HomeMy WebLinkAbout032561 RES - 09/21/2021Resolution amending the City Council Policy 29 - Charitable Care Policy for City
Emergency Medical Services specifying guidelines for waiving Emergency Medical
Services charges to increase the income requirements for patients eligible to
participate in Government Healthcare Programs from at or below 200% to at or
below 400% the Family Poverty Line.
WHEREAS, the Center for Medicare and Medicaid Services is now requiring EMS
providers to establish a Charitable Care policy in order to maintain eligibility for future
Texas Ambulance Supplemental Payment Program reimbursements;
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF
CORPUS CHRISTI, TEXAS THAT:
SECTION 1. City Council Policy 29 is amended by adding the following language that is
underlined (added) and deleting the language that is stricken (deleted) as delineated
below:
29. — Corpus Christi Fire Department Charitable Care Program
I. PURPOSE:
To provide procedures and guidelines regarding the Charitable Care Program.
II. SCOPE:
The Corpus Christi Fire Department (CCFD) is committed to providing the highest
quality care to all its patients. CCFD recognizes that some patients may be unable
to pay for all or a portion of the services provided by CCFD. In furtherance of its
mission and values, CCFD provides financial assistance to patients who meet
qualifications for financial assistance through the Charitable Care Program. No
patient will be denied financial assistance because of gender, race, creed, color,
national identity/ethnic origin, religion, age, sexual orientation or disability. In
addition, CCFD will provide, without discrimination, care for emergency medical
conditions to individuals regardless of whether they are eligible for financial
assistance.
III. DEFINITIONS:
Bad Debt: Any balance due amount submitted for payment by the guarantor that
has not paid in full and unlikely to be paid for various reasons resulting in an
uncompensated care write-off.
Family Income or Gross Income: Includes earnings, unemployment
compensation, workers' compensation, Social Security, Supplemental Security
Income, public assistance payments, veterans' payments, survivor benefits,
pension or retirement income, interest, dividends, rents, royalties, income from
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SCANNED
estates, trusts, educational assistance, alimony, child support, assistance from
outside the household, and other miscellaneous sources. Family Income is based
on definitions used by U.S. Bureau of the Census.
Federal Poverty Level ("FPL") or Federal Poverty Guidelines ("FPG"): A
measure defined by the United States Department of Health and Human Services
based on Gross Income and household size to indicate poverty threshold.
Financial Assistance: A full or partial reduction in charges incurred at CCFD and
its substantially related entities to patients for emergency or medically necessary
services who have qualified for a discounted rate in accordance with the provisions
of this Charitable Care Policy. An Uninsured Self -Pay Patient who is not eligible
for coverage through a Government Healthcare Program or other insurance, and
who has Family Income less than 200°!0100% FPG, may be eligible to receive
Financial Assistance in the form of discounted charges.
Financial Assistance Committee: A committee consisting of CCFD
administrative personnel whose purpose is to review and determine eligibility of
applicants for Financial Assistance.
Financial Assistance Deductible: The portion of a CCFD bill that is the patient's
responsibility once approved for Financial Assistance. This amount may be
determined by CCFD or its contracted EMS Billing Company as set forth in this
Charitable Care Program.
Financially Indigent: A patient who CCFD has determined to be unable to pay
some or all of the patient's bills due to the Family Income of the patient and/or the
patient's family being below specified thresholds based on the Federal Poverty
Level (FPL) and/or because their monetary assets are below specified thresholds.
Government Healthcare Program: Any healthcare program operated or financed
at least in part by the federal, state or local government, including but not limited
to, Medicare, Medicaid, Children with Special Health Care Needs ("CSHCN"), and
Children's Health Insurance Program ("CHIP").
Gross Charges: Charges that are billed to individuals receiving services at CCFD.
Presumptive Eligibility: A patient who has not submitted a completed application
for Financial Assistance, but whose circumstances fit within one or more of the
following criteria:
a. Homeless as screened by a CCFD Paramedic;
b. Qualification for Christus Spohn's, CCMC's, or Driscoll Children's
Charitable Care Policy.
c. Eligible for Governmental Healthcare Program, but not on the date of
service or for a non -covered service;
d. Enrolled in one or more Governmental Non -Healthcare Programs for low-
income individuals having eligibility criteria at or below 20-0-A4° of the
FPL;
e. Identified utilizing third party software as having eligibility criteria at or below
200%400% of the FPL.
f. Registered in the Corpus Christi Coordinated Entry Program through the
Salvation Army
IV. OVERVIEW:
CCFD or its contracted billing company will identify patients who may be eligible
for Financial Assistance through our Charitable Care Program.
A patient may also request Financial Assistance if not identified by CCFD. A patient
requesting Financial Assistance will be referred to the contracted EMS Billing
Company for guidance on the application process. A patient seeking Financial
Assistance generally must complete an application with the CCFD's Contracted
EMS Billing Company. However, if applicable, Presumptive Eligibility may be
determined in lieu of reviewing a Financial Assistance application. Patients who
meet any of the criteria for Presumptive Eligibility will be deemed eligible for a
100% discount and will not be asked to submit an application for Financial
Assistance.
