Charity Care Policy

PURPOSE:

Cascade Behavioral Hospital is committed to providing appropriate medical attention to all persons regardless of ability to pay. Cascade Behavioral Hospital is further committed to the provision of appropriate hospital-based medical services on a discounted basis to Indigent Persons, Medically Indigent Persons, and Uninsured Persons of Limited Means (“Charity Care”). 

POLICY:

In order to fulfill its commitment to provide Charity Care, Cascade Behavioral Hospital, in accordance with the requirements of RCW 70.170 and WAC 246-453, provides no charge and sliding scale discounted services to Indigent Persons. The federal poverty guidelines assist Cascade Behavioral Hospital Staff in making consistent and objective decisions regarding eligibility for Charity Care. In addition, Cascade Behavioral Hospital may provide Charity Care to all persons with insufficient income to enable them to pay for care or cost-sharing amounts. 

DEFINITIONS:

  1. “Indigent Persons” means those patients who have exhausted any third-party sources, including Medicare and Medicaid, and whose income is equal to or below 400% of the federal poverty standards, adjusted for family size or is otherwise not sufficient to enable them to pay for the care or to pay deductibles or coinsurance amounts required by a third-party payor;
  2. “Responsible Party” means the individual who is responsible for the payment of any hospital charges which are not covered by a third-party payor.
  3. “Charity Care” means medically necessary hospital health care rendered to indigent persons when Third-Party Coverage, if any, has been exhausted, to the extent that the persons are unable to pay for the care or to pay deductible or coinsurance amounts required by a third-party payer based on the criteria in this policy.
  4. “Third Party Coverage” means an obligation on the part of an insurance company, health care services contractor, health maintenance organization, group health plan, government program (Medicare, Medicaid or medical assistance programs, workers compensation, veteran benefits), tribal health benefits, or health care sharing ministry as defined in 26 U.S.C. Sec. 5000A to pay for the care of covered patients and services, and may include settlements, judgments, or awards actually received related to the negligent acts of others (for example, auto accidents or personal injuries) which have resulted in the medical condition for which the patient has received hospital health care services.

PROCEDURE:

