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 AHA Guidelines
 Access Project Testifies  at Congressional  Hearing: Medical  Bankruptcy and Medical  Debt (2007)
 Access Project Testifies  at Congressional  Hearing: Hospital Billing  and Collection Practices  (2004)

 HHS Guidance on  hospital discounting for  uninsured patients
 Senate Finance  Committee  Recommendations
 Research:

  • Make public and available their charges for services
  • Review current charges to ensure that they are “reasonably related to both the cost of the service and to meeting all of the community’s health care needs”
  • Provide financial counseling to patients about their hospital bills
  • Have understandable written policies to help patients determine if they qualify for public assistance or hospital-based assistance programs
  • Ensure that all written policies for assisting low-income patients are applied consistently, and share them with appropriate community health and human services agencies and other organizations that assist people in need
  • Educate hospital staff about these policies
  • The amounts of charity care provided by non-profit hospitals may not differ significantly from the amounts provided by for-profit hospitals;
  • The provision of charity care among non-profit hospitals varies widely, with some hospitals providing a great deal of charity care and others providing almost none;
  • Current Internal Revenue Service (IRS) standards that define what hospitals must do to receive tax-exemptions are extremely vague and do not hold hospitals to any quantifiable standards.
  • Non-profit hospitals must develop charity care policies and make them widely available on hospital websites, in emergency rooms, in admissions office, in a manner that is easily understandable by the general public. They should make written copies available to all members of the public upon request.
  • Non-profit hospitals should provide medically necessary inpatient and outpatient hospital services free of charge to all patients below the Federal Poverty Level (FPL).
  • In addition, nonprofit hospitals should provide discounts to low-income uninsured or medically indigent underinsured individuals. (Underinsured patients are those who spend ten percent or more of their income on medical expenses (or five percent for lower-income patients), or whose deductibles equal five percent or more of their income.) Charges for these individuals should not be higher than the amount paid by the government or the actual hospital cost of care, whichever is lower.  At a minimum, these rates should be offered to individuals with incomes between 100 and 200 percent of FPL.
  • Charity care would also include medical care provided through free clinics or other institutions to vulnerable populations.
  • Non-profit hospitals should dedicate a minimum of five percent of their annual patient operating expenses or revenues to charity care, whichever is greater.
  • The value of the uncompensated care will be based not on full charges, but rather on a rate that equals the lowest rate that would be paid by Medicare or Medicaid or the actual cost of the care, whichever is lower. This prevents hospitals from grossly inflating the amount they claim to devote to uncompensated care.
  • Bad debt will not count as charity care. This recommendation recognizes that it is inappropriate for a hospital to characterize unpaid bills as charity care, since patients may still face serious financial consequences if the bills appear on their credit records.
  • The Federal Debt Collection Practices Act, which protects those with debt from unfair or abusive debt collection practices, should be expanded to apply not only to external debt collection agencies, but also to internal hospital billing and collection departments.
  • Staff is also considering whether specific aggressive collection practices against uninsured or medically indigent underinsured patients should be banned or restricted.
  • All non-profit and government hospitals should report annually to the IRS and the public a range of information, such as total patient operating expenses and revenues; total amount of charity care provided, the number of people who applied for care, and the number of people who received such care; the total amount of community benefits provided; amounts reimbursed by private and governmental insurers, and amounts paid to the hospital from special indigent funds, such as charitable care pools.
  • These hospitals should also make publicly available the surveys they use to establish executive salaries.
  • Non-profit hospitals that fail to provide the required aggregate amounts of charity care will be subject to a tax equal to at least twice the amount of the shortfall.
  • The IRS could revoke the tax exempt status of a non-profit hospital that fails to meet any applicable requirements.