WAC 246-453 RULES WORKSHOP 1Community Health Systems/Hospital Charity Care and Financial Data

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Rules Workgroup Agenda

• Welcome and introductions• Rulemaking process and timeline• Current requirements under chapter 246-453 WAC and

chapter 70.170 RCW• SHB 6317 changes to 70.170 RCW • Potential conflicts between existing WAC and new

language in RCW• Dates and locations of future rules meetings• How to submit suggested changes

RULEMAKING PROCESS AND TIMELINE

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Rulemaking Process

Administrative Procedures Act - Rulemaking consists by law of three parts:

Step Process Activity

CR101 Preproposal inquiry Public outreach and stakeholder work occurs (workshops, drafts, informal input).

CR102 Proposal Theproduct that goes forward for public hearing and final testimony from the public.

CR 103 Adoption Final rule is adopted, filed with the Code Reviser’s Office, and becomes effective 31 days later unless another effective date is specified in rule.

WHAT RULES ARE BEING DISCUSSED?HOW DO I PARTICIPATE?

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What Rule(s) Will Be Discussed for Possible Revisions?

WAC 246-453 Hospital Charity Care is opened under a CR-101 for consideration of possible revisions.

The Department of Health (department) is considering updating the chapter to bring it into compliance with changes to RCW 70.170. New sections may be added as required.

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Rules Process – Roles and Responsibilities

Members of the public, interested parties, and stakeholders offer recommendations to DOH staff for possible rule revisions, repeals, or new language to existing rules.

DOH Program Staff take all public comments and recommendations into consideration, develop drafts and proposed rules in accordance with the Administrative Procedure Act (chapter 34.05 RCW).

Secretary must review and approve proposed and final rules for adoption. (RCW 18.130.065)

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Rule Development Timeline

TentativeDate Process Step Activity

AUG 2018 CR101 Announces possible rule making to address a certain issue.

OCT 2018 –JAN 2019 (estimate)

Stakeholder work Public outreach and stakeholder work occurs (workshops, drafts, informal input).

FEB 2019 CR102 The formal proposed rule is developed.

MAR 2019 –MAY 2019

Public commentperiod and hearing

Rules public hearing held and all written comments received.

JUN 2019 CR103 Final rule adoption and rules package developed .

JUL 2019 CR103 filed CR-103 is approved by the Secretary for filing with the Code Reviser.

AUG 2019 Rules effective Anticipated rule effective date. A rule becomes effective 31 days after it is filed with the Code Reviser.

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New Language in Statute

RCW 70.170.020 Definitions:(4)”Charity care" means medically necessary hospital health care rendered to indigent persons when third-party coverage, if any, 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.

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New Language in Statute

RCW 70.170.010(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 service. The pendency of such settlements, judgments, or awards must not stay hospital obligations to consider an eligible patient for charity care.

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New Language in Statute

RCW 70.170.060(5):…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 hospitalexcept to the extent the patient has third-party coverage for those charges.

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New Language in Statute

RCW 70.170.060(6):(6) Each hospital shall post and prominently display notice of charity care availability. Notice must be posted in all languages spoken by more than ten percent of the population of the hospital service area. Notice must be displayed in at least the following locations:(a) Areas where patients are admitted or registered;(b) Emergency departments, if any; and(c) Financial service or billing areas where accessible to patients.

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New Language in Statute

RCW 70.170.060(7):Current versions of the hospital's charity care policy, a plain language summary of the hospital's charity care policy, and the hospital's charity care application form must be available on the hospital's web site. The summary and application form must be available in all languages spoken by more than ten percent of the population of the hospital service area.

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New Language in Statute

RCW 70.170.060(8):(8)(a) All hospital billing statements and other written communications concerning billing or collection of a hospital bill by a hospital must include the following or a 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:You may qualify for free care or a discount on your hospital bill, whether or not you have insurance. Please contact our financial assistance office at [web site] and [phone number].(b) Nothing in (a) of this subsection requires any hospital to alter any preprinted hospital billing statements existing as of October 1, 2018.

