216-40-10 R.I. Code R. § 23.14

Current through June 12, 2024

Section 216-RICR-40-10-23.14 - Provision of Charity Care, Uncompensated Care, and Community Benefits

A. All hospitals shall, as a condition of initial and/or continued licensure:

1. Meet the statewide standards for the provision of charity care as provided in this Part;

2. Meet the statewide standards for the provision of uncompensated care as provided in this Part;

3. Meet the statewide standards for the provision of community benefits as provided in this Part;

4. Not discourage persons who cannot afford to pay from seeking essential medical services; and,

5. Not encourage persons who cannot afford to pay to seek essential medical services from other providers.

B. The Director shall, on an annual basis, review each licensed hospital's level of performance in providing charity care and uncompensated care.

C. The Director shall consider the appropriate amount of charity and uncompensated care necessary to provide safe and adequate treatment, appropriate access and balanced health care delivery to the residents of the state.

23.14.1Statewide Standards for the Provision of Charity Care

A. Every licensed hospital shall be in full compliance with the following statewide standards for the provision of charity care:

1. A hospital may expand its financial assistance beyond this Part but it shall not reduce the assistance nor restrict the qualifications further than this Part.

2. These standards apply to uninsured, low-income Rhode Island residents ineligible for state, federal or employer sponsored health insurance, and shall cover all inpatient and outpatient essential medical services routinely billed by the hospital and provided under the hospital's license, and routinely reimbursed by the Rhode Island Medicaid program(s).

3. Hospitals shall provide full charity care (i.e., a 100% discount) to patients/guarantors whose annual income is up to and including 200% of the Federal Poverty Levels (FPL), taking into consideration family unit size.

4. In addition, in order to qualify a patient/guarantor for full charity care (§23.14.1(A)(3) of this Part), a hospital may or may not also apply an assets criterion requiring that the patient's/guarantor's assets not exceed the assets protection threshold.

5. If a hospital applies the assets criterion (§23.14.1(A)(4) of this Part) in addition to the income criterion (§23.14.1(A)(3) of this Part) in determining eligibility for full charity care only, in cases where a patient/guarantor qualifies for full charity care under the income criterion but does not meet the assets criterion (i.e., has assets in excess of the assets protection threshold), the hospital must provide the patient/guarantor the highest discount offered by the hospital under §23.14.1(A)(6) of this Part on the whole hospital bill, and the maximum amount that the hospital may pursue for collection shall be the patient/guarantor's actual assets less the assets protection threshold.

6. Hospitals shall provide partial charity care (i.e., a discount less than 100%) to patients/guarantors whose annual income is between 200% and up to and including 300% of the Federal Poverty Levels (FPLs), taking into consideration family unit size. This partial charity care shall be on a sliding scale discount basis determined by each individual hospital pursuant to its own evaluation of its service area needs and financial resources. For purposes of determining eligibility for partial charity care only, hospitals may or may not also apply the assets criterion under §23.14.1(A)(4) of this Part. Should a hospital apply the assets criterion, it has the discretion in how this criterion is evaluated in determining eligibility for partial charity care.

7. Hospitals may deny charity care if the patient/guarantor does not provide the information and documentation necessary to apply for charity care or other existing financial resources that may be available to pay for the healthcare services. If a patient/guarantor is denied charity care, the hospital may place the outstanding account in bad debt status and pursue collections consistent with §§23.14.1(A)(14) and 23.14.2 of this Part.

8. The hospital shall provide public 'Notice of Hospital Financial-Aid' on forms provided by the Department. This public Notice shall be approved by the Director, no less than standard 'letter' size (8.5" x 11"), and be prominently posted in Emergency Departments, admission areas, outpatient care areas and on the hospital's website. The hospital shall also make this notice available in other languages in accordance with the applicable provisions of the "Standards for Culturally and Linguistically Appropriate Services in Health Care" incorporated in § 23.2 of this Part.

9. The hospital shall provide that same public 'Notice of Hospital Financial-Aid' on each hospital patient bill. This public notice shall be approved by the Director and may be in a size less than 8.5" x 11".

10. The hospital shall provide its 'Financial-Aid Criteria' on forms provided by the Department for qualifying patients/guarantors for charity care including information on the sliding scale discount schedule for partial charity care under §23.14.1(A)(6) of this Part. This Financial-Aid Criteria shall be approved by the Director and be made available to all persons on request. The hospital shall also make this Financial-Aid Criteria available in other languages in accordance with the applicable provisions of the "Standards for Culturally and Linguistically Appropriate Services in Health Care" incorporated in § 23.2 of this Part.

