MORE IMPLICATIONS OF FREE CARE CHANGES

The last issue of the MGH Community News highlighted some of the proposed changes to the Uncompensated Care Pool (“Free Care”) scheduled to go into effect October 1, 2004. Additional analysis from Health Care For All notes some additional areas of concern.These proposed changes to the Pool may still be altered or eliminated. Advocates are encouraging concerned parties to contact their legislators.

Notice

Many of the notice requirements about the availability of free care are eliminated. Among the changes, hospitals are no longer required to include Pool information on patient bills, and are no longer required to post notices in languages other than English.

Billing

The prohibition on billing patients enrolled in the Pool, CMSP, Healthy Start, CenterCare and other programs is eliminated. It is unclear how and for what services institutions will bill these patients. Certainly patients who are treated at hospital-sited primary care clinics who turn out to be eligible for the pool but not MassHealth may be billed by the institution. The billing will presumably be based on charges, rather than the discounts provided to insured patients (i.e., a higher rate).

Collection Actions

The prohibition on attaching cars and homes for unpaid bills without specific approval by the hospital’s board is eliminated.

Grace Period/Retroactivity

Currently, a patient can apply for Pool eligibility up to one year after receiving services, or longer if the patient is making payments to the hospital. The proposed regulation changes the retroactive eligibility period to just 60 days before the date of application.

Implications at MGH

This is not to say that our hospital would immediately take advantage of these opportunities to bill patients, attach homes or cars or reduce the notice about the availability of Free Care. But over time, as the collective memory of current regulations dims, when faced with lean budget times there may be pressure to not exceed the letter of the law or not hold our institution to a higher standard than other institutions.

-Adapted from materials from Health Care for All: http://www.hcfama.org/index.htm?fuseaction=Page.ViewPage&PageID=357&

08/2004