Phoebe approves new financial assistance policy

ALBANY — Following a look at the ongoing community needs assessment by a committee at Phoebe Putney Memorial Hospital (PPMH), the hospital’s board took action Wednesday on a new financial assistance policy, or FAP.

The Affordable Care Act created a new section of the Internal Revenue Code, and in turn created new requirements for a hospital’s tax-exempt status. By Aug. 1, Phoebe is expected to have complied with mandates including the adoption of new a community needs assessment and implementation plan, establishment of a written FAP, limitation of amounts charged for emergency or other medically necessary care and reasonable efforts to determine whether an individual is FAP-eligible before engaging in extraordinary collection actions.

Under the FAP approved Wednesday, PPMH, Phoebe Sumter Medical Center (PSMC) and Phoebe Worth Medical Center (PWMC) will be aligned under the same policy. Under the plan, free care is available to a qualified patient whose household income is at or below 125 percent of the federal poverty level.

The plan states that households with incomes ranging 126-200 of federal poverty level qualify for discounted charges. Catastrophic discounts are available to qualified individuals whose patient balance exceeds 25 percent of their household income, and uninsured qualified patients are eligible for a discount of charges for payment in full at time of service.

Phoebe officials are now tasked with widely publicizing the FAP, providing plain language summaries in English and Spanish, providing the information on Phoebe’s website, providing copies of the FAP upon request and updating signage as needed to communicate the FAP to patients and visitors.

Patients, or the legally responsible party, may request financial assistance at any time before or during the billing process. Those who have limited or no insurance, are ineligible for a federal or state program that would cover services, can prove financial need, are legal resident of the Phoebe Putney Health System service area or have less than $175,000 in assets are among those who might be eligible for assistance under the plan.

Those who refuse to apply for a state or federal health care program or a market health plan when legally entitled, have a plan of care covered under liability or worker’s compensation with no proof of denial of coverage or have a care plan covered under liability still in litigation or where the payment went to the subscriber are ineligible for assistance.

Financial assistance is not available for elective plastic surgery, services not medically necessary and services covered by state or federal agencies. For non-emergent services, application is required prior to care. The time limit to apply is 12 months from the time the patient became responsible for the balance unless the patient initiated a payment plan, the FAP states.

The application is expected to soon be available at phoebehealth.com, or from Phoebe financial counseling representatives. Patients who are asked to send more documentation will have 14 business days to do so, and an interview may be required to make a decision. If an application is denied, the patient can appeal within 30 days of the date on the letter of denial.

Prior to the board meeting, the Community Benefits Committee got an update on the ongoing needs assessment, which is expected to be voted on by the full board at PPMH in July.

Over several months, data has been compiled and interviews have been conducted to see what the priorities are and to iron out the implementation plan to address them. For this assessment, mental health, diabetes, obesity, access to care, birth outcomes, hypertension, lung cancer and health education have been among the priorities identified based on that process.

The next step will be for those priorities to be further evaluated so that three or four can be decided on for the final assessment that will go before the full boards at PPMH, PWMC and PSMC in June and July.