Indigent Classification (Financial Assistance)
POLICY STATEMENT
Eastland Memorial Hospital will provide medically necessary and appropriate treatment to the residents of the Eastland Memorial Hospital District who qualify for indigent care and/or financial assistance.(Charity Policy)
RULES
1. No person, regardless of ability to pay, will be refused emergency medical services at Eastland Memorial Hospital.
2. Eastland Memorial Hospital will comply with the legislation that created the District as well as Section 10.03, Indigent Health Care and Treatment Act (Art. 4438f, VTCS) regarding treatment of indigent patients.
3. All legal residents of the Eastland Memorial Hospital District are eligible to apply for financial assistance for qualified medical expenses. Qualified applicants must meet pre-established guidelines in order to receive financial assistance.
1. Must have applied for all other financial resources.
2. Must have income at or below federal poverty levels.
3. Must have a completed application.
4. Must prove residency within the Hospital District boundaries.
A. Eastland Memorial Hospital District will pay for mandatory services for eligible District residents unless one of the following conditions apply:
1. The resident is adequately covered for the services through another public or private health care source. The mandatory service is adequately covered if the health care source pays an amount equal to the Texas Department of Health payment standard for the service. Other health care sources may include, but not limited to the following: Crime Victim's Assistance, Texas Kidney Health Care, Chronically III Disabled Children Program and other third party payment eligibility through miscellaneous sources.
2. The resident is eligible for Medicaid/Medicare or would be eligible if he or she applied.
3. Eligible residents that exceed the National Poverty household income guidelines.
B. In evaluating an application for indigence, a patient's total resources will be taken into account, including but not be limited to, an analysis of assets (identified as those convertible to cash and unnecessary for the patient's daily living expenses), income and medical expenses. Income consideration is based on the current National Poverty guidelines and the number of people within the household. If a patient is eighteen (18) years of age or younger and is not emancipated, the parent's or legal guardian's income will be used in consideration of indigence. Income from supplemental security income (SSI), aid to families with dependent children (AFDC) or food stamps will not be considered in determining indigence eligibility.
C. Must complete the application paper work necessary to make a decision for financial assistance.
1. The Hospital District shall furnish each applicant with written application forms, and shall assist the applicant in completing the forms, as necessary. No application will be considered unless completed in its entirety.
2. The Hospital District shall require each applicant to sign a written statement in which the applicant swears to the truth of the information furnished.
3. The Hospital District shall utilize information from the completed application and from any source during the application process to verify income, earned and unearned, termination of income, residence, household composition and other resources.
4. The Hospital District shall notify the applicant within fourteen days of receiving a completed application. The applicant must report to the Hospital District any changes in income or resources that might affect the applicant's eligibility. Change in income or resources must be reported within fourteen days of its effective date. Should the applicant report false information or fail to report a change in status regarding income and resources, the District shall require prompt repayment of any assistance granted during the period in question. Additionally, legal action will be taken as deemed appropriate, and as advised by legal counsel, to protect the assets of the Hospital District.
5. The application determination for indigent program will be valid for outstanding accounts up to 30 days prior to the date of the application but will exclude accounts that have already been assigned to collections. The term of eligibility will be for six months and at the end of the six-month period, the resident may reapply for another six-month term.
6. In determining the residency of an applicant, a person is presumed to be a resident if his home or fixed place of habitation is located within the boundaries of Eastland Memorial Hospital District for a minimum period of ninety days. A person is not considered a resident of the Hospital District if the person attempts to establish residency solely to obtain health care assistance, or if his fixed place of habitation to which he intends to return after a temporary absence is not located within the Hospital District. A person who is an inmate or resident of any City, County, State or Federal institution is not considered a resident of the Hospital District. The burden of proving residency, or the intent to reside, is on the person requesting assistance.
4. Eligible expenses to be covered by Eastland Memorial Hospital are defined as:
1. Hospital inpatient and outpatient charges
2. Diagnostic testing associated with inpatient or outpatient charges
3. Mandatory medical services not offered at Eastland Memorial Hospital District.
a. Emergency Room charges and routine physician charges are not eligible expenses.
5. Eligible participants must utilize Eastland Memorial Hospital District's services if those mandatory services are available. If services are rendered at another health care facility, when the services could have been performed at Eastland Memorial Hospital District, the District will not pay the services.
6. Eastland Memorial Hospital District has established limitations as to the amount paid in a fiscal year (July 1 to June 30).
1. Eastland Memorial Hospital will institute a maximum liability for its fiscal year (July 1 to June 30) for each eligible District resident delivered by all providers, including hospitals and skilled nursing facilities. The maximum liability will be based on the maximum allowed by the County Indigent Health Care Program. The order of bills received will be used to pay claims.
OR
2. A total of 30 cumulative days in the state fiscal year for hospitals or skilled nursing facility care, or both, or up to a maximum payment for all mandatory services to the resident, whichever comes first.
3. In order to be reimbursable, bills must be submitted within ninety-five (95) days for services provided after the date of approval.
7. Applicants for financial assistance who are denied eligibility will be afforded an appeal process in accordance with the guidelines established in the County Indigent Health Care Program.
8. The burden of proof and production of necessary application documents as well as the cooperation of the applicant is solely the responsibility of the applicant. Applicants who fail to comply with this requirement will be deemed to have voluntarily withdrawn their application for assistance.
9. Eastland Memorial Hospital District will utilize the County Indigent Health Care Program in administering any issues that are not defined by this policy.
10. Exceptions to this policy can be granted only by the Administrator or his designee in association with an ad hoc committee of the Board of Directors established to hear and grant exceptions.