Newman Regional Health and Newman Regional Health Medical Partners Financial Assistance Policy

PURPOSE: To provide financial assistance for health care expenses to patients who cannot afford to pay and who are not covered by health insurance, or who are not eligible for benefits from the Jones Foundation or other charitable funds.

DEFINITIONS:

Guarantor: The person/entity that has legal responsibility to pay the bill.

Family: The patient, his/her spouse (including a legal common law spouse) and his/her legal dependents according to the Internal Revenue Service’s rules. Therefore, 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 or court document establishing place of residence.

Family Gross Income: Income from all adult members, including gross wages, salaries, dividends, interest, Social Security Benefits, workers compensation, training stipends, regular support from family members not living in the household, government pensions, private pensions, insurance and annuity payments, income from rents, royalties, estates and trusts.

Financial Assistance: Any discount provided by Newman Regional Health that is based upon financial status including uncompensated care and medical indigency.

Medical Expenses: All self-pay medical expenses for household family members, including nursing home expenses.

Service Area: Counties in the State of Kansas: Lyon, Chase, Coffey, Greenwood, Morris and Osage.

Citizenship: If not a United State citizen, the patient or guarantor must be working and paying taxes to the federal government.

POLICY:

Applicable to emergency room and Newman Regional Health Medical Partners (NRHMP) primary care, and Express Care services:

To meet criteria for financial assistance the guarantor will meet poverty guidelines as established by the Federal Government Services Agency and published annually in the Federal Register. The patient must be a resident of Newman Regional Health’s Service Area. For individuals outside the primary or secondary service area, emergent situations will be considered on a case-by-case basis with approval by the Controller or CFO. Qualification for financial assistance will be determined based upon completion of an application. Policy exceptions may be granted on a case-by-case basis with approval from the Controller or CFO.

NRH will verify that the application meets the poverty guidelines as published annually in the Federal Register (https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines)for the date of application against the following guidelines

SLIDING FEE SCHEDULE

MEDICAL INDIGENCY DISCOUNT

The discount will be rounded to the closest percentage for both formula calculations. If the patient would qualify under both Sliding Fee Schedule and Medical Indigency, the most favorable to the patient will apply.

Self-employment will be verified using most recent tax return and all applicable schedules.

In any of the following situations, a patient is deemed to be eligible for a 100 percent reduction from charges or 100% discount:

1. Is homeless and the hospital, through its own due diligence, doesn’t find any evidence to the contrary. The due diligence efforts are to be documented and included with application.

2. Patient dies without an estate.

3. Mentally or physically incapacitated with no power of attorney.

Applicable to all other Hospital Services, NRHMP specialty clinics, DME, and Hospice

To meet criteria for financial assistance the guarantor will meet poverty guidelines as established by the Federal Government Services Agency and published annually in the Federal Register. Additionally, the patient must be a citizen of the United States and a resident of Newman Regional Health’s Service Area. For individuals outside the primary or secondary service area, emergent situations will be considered on a case-by-case basis with approval by the Controller or CFO. Qualification for charity care will be determined based upon completion of an application. Policy exceptions may be granted on a case-by case basis with approval from the Controller or CFO. Elective procedures and non-emergent-urgent services will NOT be considered for financial assistance. Reference the Self-Pay Surgical Pre-Authorization Policy. The Self-Pay Surgical Pre-Authorization Form (see attached form) is required for Semi-Elective and Elective procedures.

Eligibility Determination

NRH will verify that the application meets the poverty guidelines as published annually in the Federal Register (https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines) for the date of application against the following guidelines:

SLIDING FEE SCHEDULE

MEDICAL INDIGENCY DISCOUNT:

The discount will be rounded to the closest percentage for both formula calculations. If the patient would qualify under both Sliding Fee Schedule and Medical Indigency, the most favorable to the patient will apply.

Assets are reviewed as part of the application. If there are sufficient assets to pay the account, then payment will be expected. Exceptions will be granted if the persons are self-employed and the assets are needed to ensure future income. Self-employment will be verified using most recent tax return and all applicable schedules.

Applications will be reviewed for excessive liabilities, such as large credit card payments or large car payments. This indicates patient is credit worthy to obtain credit for payment of account.

In any of the following situations, a patient is deemed to be eligible for a 100 percent reduction from charges or 100% discount:

1. Is homeless and the hospital, through its own due diligence, doesn’t find any evidence to the contrary. The due diligence efforts are to be documented and included with application.

2. Patient dies without an estate.

3. Mentally or physically incapacitated with no power of attorney.

Applicable to all services:

Charitable Foundations will receive 30% discount.

PROCEDURE:

Financial assistance applications will be considered if an account is open or when a change in patient financial status is determined. A financial assistance application will not need to be repeated for dates of services occurring up to six (6) months after the last date of application approval. Accounts that have been referred to an attorney for legal action are not eligible for financial assistance discounts. Any payments made prior to application will be retained. Date of receipt of application will be documented by Newman Regional Health in the hospital’s billing information system and on the application.

The Credit/Collection Coordinator will review application for final approval or denial with the Patient Accounts Supervisor.

Prior to an account being authorized for the filing of suit, a final review of the account will be conducted and approved by the Patient Account Supervisor to make sure that no application of financial assistance was ever received.

Application Availability

Applications may be obtained from Patient Accounts and Patient Access departments Monday through Friday from 8:00 a.m. to 4:30 p.m. Applications can also be obtained from the Care Coordination department, or at www.newmanrh.org

Documentation Requirements

All forms of income verification should be pursued to validate accuracy of the application. The following will be requested as part of the application:

1. Three most recent pay stubs (52 weeks or 2080 hours = 1 FTE).

2. Prior year federal tax return, including all schedules.

3. Any applicable forms approving or denying unemployment compensation or worker’s compensation.

4. Written verification of wages from employer if pay stubs are not available.

5. Written verification from public welfare agencies. Social services may verify information

6. Letter of support/recommendation

7. Copy of most recent bank statement

Notification of Approval or Denial

All applicants will be notified of approval or denial status in writing. If a determination is not possible due to incomplete application or documentation, Newman Regional Health will notify the applicant of needed information in If applicant fails to provide information as requested, application will be denied,