Pennsylvania law (Act 77 of 2001)provides some funding for hospitals through the state Medical Assistance program for uncompensated care. This includes direct uncompensated care or payments for extraordinary expenses. To receive these funds, hospitals (regardless of their tax-exempt status) must:
Submit annual attestation statements to the Department of Public Welfare (DPW) affirming the existence of their charity care program, their efforts to seek collection for all claims, and attempts to obtain health care coverage for patients. Virtually all eligible hospitals in Pennsylvania have complied with this requirement since it was established during 2001.
Have a charity care policy that addresses:
Patient eligibility for other public or private coverage.
Income eligibility threshold based on family size.
Consideration of other resources available to a patient or responsible party.
Patient or responsible party employment status and earning capacity.
Other financial obligations of the patient or responsible party.
Other sources of funds available to the hospital such as endowments or donations specified for charity care.
Have a plan in place to serve the uninsured and:
Accept all individuals, regardless of their ability to pay, for emergency medical screening and for stabilization services, as necessary, within the scope of the hospital’s capabilities and capacity.
Seek collection of a claim, including collection from an insurer or payment arrangements with the person who is responsible for payment of the care rendered.
Attempt to obtain health care coverage for patients, including assisting patients in applying for Medical Assistance and the Children’s Health Insurance Program (CHIP).
Ensure that an emergency admission or treatment is not delayed or denied pending determination of coverage or requirement for prepayment or deposit.
Post adequate notice of the availability of medical services and the general obligation of the hospital to provide charity care.
DPW issued a Medical Assistance Bulletinon August 30, 2010 (01-10-24), that outlines in detail the requirements for hospitals to receive uncompensated care funds, including addressing the steps that hospitals should take to provide assistance to patients applying for publicly-funded programs; a model charity care application that includes the maximum scope of information hospitals may collect from charity care applicants in determining charity care eligibility; the requirements for posting notices; and the attestation process for hospitals for purposes of compliance.