Quarterly Newsletter - SPRING EDITION 2014 - #11
Senate Bill 1272 Seeks to Expand Hospital and Emergency Physician Charity and Discount Policies Under AB 774 “Fair Billing Policies” By Rich Lovich, Esq. Recently introduced Senate Bill 1276 seeks to expand the current scope of AB 774 (California Health & Safety Code Section 127400, et seq.) dealing with mandated charity and discount policies imposed upon hospitals and emergency physicians. The new bill seeks to do the following: • Expand the definition of who must be covered under the charity and discount policies; • Increases the information hospitals are required to provide to qualified individuals; • Places additional requirements on the hospital when an external debt collection entity is used. AB 774, which became California Health and Safety Code Section 127400, et seq., was enacted in 2007, and requires each hospital as a condition of licensure to maintain a written charity care policy as well as policiesallowing for discounts for financially qualified patients.Currently, both the charity care and discount policies must include patients who are uninsured; or patients with ‘high medical costs’ whose family income meets the financial criteria,(specified patients must also be eligible for a discount from the emergency physician). Under the current statute, the definition of a patient with “high medical costs“ is someone whose family income is at or below 350% of the federal poverty level; whose out of pocket medical costs or expenses, paid or incurred in the previous 12 months exceed 10% of the family income;and who does not receive a discounted rate from the hospital or physician as a result of 3rd party coverage. The new Bill seeks to expand this definition by dropping the 3rd party coverage exclusionand thus extending the scope of the policy to all who qualify financially.
In the same vein, current law requires hospitals and emergency room physicians to make a reasonable attempt to determine whether private or public insurance may fully or partially cover the charges for care. The law also requires the hospital or emergency physician to provide to a patient, who has shown proof of third party coverage, with information concerning their potential eligibility under programs such as Medi-Cal and California Children’s Services Programs, along with applications for those programs. SB 1276 expands this by adding the requirement that hospitals and emergency physicians obtain information as to whether the patient may be eligible for the California Health Benefit Exchange or any other state or county funded program. The bill would also require that if a patient has a pending application for assistance under a health coverage program at the same time he or she applies to the hospital for charity or discount payment programs, that neither application precludes eligibility for the other program. Finally, the bill expands requirements for external debt collection entities dealing with patients who qualify under the charity or discount policies. Existing law requires such an entity to sign an agreement that they will abide by the hospital’s debt collection standards and practices underthe charity and discount policies. The new bill would require such an agreement to require the debt collection entity to adhere to the hospital’s definition of a “reasonable payment plan”. The bill provides a definition of a reasonable payment plan as one where the monthly payments are not more than 5% of the family income for a month, excluding deductions for essential living expenses. Senate Bill 1276 is authored by Senator Ed Hernandez, Chairman of the Senate Committee on Health to which the bill was recently referred.
Care Coordination The Importance of Easing Patient Concerns
By George Colman, Esq. In our last newsletter, I wrote an article and listed some points related to the fact that readmission begins at admission, and the importance of implementing a care coordination program with continuing and ease of concern for your patients. Here are some additional pointers to assist in the care transitions as a healthcare provider. Care transition is when the responsibility for a patient’s care moves from one provider to the next; when a patient moves from one point along the continuum of care to another. This can be a temporary responsibility or permanent one; it is a big component of care coordination; multiple providers must work together to ensure patients receive comprehensive care; this care transition is a subcategory of care coordination by which two or more providers carry out disparate activities in a patients’ care. Some examples of this is when a provider refers a patient to specialty care, a patient shows up in the emergency department, or a hospital discharges a patient to an outpatient clinic or recuperative care (a medical home). Providers’ care transition responsibilities have increased under the Affordable Care Act as well as under many new regulations issued by the state, as well as under newer network contracts (under the guise of revising the meaning of “medical necessity”). Problems uncovered by these new requirements include: poor direct communication between the hospital and a patient’s primary care provider; incomplete instructions on discharge summaries (i.e., pending test results, medication discrepancies, missing contact information, etc.), and failure to give clear concise postdischarge instructions to patients.
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