revenue Code ?501(r)(6).

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Financial Assistance Policy (Charity Care/Kid Care/Medicaid) _______________________________________________________________________ ATTACHMENT A: PRELIMINARY SCREENING DEFINITIONS Family Size The patient, spouse, and any minor children are considered family. An adult is any person 18 years old and older. However, if the adult is a full time student, then he/she is considered a minor until the age of 22. A pregnant woman is counted as a family of two (2). Marital Status Single ? Family size of 1. Divorced ? A family size of 1 unless the individual has custody of minor children. Then the minor children are counted in the family size. Separated ? Unless they have a legal document, a separated couple is a family of two (2). Family Income Gross amount of income for the year. Family asset amount Assets, which are owned by the spouse and minor children, are counted for the patient. Assets are bank accounts, both checking and savings, cash, IRAs, or other retirement accounts.

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