  1. NOTICE REQUIREMENTS
    • Cascade Behavioral Hospital’s Charity Care Policy shall be posted or prominently displayed within public areas of the hospital in the inpatient and outpatient admitting areas and other public areas of the business office. This policy shall be provided to the Responsible Party and explained at the time that Cascade Behavioral Hospital requests information with regard to the availability of any third-party coverage. The written notices, the verbal explanations, the policy summary and the application form will be available in any language spoken by more than ten percent of the population in Cascade’s service area, and interpreted for other non-English speaking or limited-English speaking patients and for other patients who cannot understand the writing and/or explanation. The following non-English translation(s) of these are currently made available.
    • Cascade has established a standardized training program on its Financial Assistance and Charity Care policy and the use of interpreter services to assist persons with limited English proficiency and non-English-speaking persons in understanding information about its Financial Assistance and Charity Care policy. Cascade will provide regular training to front-line staff who work in registration, admissions and billing, and any other appropriate staff, to answer Financial Assistance and Charity Care
    • Cascade has made available on its web site, current versions of this policy, a plain language summary of this policy, and Cascade’s Charity Care application form.
  1. ELIGIBILITY CRITERIA:
    • Eligibility determinations regarding Charity Care and decisions regarding collection of amounts owed to Cascade Behavioral Hospital by Responsible Parties shall be made in accordance with this Policy and the Cascade Behavioral Hospital Charity Care Policy Procedures.
    • Cascade Behavioral Hospital will not impose unreasonably burdensome application procedures for Charity Care eligibility upon the Responsible Party, and will take into account any physical, mental, intellectual, or sensory deficiencies or language barriers which may hinder the Responsible Party’s capability of complying with the application procedures. Cascade Behavioral Hospital must make every reasonable effort to determine the existence or nonexistence of any available third-party coverage that might cover in full or in part the charges for services provided to each patient.
    • Cascade Behavioral Hospital may deny Charity Care to any person who is uncooperative with Cascade Behavioral Hospital in the Charity Care eligibility determination process. Responsible Parties will be considered for Charity Care on the following basis:
Federal Poverty Standard Charity Adjustment
0 to 100% 100%
101% to 200% 80%
201% to 300% 75%
301% to 400% 50%
  • All Responsible Parties with family income equal to or below one hundred percent of the federal poverty standard, adjusted for family size, shall be determined to be Indigent Persons qualifying for Charity Care for the full amount of hospital charges related to appropriate hospital-based medical services that are not covered by private or public third-party coverage; and Responsible Parties with family income between one hundred one and four hundred percent of the federal poverty standard, adjusted for family size, shall be determined to be Indigent Persons qualifying for discounts from charges related to appropriate hospital-based medical services in accordance with Cascade Behavioral Hospital’s above Sliding Fee Schedule. Other additional amounts as Cascade Behavioral Hospital may determine in its sole discretion, may be offered depending on individual financial circumstances.
  • Cascade Behavioral Hospital, in its sole discretion, may classify any individual Responsible Party whose income exceeds four hundred percent of the federal poverty standard, as adjusted for family size, as an Indigent Person eligible for a discount from charges based upon that Responsible Party’s individual financial circumstances, severe financial hardship or personal catastrophic loss.
  • Cascade Behavioral Hospital’s Sliding Fee Schedule shall be updated annually in accordance with the federal poverty guidelines published in the Federal Register.
  • Responsible Parties receiving discounts under the Cascade Behavioral Hospital Charity Care Policy shall remit the balance of the discounted charges in accordance with Cascade Behavioral Hospital’s ordinary billing and collection practices.
  1. BILLING NOTIFICATION
    • Cascade Behavioral Hospital billing statements and other written communications concerning billing or collection of a hospital bill by Cascade Behavioral Hospital will include the following statement on the first page of the statement in both English and the second most spoken language in the Cascade Behavioral Hospital Service Area:
    • You may qualify for free care or a discount on your hospital bill, whether or not you have insurance. Please contact our financial assistance officer at www.cascadebh.com and at 206-248-4711.
  1. QUALIFICATION PROCEDURES
    • Responsible Parties may qualify for Charity Care at any time from pre-admission through two years after time of service for any period of time as determined by Cascade Behavioral Hospital Medical Center. During the patient registration process, Cascade Behavioral Hospital will make an initial determination regarding Charity Care eligibility based on an oral or written application for Charity Care. The initial determination of Charity Care eligibility shall be made at the time of admission or as soon as possible following the initiation of services to the patient. Provided that the Responsible Party is cooperative, Cascade Behavioral Hospital will suspend all collection efforts and will not require any deposit pending an initial determination of Charity Care eligibility. During the pendency of Cascade Behavioral Hospital’s initial or final determination of Charity Care eligibility, Cascade Behavioral Hospital may pursue reimbursement from any third-party coverage that may be identified to Cascade Behavioral Hospital.
