Comanche County Medical Center (CCMC) will provide necessary medical care without regard to race, creed, color, national origin, or financial status. Financial assistance only applies to services provided by CCMC. Emergency medical services will be provided regardless of the patient's ability to pay. All patients that present to the Emergency Room are seen and provided a medical screening exam to determine if they have an emergency medical condition as required by EMTALA before obtaining any financial information from the patient. While financial assistance does apply to most diagnostic services, elective surgeries will be evaluated on a case by case basis. Based upon the financial assistance rating, amounts estimated to be due from the patient must be paid in advance.
Financially Charitable: A financially charitable patient is a resident of Comanche County and those patients that present at CCMC, including the clinic, emergency services, inpatient and outpatient services, who are uninsured or under-insured. Patients that are not residents of Comanche County receiving care for an emergency medical condition through the emergency department may be eligible for financial assistance based upon individual circumstances and residence, and are encouraged to complete the application for financial assistance. Those patients that do qualify for financial assistance will receive significant discounts based upon criteria set forth in the policy. In the case of the uninsured patient who qualifies as financially charitable we have a sliding scale based upon Medicare rates. In the case of an under-insured patient, there are regulatory and contract restrictions with which CCMC must abide regarding discounts of co-pays and deductibles required by your insurance plan.
To be eligible for charity care, a person's income and family size will be compared to the current federal poverty guidelines. CCMC will consider other financial assets and liabilities of the person when determining eligibility. A charity discount schedule which indicates the amount of discount for which a patient is eligible is attached and will be used to determine the percentage discount for which the patient is eligible. The sliding scale is based on the federal poverty income guidelines and will be reviewed and updated annually.
CCMC will not establish eligibility criteria for charity patients which set the income level for charity care lower than required for counties under the Texas Indigent Health Care and Treatment Act, or higher than 250 percent of the federal poverty income guidelines. CCMC may, however, adjust the eligibility criteria from time to time based on the financial resources of CCMC and as necessary to meet the charity care needs of the community.
Medically Charitable: A patient is medically charitable when the Medical Debt, after any payment by third-party payers, exceeds 33% of the patient's annual household gross income (based on most recent income tax return) and who is expected to be unable to pay the account in full over a two year period. CCMC will consider other financial assets and liabilities of the person when determining the ability to pay. A charity adjustment will be made to reduce the financial obligation to 33% of the patient's annual household gross income.
If a determination is made that a patient does have the ability to pay the remainder of the bill, this does not prevent a reassessment of the patient's ability to pay at a later date when financial circumstances have changed.
If a patient has Medicaid or Medicare/Medicaid and for some reason the medical service is not covered, the charges for the uncovered service may be considered for Charity Care for those medically necessary services.
Indigent Health Care Program: A patient qualifies for the Indigent Health Care Program who is a resident of Comanche County, a U.S. resident, and meets strict income guidelines set forth in the Texas County Indigent Healthcare Program. The Indigent Health Care Program is governed by a separate policy and guidelines. Failure to report changes in income or assets within fourteen days can result in cancellation of eligibility for financial assistance.
Medical Debt: For purposes of this policy the term Medical Debt for uninsured patients is defined as the lower of billed charges or the amount Medicare fee schedule (Parts A&B) would pay for all services provided to the patient. For purposes of this policy, all amounts due from the patient or household should be considered in determining Medical Debt.
Sliding Scale: The schedule which determines the Applicable Discount Rate to be applied to Medical Debt to determine the remaining Patient Balance.
Patient Balance: The balance due from patient or guarantor after all appropriate charity adjustments and/or discounts are applied which the patient is expected to pay as the final result of application of this policy. Payment of this estimated balance may be requested at time of service for non-emergent services.
Identification of Charity Cases
CCMC will post a notice of its Financial Assistance Policy and the application with instructions on how a patient may apply for Financial Assistance on the CCMC website.
Business Office personnel will handle those patients who may qualify for financial assistance. Patients who are eligible for Medicaid and any other indigent health care programs do not qualify as charity, however any items not covered by Medicaid will be considered as charity. To be eligible for financial assistance, the Medicaid denial letter must be provided with the financial assistance application unless the patient completes the Medicaid eligibility screening questionnaire (Exhibit B) provided by the Business Office. If the Business Office personnel determine the patient is not eligible for Medicaid, then a Medicaid denial letter is not required to qualify for financial assistance.
As soon as sufficient information is available concerning the patient's financial resources and eligibility for governmental assistance, a determination will be made concerning the patient's eligibility for charity. Collection efforts will be suspended on a charity account after such determination is made. Patients identified as possible charity cases will be asked to complete a financial assessment form (Exhibit A). Identification of patients in need of financial assistance may occur after medical care has been provided. In those cases, a retroactive adjustment will be made to the patient's account.
The following factors may be considered in determining the eligibility of the patient for charity care:
Employment status and future earning capacity other financial resources Other financial obligations
The amount of Total Bills and frequency of medical bills.
The federal poverty income guidelines are included in this policy as Attachment 3. The definitions of "family", "Income", and "exclusions from income" are included in the poverty guidelines and will be used in all charity eligibility determinations. The federal poverty income guidelines will be revised and updated annually as provided by the federal government.
Failure to provide information necessary to complete a financial assessment may result in a negative determination, but the account may be reconsidered upon receipt of the required information. A determination of eligibility for charity may be made without a completed assessment form if the patient or information is not reasonably available and presumptive eligibility is warranted under the circumstances.
A determination of eligibility will be made by CCMC within 15 working days after receipt of all information necessary to make a determination.
Once an eligibility determination has been made, the results of the determination will be noted in the computer. A copy will be filed in the business office. A determination notice will be sent by CCMC to the patient.
Information regarding the amount of charity care provided by the CCMC in its fiscal year will be aggregated and included in CCMC's annual report filed with the Bureau of State Health Data and Policy Analysis at the Texas Department of Health.
The eligibility period is six months from the date of the qualifying service. After six months, persons who previously qualified for assistance will need to re-apply.
Amounts charged for medical care are limited to not more than the amounts generally billed (AGB) to patients with insurance covering such care.
Billing gross charges to a patient eligible for financial assistance is strictly prohibited. Patients who qualify for financial assistance will be based on the applicable Medicare fee schedule.
Extraordinary collection actions, such as authorizing our collection agencies to report to credit agencies and place liens, will not take place for 120 days that the patient is allowed to request financial assistance and should the patient request financial assistance an additional 120 days will be allowed for the return of the completed applications. The CEO, CFO, and Business Office Manager will consider the patient's ability to pay and effort made to apply for financial assistance and make additional payment arrangements for the discounted balance before approving extraordinary collection actions.
After consideration of all the factors above, the Applicable Discount Rate will be determined according to the Sliding Scale for the patient and members of their household (if any) to determine the remaining Patient Balance which patients will be expected to pay.
Comanche County Medical Center reserves the right to administer and interpret this policy as necessary for the efficient operations of all its facilities and may amend this with or without notice.
Comanche County Medical Center reserves the right to administer and interpret this policy as necessary for the efficient operations of all its facilities and may amend this policy with or without notice.