St. Dominic-Jackson Memorial Hospital

Title:Financial Assistance

Date Authenticated By Policy
Management Committee: / Number:
Document Type: Procedure / Approved By: Board of Directors
Owner/Author: Jennifer Sinclair, SVP / Date Approved: 10/25/2012
Applies To: St.DominicHospital / Inception Date: 1/1/2013
Category: Fiscal Services and Materials / Date(s) Reviewed* or Revised:

*Reviewed but not changed

Policy:

It is the policy of St. Dominic – Jackson Memorial Hospital (SDJMH) to provide medically necessary health care to all patients, without regard to the patient’s financial ability to pay. Financial assistance is not considered to be a substitute for personal responsibility, and patients are expected to cooperate with SDJMH’s procedure for obtaining financial assistance, and to contribute to the cost of their care based on their individual ability to pay.

In addition, SDJMH is required by the Internal Revenue Service to adopt and widely publicize its financial assistance policy. The purpose of this policy is to outline the circumstances under which SDJMH will provide free or discounted care to patients who are unable to pay for services and to address how SDJMH will calculate amounts charged to patients.

SDJMH will provide financial assistance for medically necessary healthcare services on a sliding scale of up to 100% of charges and up to a full waiver of co-payments after third-party insurance proceeds based on indigence. The scale will offer discounts ranging from 20-100% based on family size on published Federal Poverty income levels of 200-350%. The scale will be updated annually.

Definitions:

FAP - The Financial Assistance Policy of St. Dominic – Jackson Memorial Hospital.

Medically Necessary – Any procedure reasonably determined to prevent, diagnose, correct, cure, alleviate, or avert the worsening of conditions that endanger life, cause suffering or pain, result in illness or infirmity, threaten to cause or aggravate a handicap or cause physical deformity or malfunction, if there is no other equally effective, more conservative or less costly course of treatment available.

Federal Poverty Guidelines (FPG) – Poverty guidelines issued by the federal government at the beginning of each calendar year that are used to determine eligibility for poverty programs. The current FPG can be found on the U.S. Department of Health and Human Services website at hhs.gov.

EMTALA –The Emergency Medical Treatment and Active Labor Act.

Procedures:

  1. Upon registration and after all EMTALA requirements are met, Hospital patients who are uninsured, underinsured or cannot pay their deductible or co-pays will be provided (1) a packet of information that contains the FAP, the financial assistance application and a plain language summary of the FAP and (2) immediate financial counseling assistance from staff including the presentation of the Financial Assistance Application if requested. In certain situations, the financial assistance application process may be instituted by the Hospital.
  2. The FAP, financial assistance applications and a plain language summary of the FAP will also be available at each registration desk through-out the Hospital and can be downloaded from the Hospital’s website.
  3. Patients requesting financial assistance will be required to complete and return the Financial Assistance Application with supporting documentation in order to establish eligibility. This documentation includes proof of family income in the form of the applicant’s most recent federal income tax return or other evidence of the applicant’s earned and unearned household income.
  4. Eligibility for financial assistance will be based on family size and income. All available financial resources shall be evaluated before determining financial assistance eligibility. This will include not only the resources of the Hospital patient but also of other persons having legal responsibility to provide for the patients (e.g. the parent of a minor child or a patient’s spouse).
  5. Financial assistance will be re-evaluated every 90 days for visits after the initial approval. However, the need for financial assistance may be re-evaluated at any time additional information relevant to the eligibility of the patients becomes known.
  6. Patients and/or guarantors shall be notified in writing when the Hospital determines the amount of financial assistance discount eligibility.
  7. Charges for medical care provided to uninsured patient will be limited to not more than the amounts generally billed to those individuals who have insurance using the prior fiscal year look back method. Discounts will be applied at the time of billing. The effective discount for 2012 is 60% of total gross charges.
  8. The Hospital’s Financial Counselor is available to answer any questions about the FAP at 601-200-5446.

Related Documents:

  1. Billing and Collections Policy
  2. Financial Aid Application
  3. Financial Assistance Scale
  4. EMTALA Policy

Page 1 of 3