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New Language in Statute

RCW 70.170.060(9):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 shall 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 perform functions relating to registration, admissions, or billing.

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New Language in Statute

RCW 70.170.060(10):(10) Each hospital shall make every reasonable effort to determine the:(b) The annual family income of the patient as classified under federal poverty income guidelines; as of the time the health care services were provided, or at the time of application for charity care if the application is made within two years of the time of service, the patient has been making good faith efforts towards payment of health care services rendered, and the patient demonstrates eligibility for charity care; and(c) 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.

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New Language in Statute

RCW 70.170.060(11):At the hospital's discretion, a hospital may consider applications for charity care at any time, including any time there is a change in a patient's financial circumstances.

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Conflicts between new law and old rule

Charity Care in RCW 70.170.020(4):"Charity care" means medically necessary hospital health care rendered to indigent persons when third-party coverage, if any, 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.

Charity Care in WAC 246-453-010(5):(5) "Charity care" means appropriate hospital-based medical services provided to indigent persons, as defined in this section;

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Conflicts between new law and old rule

“Medically Necessary” in statute vs. “Appropriate hospital-based medical services in rule:WAC 246-453-010(7) "Appropriate hospital-based medical services" means those hospital services which are reasonably calculated to diagnose, correct, cure, alleviate, or prevent the worsening of conditions that endanger life, or cause suffering or pain, or result in illness or infirmity, or threaten to cause or aggravate a handicap, or cause physical deformity or malfunction, and there is no other equally effective more conservative or substantially less costly course of treatment available or suitable for the person requesting the service. For purpose of this section, "course of treatment" may include mere observation or, where appropriate, no treatment at all;

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Conflicts between new law and old rule

Third-party coverage in RCW 70.170.010(4):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 service. The pendency of such settlements, judgments, or awards must not stay hospital obligations to consider an eligible patient for charity care.

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Conflicts between new law and old rule

Third-party coverage in WAC 246-453-010(9):"Third-party coverage" and "third-party sponsorship" means an obligation on the part of an insurance company or governmental program which contracts with hospitals and patients 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 services;

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Conflicts between new law and old rule

RCW definition compared with WAC Definition:"Third-party coverage" and "third-party sponsorship" means an obligation on the part of an insurance company, health care service contractor, health maintenance organization, group health plan, or governmental program, tribal health benefits, or health care sharing ministry as defined in 26 U.S.C. Sec. 5000A which contracts with hospitals and patients 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 services; The pendency of such settlements, judgments, or awards must not stay hospital obligations to consider an eligible patient for charity care.

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New language in RCW – are rules needed?

Public notice (RCW 70.170.060)(6)and (7) – do they conflict with or pre-empt rule?

Billing Statements RCW 70.170.060(8)

Standardized training RCW 70.170.060(9)

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New language in RCW – are rules needed?

RCW 70.170.060:(10)(b) The annual family income of the patient as classified under federal poverty income guidelines; as of the time the health care services were provided, or at the time of application for charity care if the application is made within two years of the time of service, the patient has been making good faith efforts towards payment of health care services rendered, and the patient demonstrates eligibility for charity care; and,…(11) At the hospital's discretion, a hospital may consider applications for charity care at any time, including any time there is a change in a patient's financial circumstances.

Questions?

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Meeting Locations

Unless otherwise announced, the meetings will be held at Department of Health Tumwater campus:

Department of Health 111 Israel Road

Tumwater, WA 98501

Webinar access for all meetings will be sent out via the Charity Care Rule Making GovDelivery account.

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How to Stay Informed• Visit DOH Website• Subscribe to GovDelivery • Email comments to

CharityCare@doh.wa.gov• Attend workgroup meetings• Contact DOH Charity Care Staff

@WADeptHealth

Hospital Charity Care and Financial Data Manager

Office of Community Health Systems

Program Contact

Randy Huyck

CharityCare@doh.wa.gov

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800-525-0127 or by email at civil.rights@doh.wa.gov. TTY users dial 711.