S-3369.2

SENATE BILL 6273


State of Washington	65th Legislature	2018 Regular Session

By Senators Cleveland, Rivers, Fain, Mullet, Palumbo, and Saldaña

Read first time 01/11/18. Referred to Committee on Health & Long Term Care.

(4) "Charity care" means medically necessary hospital health care rendered to indigent persons when third-party coverage has been exhausted, to the extent that the persons are unable to pay for the care or to pay deductibles or coinsurance amounts required by a third-party payer, as determined by the department.

(5) "Third-party coverage" means an obligation on the part of an insurance company, health care service contractor, health maintenance organization, group health plan, government program, tribal health benefits, or health care sharing ministry as defined in 26 U.S.C. Sec. 5000A to pay for the care of covered patients and services, and may include settlements, judgments, or awards actually received related to the negligent acts of others which have resulted in the medical condition for which the patient has received hospital health care services.

(6) "Sliding fee schedule" means a hospital-determined, publicly available schedule of discounts to charges for persons deemed eligible for charity care; such schedules shall be established after consideration of guidelines developed by the department.

(b) A significant reduction in the proportion of individuals admitted for inpatient hospital services for which payment is, or is likely to be, less than the anticipated charges for or costs of such services; or

(c) The refusal to admit patients who would be expected to require unusually costly or prolonged treatment for reasons other than those related to the appropriateness of the care available at the hospital.

(2) No hospital shall adopt or maintain practices or policies which would deny access to emergency care based on ability to pay. No hospital which maintains an emergency department shall transfer a patient with an emergency medical condition or who is in active labor unless the transfer is performed at the request of the patient or is due to the limited medical resources of the transferring hospital. Hospitals must follow reasonable procedures in making transfers to other hospitals including confirmation of acceptance of the transfer by the receiving hospital.

(3) The department shall develop definitions by rule, consistent with RCW 70.170.020, as appropriate, for subsection (1) of this section and, with reference to federal requirements, subsection (2) of this section. The department shall monitor hospital compliance with subsections (1) and (2) of this section. The department shall report individual instances of possible noncompliance to the state attorney general or the appropriate federal agency.

(b) A definition of residual bad debt including reasonable and uniform standards for collection procedures to be used in efforts to collect the unpaid portions of hospital charges that are the patient's responsibility.

(5) For the purpose of providing charity care, each hospital shall develop, implement, and maintain a charity care policy which, consistent with subsection (1) of this section, shall enable people below the federal poverty level access to appropriate hospital-based medical services, and a sliding fee schedule for determination of discounts from charges for persons who qualify for such discounts ((by January 1, 1990)). The department shall develop specific guidelines to assist hospitals in setting sliding fee schedules required by this section. All persons with family income below one hundred percent of the federal poverty standard shall be deemed charity care patients for the full amount of hospital charges, provided that such persons are not eligible for ((other private or public health coverage sponsorship. Persons who may be eligible for charity care shall be notified by the hospital)) third-party coverage.

(a) The hospital must offer a plain language summary of the hospital's charity care policy to patients as part of the intake or discharge process. A plain language summary must include the current federal poverty guidelines and sliding fee schedule and be available in all languages spoken by more than ten percent of the population of the hospital service area;

(b) If the hospital orally asks patients about the availability of any third-party coverage, the hospital must orally offer patients information about applicable government programs and charity care;

(c) Current versions of the hospital's charity care policy, a plain language summary of the hospital's charity care policy, the hospital's charity care application form, and the federal poverty guidelines must be conspicuously posted on the hospital's web site;

(d) All hospital billing statements and other written communications concerning billing or collection of a hospital bill must include the following or substantially similar statement prominently displayed on the first page of the statement in both English and the second most spoken language in the hospital's service area:

(f) Signage notifying patients and visitors of the availability of charity care must be available in all languages spoken by more than ten percent of the population of the hospital service area. Such signage must be clearly and conspicuously posted in at least the following locations:

(7) Hospital obligations under federal and state laws to provide meaningful access for limited English proficiency and non-English-speaking patients apply to information regarding billing and charity care. Hospitals must develop standardized training programs on the hospital's charity care policy and use of interpreter services and provide regular training for appropriate staff, including the relevant and appropriate staff who work in registration, admissions, and billing.

(8)(a) Charity care applications must be completed and submitted within two hundred forty days of the first postdischarge billing. If a patient has begun the application process during the two hundred forty-day application period, the patient has sixty days from the date of notice to complete the charity care application if the hospital provides written notice to the patient that the application is incomplete and a description of the additional information or documentation needed to complete the application. During the two hundred forty-day application period and, if applicable, the sixty-day completion period, a hospital may not report adverse information to consumer credit reporting agencies or credit bureaus in connection with a bill for medically necessary hospital health care.

(b) Hospitals may require patients to use an application process attesting to the accuracy of the information provided to the hospital and reflecting the patient's income and family size at the time the service was provided. Hospitals may also require patients to provide a supporting document regarding each family income source for purposes of determining the person's qualification for charity care.

(9) Subject to the requirements of this chapter and this section, each hospital shall make every reasonable effort to determine the existence or nonexistence of ((private or public sponsorship)) third-party coverage which might cover in full or part the charges for care rendered by the hospital to a patient; the family income of the patient as classified under federal poverty income guidelines; and the eligibility of the patient for charity care as defined in this chapter and in accordance with hospital policy. ((An initial determination of sponsorship status shall precede collection efforts directed at the patient.)) Patients who are potentially eligible for government programs must have applied for and been determined to be ineligible to receive government program coverage, including medicare and medicaid, before being eligible for hospital charity care. If denied such program coverage, the patient must provide the hospital with a copy of the denial.

(((7))) (10) The department shall monitor the distribution of charity care among hospitals, with reference to factors such as relative need for charity care in hospital service areas and trends in private and public health coverage. The department shall prepare reports that identify any problems in distribution which are in contradiction of the intent of this chapter. The report shall include an assessment of the effects of the provisions of this chapter on access to hospital and health care services, as well as an evaluation of the contribution of all purchasers of care to hospital charity care.

(12)(a) The department shall amend any existing rules established under this section to be consistent with this act and adopt rules necessary to implement the priorities established in this act including improving the notice and information provided by hospitals to patients regarding charity care, improving training regarding interpreter services and charity care eligibility, and establishing clear deadlines by which patients must complete a charity care application, taking into consideration any applicable federal requirements.

(c) The legislature's delegation of authority to the department under this act is strictly limited to the minimum delegation necessary to administer the clear and unambiguous directives of this act.