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To describe how Cook Children's Health Care System (CCHCS) will allocate resources for emergency and other medical care provided at Cook Children's Medical Center (CCMC) to meet the needs of patients that need financial assistance and to manage CCHCS' limited resources to appropriately provide necessary health care to:
The CCHCS primary service area is comprised of Tarrant, Johnson, Parker, Denton, Hood, and Wise counties.
In connection with CCHCS and CCMCs' exemption from certain federal and state taxes, and in support of CCCHS' mission to serve the health care needs of the community, CCHCS entities will provide charity care or financial assistance to eligible needy patients.
Information about charity or financial assistance must be widely publicized and made available to guarantors whose children have received care from Cook Children's Medical Center and:
Financial assistance may be granted to United States (U.S.) citizens or lawful permanent residents who are not residents of the CCHCS primary service area within the limitations of this policy. The application for financial assistance from these individuals will be approved in accordance with the levels of authority indicated in this policy. The approving individual(s) will review and document that the aforementioned policies were followed.
Charity and/or financial assistance will be available to all individuals that are admitted to CCMC on an emergency basis and do not have the resources to pay for the services, regardless of residency or citizenship status.
CCHCS will, through the Case Management Department, on a case-by-case basis, provide prescription medications to a patient whose family has no resources with which to fill physician prescribed medications. These medications will be dispensed in accordance with applicable state and federal statutes and will be done only for inpatients at CCMC, and/or outpatients in the hospital-based specialty clinics, and emergency room. Other CCHCS entities, also on a case-by-case basis, may provide prescription medications to a patient whose family has no resources to fill physician-prescribed medications.
CCHCS will also assist families whose children are in current treatment and require financial assistance with other aspects of a child's care which might include such things as lodging, transportation, etc. This will be done on a case-by-case basis and after all other sources of assistance have been explored or exhausted.
Charity and/or financial assistance will be granted, if qualified, without regard to gender, race, creed, color, or national origin.
CCHCS is required to make a reasonable effort to determine whether an individual is eligible for financial assistance in accordance with the terms of this policy. Eligibility must be determined no later than 240 days after CCMC provides the individual with the first billing statement for care rendered. It is the goal of CCHCS to make a charity or financial assistance determination as soon as possible after all information is collected in the application process.
There may be unique situations when a guarantor may have a financial hardship, but not meet the requirements of this policy to receive financial assistance.
Family - A group of two or more persons related by birth, marriage, or adoption; all such related persons are considered members of one family. For instance, if an older married couple, their daughter and her husband and two children, and the older couple's nephew all lived in the same house or apartment, they would all be considered members of a single family.
Unrelated individual - A person 15 years old or over (other than an inmate of an institution) who is not living with any relatives. Examples of unrelated individuals residing with others include a lodger, a foster child, a ward, or an employee.
Household - A household consists of all the persons who occupy a housing unit (house or apartment), whether they are related to each other or not. If a family and an unrelated individual, or two unrelated individuals, are living in the same housing unit, they would constitute two family units, but only one household.
Income - Total annual cash receipts before taxes from all sources, with the exceptions noted below. Income includes money wages and salaries before any deductions; net receipts from self-employment; regular payments from social security, railroad retirement, unemployment compensation, strike benefits from union funds, workers' compensation, veterans' payments, public assistance and training stipends; alimony, child support, and military family allotments or other regular support from an absent family member or someone not living in the household; private pensions, government employee pensions (including military retirement pay), and regular insurance or annuity payments; college or university scholarships, grants, fellowships, and assistantships; and dividends, interest, net rental income, net royalties, periodic receipts from estates or trusts, and net gambling or lottery winnings.
Exclusions From Income - Income does not include the following types of money received: capital gains; any assets drawn down as withdrawals from a bank, the sale of property, a house, or a car, tax refunds, gifts, loans, lump-sum inheritances, one-time insurance payments, or compensation for injury, or non-cash benefits.
Resident - An individual who is either a U.S. citizen or a lawful permanent resident and lives in the CCHCS primary service area. A lawful permanent resident is issued an alien registration card, an I-551 card, which is better known as a "green card." Persons in the U.S. on any valid visa are not considered to be residents.
Undocumented Immigrant - A non-citizen who enters the U.S. without inspection or who overstays his/her visa. Also referred to as "person not lawfully present," "illegal alien," or "illegal immigrant."
CCHCS will widely publicize information in this Financial Assistance Policy by:
Except for individuals that are admitted to CCMC on an emergency basis, to be eligible for charity or financial assistance, the individual must be a resident of either Denton, Hood, Johnson, Parker, Tarrant, or Wise county or they must be a patient of a physician that has an established relationship with CCHCS.
Accounts worked by contracted collection agencies that have been screened for financial ability to pay and are determined not to be able to pay account balances will be considered to be charity. Collection agencies will provide separate reports for accounts returned to CCHCS indicating the accounts where the guarantor does not have the ability to pay and those that have been determined to have the ability to pay but refuse NON-ELIGIBILITY FOR CHARITY CARE.
Patients may not be covered under this charity policy if they are covered by a commercial insurance company that:
Patients are ineligible if they do not provide all required information to CCHCS or to their insurance company. If the family chooses to receive non-emergency care for their child(ren) at CCHCS, even though they know the services will not be covered, the family will be responsible for payment of the estimated amount of the claim in full prior to service.
A copy of the plain language summary of this policy must be included with all (and at least three) billing statements for the care rendered and all other written communications regarding the bill provided to the individual during the notification period (i.e., the period starting the date the care is provided and ending on the 120th day after CCMC provides the individual with the first billing statement for the care).
Documentation of the following is required following a determination of financial assistance eligibility:
If any excess payments were made by the individual or any ECAs were taken against them prior to being determined eligible for financial assistance, those payments must be refunded and reasonable measures must be taken to reverse the ECAs (with the exception of the sale of Document Owner: Assistant to the President debt).
If the CCHCS does not know whether a person is eligible, it can bill the person its usual charges provided that it makes timely attempts to determine the person's eligibility and refunds excess payments if eligibility is found.
Information regarding the amount of charity care provided by CCMC each fiscal year is aggregated and reported to the Texas Department of Health in the America Hospital Association (AHA)/ Department of Health and Human Services (DHHS)/Texas Hospital Association (THA) Annual Survey of Hospitals (cooperative annual survey). It is broken down into two sections: The American Hospital Association Annual Survey and the Texas Department of Health Survey Supplement.
U.S. Department of Treasury proposed regulations See [4830-01-p] DEPARTMENT OF THE TREASURY Internal Revenue Service, 26 CFR Part 1, [REG-130266-11], RIN 1545-BK57, Additional Requirements for Charitable Hospitals, AGENCY: Internal Revenue Service (IRS), Treasury, page 52, released June 26, 2012.
Catastrophic Eligibility - Insured Patients or Patient's Income exceeds 500% of Federal Poverty Guidelines (also applies to Medically indigent).
Balance due must be equal to or greater than 35% of the patient's gross annual household income.
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