A patient is only eligible for Financial Assistance after all other financial resources
available to the patient have been exhausted and the patient is without sufficient
income to cover out of pocket expenses, as determined by CCFD or its Contracted
EMS Billing Company. Existing and potential financial resources for the patient,
including but not limited to, private health insurance and any Governmental
Healthcare Program, will be reviewed.
ELIGIBILITY
1. Any patient receiving or seeking to receive emergency or medically
necessary care from CCFD may apply for Financial Assistance. If the
patient does not qualify for any Governmental Healthcare Program and
Family Income is below 200%100% of the FPL, 100% of the gross charges
will be written off according to the Charitable Care Policy. In addition to
using the FPL to determine a patient's eligibility for Financial Assistance,
the following factors will be considered:
a. Family Income: Family Income generally must fall within FPL with
consideration to family size, geographic area, and other relevant
factors.
b. If a patient may qualify for coverage, the patient must have applied
for and been denied coverage by all potential funding sources,
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including but not limited to, Medicaid, CSHCN, CHIP, Medicare (if
applicable), and/or any potential commercial program.
c. Employment Status.
d. Current Financial Obligations (e.g. medical debt, tax obligations,
child support, mortgages, student loans, etc.).
e. Good Faith: Patients are expected to cooperate with the application
process. A patient's cooperation with the application process may be
a consideration of a Financial Assistance determination
ELIGIBILITY DETERMINATION
1. A determination of eligibility for Financial Assistance is effective for six
months and is applicable toward all outstanding balances incurred during
the time period approved. Financial Assistance may be extended for a time
period longer than six months as an exception, but not longer than a twelve-
month period of time without review and approval extension.
2. If Financial Assistance is approved, Financial Assistance will apply to
balances after all third -party payments have been collected. If a patient or
any other payer source has made a payment during the period of Financial
Assistance approval, the payment(s) will be applied to the balance owed by
the patient and Financial Assistance will apply to the remaining balance.
3. The Financial Assistance Committee retains the authority to change a
previous decision regarding a patient's eligibility for Financial Assistance or
may adjust the extent of Financial Assistance on a case by case basis.
4. A patient's eligibility for Financial Assistance may be reevaluated when one
or more of the following occur:
a. Subsequent rendering of services;
b. Change in Family Income;
c. Family size change;
d. Six months has elapsed since the patient qualified for Financial
Assistance; or
e. The Financial Assistance process is not completed.
AMOUNTS CHARGED TO A PATIENT
1. If a patient/family is not eligible to participate in a Government Healthcare
Program, CCFD offers the following Financial Assistance to Uninsured Self -
Pay Patients who qualify for CCFD's Charitable Care Program.
a. With Gross Income between 0% and 200%100% of the FPL, there is a
100% discount off billed charges.
APPLICATION FOR FINANCIAL ASSISTANCE
1. A Financial Assistance application may be completed by anyone who
requests it or is identified with a need. A sample application is attached as
Appendix B — Financial Assistance Application.
2. The patient must cooperate with the application process to be considered
for Financial Assistance. If a patient does not cooperate with the application
process, Financial Assistance may be denied or revoked. The patient is
required to provide the following documentation, at a minimum: any
evidence of third -party coverage, employment status, verification of
employment and income, proof of residency, and family size.
3. Proof of household income including any of the following:
a. Most recent federal income tax returns
b. Last 2 paycheck stubs, or written verification of wages from
employer, or current W2 forms
c. Unemployment, disability, or child support payments
d. Food Stamp or SSI/SSA/SSD award letter
e. Most current 2 bank statements
f. If you report a $0 income, please attach a brief explanation of how
you are meeting basic needs.
4. A Listing of current household expenses such as Mortgage/Rent, Utilities,
Loans, Credit Cards, Food, Child Support, Medical and Auto Insurance,
Medical Bills/Medications and other types of expenses incurred each month
5. CCFD or its Contracted Billing Company will provide a written decision
regarding a patient's eligibility for Financial Assistance to the applicant
within 60 days of receipt of Financial Assistance determination. This
notification will include the discount amount approved and if payment is
expected from the patient. The notification does not include specific reasons
for the determination.
6. A patient whose Financial Assistance application has been denied may
appeal such determination. Appeals should include supporting documents
that demonstrate inability to pay that were not available or included at the
time of the initial consideration.
7. Financial Assistance applications are available at no charge.
PASSED AND APPROVED on the 131.-- day of 50toO ' , 2021:
Paulette M. Guajardo
Roland Barrera
Gil Hernandez
Michael Hunter
Billy Lerma
John Martinez
Ben Molina
Mike Pusley
Greg Smith
ATTEST:
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OF CORPUS CHRISTI
Reb-cca Huerta aulette M. Guajardo
City Secretary
Mayor
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