11. The hospital shall use a standardized 'Application for Hospital Financial-Aid' on forms provided by the Department or as approved by the Director in determining eligibility for full and partial charity care. With the exception of the deletion of the "Assets" Section on the Application (in cases where the hospital does not apply the assets criterion), any material changes to the Application (additions and/or deletions) must first be approved by the Director.

12. Within fourteen (14) days after receipt of a completed Application for Hospital Financial-Aid, the hospital shall render a decision on charity care and notify the patient/guarantor of its decision in writing.

13. The hospital shall have a timely Appeals Process in place should a patient/guarantor be denied charity care. This appeal process shall be set forth in writing and adopted as formal hospital policy and be made available to all persons on request.

14. The hospital shall have a Collections Process in place with this process set forth in writing and adopted as formal hospital policy, and be made available to all persons on request.

15. The hospital shall provide the Department on an annual basis or as required by the Director information including, but not be limited to:

a. The 'Annual Financial-Aid Data Filing' on forms provided by the Department or as determined by the Director;

b. The public Notice of Hospital Financial-Aid pursuant to §23.14.1(A)(8) of this Part;

c. A copy of a hospital bill including the public Notice of Hospital Financial-Aid pursuant to §23.14.1(A)(9) of this part;

d. The Financial-Aid Criteria for charity care including full disclosure of the discount schedule for partial charity care and, if applicable, how the assets criterion is evaluated in determining eligibility for partial charity care under §23.14.1(A)(10) of this Part;

e. The Application for Hospital Financial-Aid under §23.14.1(A)(11) of this Part;

f. The hospital's adopted Appeals Process under §23.14.1(A)(13) of this Part;

g. The hospital's adopted Collections Process pursuant to §23.14.1(A)(14) of this Part.

23.14.2Statewide Standards for the Provision of Uncompensated Care

A. The statewide standards for the provision of uncompensated care shall be that the hospital (or its agent(s)) may attach, but shall not force foreclosure of a patient's/guarantor's primary residence for non-payment of amounts owed (bad debt).

1. Hospitals shall report the amounts of Medicaid Shortfalls, Charity Care, and Bad Debt to the Department, as well as other financial information as determined by the Director.

23.14.3Statewide Standards for the Provision of Community Benefits

A. The statewide standards for the provision of community benefits shall be full compliance with the following:

1. Each licensed hospital shall provide on or before March 1st of each calendar year (as practicable), a report in a form acceptable to the Director, a detailed description with supporting documentation, evidence of compliance of this section including, but not limited to, the cost of charity care; bad debt; contracted Medicaid shortfalls; and any additional information demonstrating compliance with this section.

2. On and after 1 January 2001, each licensed hospital shall have a formal, Board-approved plan for the provision of community benefits. This plan shall be updated and Board-approved, at a minimum, every three (3) years. The plan shall incorporate, at a minimum, the following principles:

a. The governing body shall adopt/affirm and make public a community benefits mission statement setting forth the hospital's commitment to a formal community benefits plan;

b. The governing body, the chief executive officer, and senior management shall be responsible for the oversight of the development and implementation of the community benefits plan, the methods to be followed, the resources to be allocated, and the mechanism for regular evaluation of the plan on no less than an annual basis;

c. The governing body shall delineate the specific community or communities, including racial or ethnic minority populations, that will be the focus of its community benefits plan and shall involve representatives of that designated community or communities in the planning and implementation process;

d. The community benefits plan shall include a comprehensive assessment of the health care needs of the identified community or communities, which shall include, but not be limited to, needs related to the goals articulated in A Healthier Rhode Island by 2010: A Plan for Action, as well as a statement of priorities consistent with the hospital's resources; and

e. The community benefits plan shall specify the actual or planned dates for implementation of the activities and/or proposals included therein.

B. If the Department receives sufficient information indicating that a licensed hospital is not in compliance with § 23.14 of this Part, the Director shall hold a hearing upon ten (10) days notice to the licensed hospital and shall issue in writing findings and appropriate penalties as set forth in § 23.17 of this Part.

216 R.I. Code R. § 216-RICR-40-10-23.14