Testimony to Improve Charity Care Rules

On April 17, 2013, Laura Dean F. Friedrich, Director of Policy and Advocacy at Protestants for the Common Good, a unit of the Community Renewal Society, testified at the public hearing on the Proposed Rules for Hospital Financial Assistance under the Fair Patient Billing Act to the Office of the Attorney General of the State of Illinois on April 17, 2013.  Her testimony is below. Read Making Rules, Playing Fair for more information about PCG's and the Fair Care Coalition's involvement in the rule-making process. Final rules will be issued in June 2013.

Protestants for the Common Good appreciates this opportunity to comment on the Proposed Rules for Hospital Financial Assistance under the Fair Patient Billing Act.  We commend the Attorney General, Lisa Madigan, and her staff for their diligent work on this important matter for the people of Illinois.

We affirm the clear definition of “Hospital Financial Assistance” which specifies that bad debt and uncollectible charges cannot be recorded as financial assistance, and we agree with the criteria established for presumptive eligibility. We also support the clear reporting requirements for hospitals, the opening language stating that a Social Security is not required to qualify for free or discounted care, and the best-practice language requirement of having the application in every primary language of at least 5% of patients served by the hospital. These provisions will help reduce barriers to free and discounted care for low-income, un-insured or under-insured individuals and, at the same time, ensure that hospitals meet their responsibility to provide charity care.

We at Protestants for the Common Good also believe that the Proposed Rules can be improved in the following ways:

Specify the Presumptive Eligibility Process.  While the criteria for presumptive eligibility are appropriate, the rules do not clearly establish a process or timeline for determining presumptive eligibility. The rules should include language that requires that patients be asked about the presumptive eligibility criteria before being discharged from the hospital and that decisions determining presumptive eligibility be made before the patient is billed.

Simplify the application.  The application proposed in the rules is long and burdensome to patients needing free or reduced hospital care.  The application should ask only the minimum questions necessary to determine income eligibility for charity care and omit those questions more appropriately related to Medicaid eligibility.  Detailed information about employers of the applicant and his/her family members and personal expenses, among other items, should not be required.

Include an affidavit for income verification.  We support the language in the rules that allows for “other documentation provided by the patient” to verify family income, but it is unclear how patients who have no income or cash-only income should report that information.  We suggest that the rules indicate that patients in this situation can sign a simple statement saying that they have no income or receive cash from their employers to verify that they do not have the customary documentation for their incomes.

Allow only one application.  Additional language should be added to the rules indicating that a hospital may not create an additional application or add a form, e.g., a cover sheet with a list of required documents for multiple programs, to the eligibility/application process.

Revise the application certification.  The certification paragraph at the end of the application is overwhelming and intimidating.  A simple statement to the effect that the patient certifies that the information contained in the application is “true and complete to the best of my ability” should suffice.  Some hospitals are already using a short and concise statement on their applications.  We recommend that practice be applied to the universal application for the charity care process.

Protestants for the Common Good appreciates this opportunity to comment on the Proposed Rules for Hospital Financial Assistance, and we thank the Attorney General for her consideration of our recommendations.