The Pagosa Springs Medical Center has developed a charity care policy and a set of guidelines that, for some in the community, will provide a breath of relief.
While PSMC has had an Upper San Juan Health Service District board-approved charity care policy in place for the past year, that policy will have to be slightly revamped to comply with the requirements of Senate Bill 12-134 which was signed into law this May. The required date that hospitals must be in compliance is Aug. 8.
At the USJHSD board of directors’ Tuesday meeting, PSMC Chief Financial Officer Dennis Wilson explained the two areas where significant changes will be seen.
“The first is based on Colorado Senate legislation. We are required to extend (charity care) to high levels of the federal poverty level,” Wilson said.
The current policy in use at the hospital has an ability-to-pay scale, which only goes up to 185 percent above the federal poverty level (FPL). This must be pushed up to 250 percent FPL.
The second area, Wilson explained, is the policy must be publicized more than it currently is.
“We will have to post it on our website and post it in public areas in the hospital,” Wilson said. The policy will also be put on billing statements for all self-pay patients. In addition, the law requires that the policy must be publicized in English and Spanish.
Wilson said he cannot yet predict all the exact ways in which this change in policy will affect the hospital, but said he knows it will.
“It will reduce bad debt and increase charity,” Wilson said, adding that this is not a bad thing.
The policy outlines, “circumstances under which charity care and financial assistance may be provided to uninsured low-income patients for medically necessary healthcare services.”
To be eligible for PSMC financial assistance and/or charity care programs, the interested parties must meet the following requirements:
• the PSMC assistance must be secondary to all other financial resources available to the patient including but not limited to insurance, third party liability payer, government and other programs;
• are not considered as a substitute for personal responsibility;
• are not applicable to patients with insurance and do not apply to deductibles and coinsurance.
Interested parties are determined eligible after their application is received and reviewed by the proper staff.
The following documents must be turned in with the completed and signed application form:
• Proof of income and assets from any source.
• Proof of denial of Medicaid eligibility (for charity care only).
• Other information deemed appropriate based on individual circumstances.
PSMC reports that charity care will be provided on a sliding scale to those patients whose gross family income is at or below 250 percent of the current federal poverty guideline. Those qualifying for partial charity care will be offered a payment plan as well.
Allow up to 90 days for PSMC staff to process an application.
This new policy was approved by the USJHSD at the board meeting. Wilson believes the hospital will not have a problem being in compliance by Aug. 8.