    • For the purpose of reaching an initial determination of Charity Care eligibility, Cascade Behavioral Hospital shall rely upon information provided orally by the Responsible Party. Any Responsible Party who is initially determined to be Charity Care-eligible shall be provided with at least fourteen (14) calendar days or such time as the person’s medical condition may require, or such time as may reasonably be necessary to secure and to present required documentation.
    • All applications must be accompanied by one or more of the following documentation to verify income amounts indicated on the application form:
      • A “W-2” withholding statement;
      • Pay stubs;
      • An Income tax return from the most recently-filed calendar year.
      • Forms approving or denying eligibility for Medicaid and/or state-funded medical assistance;
      • Forms approving or denying unemployment compensation; or
      • Written statement from employers or welfare agencies;
    • The Annual Family Income of the Applicant will be determined as of the time the Appropriate Hospital-Based Medical Services were provided, or at the time of application for Charity Care or Financial Assistance if the application is made within two years of the time the Appropriate Hospital-Based Medical Services were provided, the Applicant has been making good faith efforts towards payment for the services, and the Applicant demonstrates eligibility for Charity Care and/or Financial Assistance
    • In the event that the Responsible Party is not able to provide any of the documentation described above, Cascade Behavioral Hospital shall rely upon written and signed statements from the Responsible Party for making a final determination of eligibility for classification as an Indigent Person. Information requests, from Cascade Behavioral Hospital to the Responsible Party, for the verification of income and family size shall be limited to that which is reasonably necessary and readily available to substantiate the Responsible Party’s qualification for Charity Care, and may not be used to discourage applications for Charity Care. Duplicate forms of verification shall not be demanded from the Responsible Party.
    • Cascade Behavioral Hospital may request such further financial statements or information should it consider extending Charity Care to Responsible Parties in excess of the amount indicated by the Sliding Fee Schedule. If identification as an Indigent Person is obvious to Cascade Behavioral Hospital personnel, and Cascade Behavioral Hospital is able to establish the position of the income level within the broad range of the federal poverty guidelines or Cascade Behavioral Hospital’s Sliding Fee Schedule, Cascade Behavioral Hospital is not obligated to establish the exact income level or to request the documentation listed above from the responsible party, unless the patient or Responsible Party requests further review.
  1. APPROVAL/DENIAL:
    • The failure of a Responsible Party to reasonably complete Cascade Behavioral Hospital’s application procedures shall be sufficient grounds for the hospital to initiate collection efforts directed at the patient. Cascade Behavioral Hospital must notify persons applying for Charity Care in writing of its final eligibility determination within fourteen (14) calendar days of receiving a complete application, including one or more of the financial documentation identified above. Such determination must include a determination of the amount for which the Responsible Party will be held financially accountable.
    • In the event that Cascade Behavioral Hospital denies the application for Charity Care, Cascade Behavioral Hospital shall notify the Responsible Party in writing of the denial and the basis for the denial. All responsible parties denied Charity Care shall be provided with, and notified of, an appeals procedure that enables them to correct any deficiencies in documentation or request review of the denial and results in review of the documentation by the Cascade Behavioral Hospital Chief Financial Officer or equivalent.
    • Responsible Parties shall be notified that they have thirty (30) calendar days within which to request an appeal of the final determination of Charity Care eligibility. Within the first fourteen (14) days of the appeal period, Cascade Behavioral Hospital may not refer the account to an external collection agency.
    • After the fourteen (14) day period, if no appeal has been filed, Cascade Behavioral Hospital may initiate collection activities. If Cascade Behavioral Hospital initiates collection activities and thereafter discovers that an appeal has been filed, it will cease collection efforts until the appeal is finalized.
    • In the event that Cascade Behavioral Hospital’s final decision on appeal upholds the previous denial of Charity Care Eligibility, the Responsible Party and the Department of Health shall be notified in writing of the decision and the basis for the decision, and the Department of Health shall be provided with copies of documentation upon which the decision was based. Cascade Behavioral Hospital will make every reasonable effort to reach Charity Care eligibility determinations in a timely manner, and shall make such determinations at any time upon learning of facts or receiving financial documentation identified above indicating that the Responsible Party’s income is equal to or below four hundred percent of the federal poverty standard, as adjusted for family size.
    • In the event that a Responsible Party pays a portion or all of the charges related to appropriate hospital-based medical care services, and is subsequently found to have met the Charity Care criteria at the time services were provided, any payments in excess of the amount eligible for discount shall be refunded to the patient within thirty days of establishing Charity Care eligibility. If it is determined that a patient has financial resources which can be used to satisfy the medical liability but demonstrates an unwillingness to do so, the charity application will be denied.
  1. CONFIDENTIALITY:
    • All information relating to the applications will be kept confidential. Copies of documents that support the application will be kept with the application form. All records will be retained for 7 years.
  1. Attachment:

Charity Application, Financial Disclosure Form