Eligibility for Full or Partial Charity Care Discounts
Self Pay Patients whose family incomes are at or below 350% of the FPL
will be eligible for full or partial charity care discounts, depending
upon family income.
- Self Pay Patients whose family income is less than 200% of the FPL will
be eligible for a full, 100% charity care discount on services rendered.
- Self Pay Patients whose family income is between 200% and 350% of the FPL
will be eligible for a partial charity care discount on services rendered
equal to 60% of applicable cash price -- see Cash Price Policy.
The Hospital may ask the patient to complete a FAR form in order to assess
the patient’s eligibility for Self Pay or charity care discount.
- Upon the request of the Hospital, the patient may be required to document
his or her family income by submitting the most recently filed Federal
tax return or recent paycheck stubs.
Assets above the statutorily excluded amount will be considered exceeding
allowable assets and may result in the denial of a charity care discount.
However the following assets will be excluded from consideration:
- Retirement accounts and IRS-defined deferred compensation plans both qualified
- The first $10,000 of all monetary assets.
- 50% of all monetary assets above $10,000.
- The patient’s primary family residence.
- A High Medical Cost Patient is eligible for a 100% Charity Discount on
outstanding patient liability amounts if his or her family income is at
or below 350% of the FPL, and his or her out-of-pocket medical expenses
in the prior twelve (12) months (whether incurred in or out of any hospital)
has exceeded 10% of his or her family income. Eligibility for such discounts
will be reevaluated as necessary to satisfy the prior twelve month test.
- Accounts for Self Pay Patients and High Medical Cost Patients who meet
the eligibility criteria noted above for charity care discounts may be
submitted to QueensCare, a public benefit charity, or Good Hope, a private
charitable grant, when appropriate. Patients whose accounts will be submitted
to QueensCare will be required to complete and sign a QueensCare certification.
Good Hope patients will be required to pay a nominal amount towards their
greatly discounted services.
- Homeless patients (which includes all patients who indicate they have no
address) will be asked if they would accept a referral to a program such
as People Assisting the Homeless (PATH) which provides follow-up medical
care after discharge through its outpatient clinic and provides a post
office box service to facilitate follow-up communication with the patient.
GSH will provide a brochure to the patient listing the services that PATH
or a similar program provides. Homeless patients who accept the referral
to PATH or similar programs will be asked to sign the “Referral
Acceptance Confirmation Form” indicating acceptance of the referral.
The patient will be given a copy of the signed document and the signed
original will be placed in the patient’s medical record. Staff facilitating
discharge planning should make the appropriate contact with PATH or the
similar program to help arrange follow-up. The GSH discharge planner shall
send PATH or the similar program a referral form and a mailbox referral
form so that the patient can be registered for postal services and facilitate
follow-up care with GSH when the patient presents to the clinic for continuing care.
- Patients will be offered an extended payment plan if they indicate they
cannot pay their discounted bills. The terms of the payment plan will
be negotiated by the hospital and the patient. Extended payment plans
will be interest-free. If agreement cannot be reached on a payment plan,
the hospital may require payment using the “reasonable payment formula”
which “means monthly payments that are not more than 10 percent
of a patient’s family income for a month, excluding deductions for
essential living expenses. ‘Essential living expenses’ means
… expenses for any of the following: rent or house payment and
maintenance, food and household supplies, utilities and telephone, clothing,
medical and dental payments, insurance, school or child care, child or
spousal support, transportation and auto expenses, including insurance,
gas, and repairs, installment payments, laundry and cleaning, and other
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