State law prohibits hospitals from denying patients access to emergency care because of the inability to pay. Hospitals are required to have a charity care policy that allows individuals below the federal poverty level (FPL) to access appropriate, hospital-based medical services, and a sliding fee schedule for determining how much an individual receiving charity care pays for their hospital visit. Patients whose family income is below 100 percent of the FPL must receive charity care for the full amount of their hospital charges, unless third-party coverage applies. Under Department of Health regulations, a patient whose family income is 101 to 200 percent of the FPL qualifies for discounts based on the hospital's sliding fee schedule. Hospitals may provide charity care to patients whose family income is over 200 percent of the FPL.
The requirements for hospitals to have a sliding fee schedule and provide charity care for the full hospital charges to patients below 100 percent FPL are replaced with new minimum requirements. Two categories of hospitals are established, each with different minimum requirements for providing charity care. Individuals up to 300 percent of the FPL are required to receive some level of charity care.
The first category includes hospitals that (1) are owned or operated by a health system that owns or operates three or more acute care hospitals in Washington; (2) have over 300 licensed beds located in the most populous county in the state; or (3) have over 200 licensed beds located in a county with at least 450,000 residents and located on Washington's southern border. For hospitals in this category, the minimum standards require patients and their guarantors whose family income is:
The second category includes all hospitals that do not meet the criteria for the first category. For these hospitals, the minimum standards require patients and their guarantors whose family income is:
For patients who are not receiving charity care for the full amount of their charges, a hospital may reduce the patient's discount based on their assets. The hospital must maintain a policy regarding such asset consideration and corresponding discounts, and make it publicly available. A hospital may not consider a minimum of $5,000 of monetary assets or $8,000 of monetary assets for a family of two and $1500 of monetary assets for each additional family member any equity in a primary residence, retirement plans other than 401(k) plans, one motor vehicle and a second vehicle when it is used for employment or medical purposes, a prepaid burial contract or plot, and a life insurance policy of $10,000 or less. Any asset considered with an early withdrawal penalty must be the value after the penalty has been paid. A hospital may not impose application procedures that are an unreasonable burden on the responsible person. Information requests to verify assets are limited to those reasonably necessary and readily available, and may not be used to discourage applications. When considering monetary assets, one current account statement is sufficient for asset verification. If no documentation for an asset is available, a written and signed statement from the party is adequate. The hospital may not use asset information for collection activities.
A hospital's charity care policy must include procedures for identifying patients who may be eligible for health care coverage through public medical assistance programs or the Washington Health Benefit Exchange. The hospital must actively assist patients to apply for any available coverage. A hospital is not obligated to provide charity to any patient or their guarantor if the patient or guarantor fails to make reasonable efforts to cooperate with the hospitals' efforts to assist them in applying for coverage. Hospitals may not impose application procedures for charity care or for assistance with retroactive coverage applications which place an unreasonable burden upon the patient or guarantor and must take into account any physical, mental, intellectual, sensory deficiencies, or language barriers which may hinder the patient or guarantor from applying for coverage. Hospitals may not require patients to apply for any state or federal program where the patient is obviously or categorically ineligible or has been deemed ineligible in the prior 12 months.
The new charity care requirements only apply to care provided on or after July 1, 2022, and care provided before that date is governed by the previous charity care requirements.
The committee recommended a different version of the bill than what was heard. PRO: This is request legislation from the Office of the Attorney General which has been heavily negotiated with the hospital association. The current charity care laws are inadequate. The bill expands the social safety net to ensure no one goes bankrupt or has their credit destroyed because they require hospital care. Many hardworking people do not have adequate insurance coverage. There are health care providers, teachers, and grocery store clerks who have served the front lines during the pandemic, have caught COVID, and aren't able to afford their hospital stays because they can't afford their deductibles and co-payments. Access to charity care is an equity issue because communities of color are often under insured. The levels of charity care hospitals provide varies. People shouldn't have to rely on luck or balance the need for care with acquiring debt. Charity care should not be a replacement for insurance and we need to make sure that the bill provides levels of charity care that are sustainable for all hospitals to support. The bill addresses the financial needs of smaller hospitals by putting them in the second tier and not requiring them to provide the same level of discounts as bigger tier 1 hospitals. We are concerned that more hospitals are included in tier 2 than should be. This allows hospitals with more resources to do less. Only critical access hospitals, sole community hospitals, and hospitals with less than 25 beds should be included in tier 2. From a rural hospital perspective who relies heavily on public payers, we request that the discount levels not extend beyond 200 percent FPL for tier 2 hospitals. Medicare does not cover all health care costs and many Medicare beneficiaries are financially burdened by health care, which is why we request that all retirement accounts, including 401ks, be excluded from the asset determination.
PRO: This is request legislation from the Office of the Attorney General which has been heavily negotiated with the hospital association. The current charity care laws are inadequate. The bill expands the social safety net to ensure no one goes bankrupt or has their credit destroyed because they require hospital care. Many hardworking people do not have adequate insurance coverage. Access to charity care is an equity issue because communities of color are often under insured. The levels of charity care hospitals provide varies. People shouldn't have to rely on luck or balance the need for care with acquiring debt. Charity care should not be a replacement for insurance and we need to make sure that the bill provides levels of charity care that are sustainable for all hospitals to support. The bill addresses the financial needs of smaller hospitals by putting them in the second tier and not requiring them to provide the same level of discounts as bigger tier 1 hospitals. Medicare does not cover all health care costs and many Medicare beneficiaries are financially burdened by health care, which is why we request that all retirement accounts, including 401ks, be excluded from the asset determination.