Carrier Clinic Financial Assistance Policy

Introduction:

In connection with its mission to promote the health of the community it serves, and subject to the availability of resources, Carrier Clinic®, an NJ psychiatric hospital and recovery center, will from time to time provide Financial Assistance / Compassionate Care in the form of discounted or free care and services to uninsured or underinsured patients who are unable to pay for these health care services. In order to do so, Carrier Clinic has established this Financial Assistance Policy (FAP) to ensure that the decision to provide financial assistance is based upon uniform, objective criteria, and to ensure that processes and procedures exist for identifying and assisting patients who may be in need of such financial assistance.

Purpose:

To inform patients of the availability of financial assistance, provide an opportunity for patients to apply and qualify for financial assistance and comply with IRC Section 501(r) which includes in part the following requirements:

1. Maintaining a Financial Assistance Policy
2. Providing emergency medical care pursuant to EMTALA
3. Setting limits on amounts billed to individuals eligible for financial assistance
4. Limiting extraordinary collection activity in advance of determination of an individual’s eligibility for financial assistance

Definitions:

• “Compassionate Care or Financial Assistance” refers to financial assistance to uninsured or underinsured patients who may prove financial hardship for any deductible, co-pay, or balance not covered by their government or commercial insurance benefits, in which case they may qualify for financial assistance based on the patient’s “available household resources” as compared to federal guidelines. Financial Assistance and Compassionate Care may be used interchangeably and have the same meaning in this policy.
• “Uninsured” means the patient has no level of insurance or third party assistance to assist with meeting his payment obligations.
• “Underinsured” means the patient has some level of insurance or third party assistance but still has certain out of pocket expenses that may exceed his financial obligations.
• “Available Household Resources, (AHR)” is the sum of all income and assets earned or held by the patient and all family relatives if the patient resides with an adult relative (that is, a relative by blood, marriage or adoption), such relative(s) shall be part of the patient’s Household, and the income and assets of such relative(s), in addition to the patient’s income and assets shall be included in the determination of total AHR, whether or not the patient is claimed as a dependent on that relative(s) income tax returns. Further details of the financial categories noted herein are described further in the Application for Financial Assistance.

Policy:

1. Notice of Availability of Financial Assistance. Carrier Clinic® provides its patient’s access to Financial Assistance subject to specific personal financial conditions and resources. All patients will be informed of the availability of Financial Assistance. This is accomplished via signs throughout the hospital campus and pertinent information on the Carrier Clinic® website; and during the admissions process or before discharge, the Plain Language Summary (PLS) of this policy is provided to the patient, family, and/or guarantor as practicable.If after admission, the patient, family and/or the guarantor desires further details, they may obtain a copy of the Financial Assistance Policy and/or the Application for Financial Assistance by contacting a patient service representative, social service department representative, or after discharge, by contacting a patient services representative (908-281-1624), or may obtain such information on the Financing page of our site.
2. Applicability. Compassionate Care and Financial Assistance pursuant to this Policy shall refer to financial assistance in the provision of medically-necessary health care services and supplies by employed Licensed Independent Practitioner (LIP’s) of Carrier Clinic® to qualifying patients. Compassionate Care shall not apply to services rendered by non-employed physicians or other providers and suppliers who bill patients separately for their services and supplies at Carrier Clinic®.
3. Qualifying for Financial Assistance/Compassionate Care. Any patient seeking Financial Assistance must fully complete the Application for Financial Assistance (the “Application”), which includes providing relevant personal and family financial documentation as outlined in the Application. Decisions to consider qualification will be based on the total Available Household Resources (AHR) as compared to the United States Department of Health and Human Services Federal Poverty Guidelines (US DHHS FPG) on a sliding scale basis. AHR includes patient and family financial resources including: all sources of income, balances in checking, savings, investments and mutual fund accounts, and certain real estate other than primary residence as further defined in the Application. The Application further details the resources that will be considered in the evaluation and decision to provide Financial Assistance, which is solely based on information and documentation provided by the patient, family or guarantor.
   • Financial Assistance does not apply to any Somerset County resident who meets the criteria for medical indigence for the provision of inpatient and detoxification services and is eligible for Somerset County Chapter 51 funding grant with Carrier Clinic®.
   • The patient and/or the patient’s guarantor (if applicable) will receive a written communication upon the review of the Application and supporting documentation within 45 days from receipt of the completed Application indicating the decision with respect to that Application and any further balances due. Questions on the outcome may be directed to the Director, Patient Financial Services (908-281-1526). The Application is available while at the hospital or on the Financing page of our site.
4. Financial Assistance Discount Percentage. The amount of approved Financial Assistance will be based on a sliding scale using the documented AHR and the US DHHS FPGs, as follows: Carrier Clinic® reserves the right to modify the criteria considered in reviewing Household income and assets upon notice consistent with this Policy.
5. Calculation of Amounts Generally Billed (AGB) and Amount Due. Individuals eligible for Financial Assistance will not be charged more for emergency or medically necessary care than the AGB to individuals who have insurance covering such care. The Discount Percentage will be applied to the AGB. The AGB is determined annually per regulation. After applying the AGB adjustment, the resulting amount is then subject to the applicable Discount Percentage described in paragraph (3) above. Any remaining balance after applying the Discount Percentage will be billed to the patient and/or guarantor.
6. Effect of Non-Payment. Balances remaining after the application of the Discount Percentage are subject to timely payment consistent with standard Carrier billing and collection practices. In the event of continued non-payment, upon 30 day written advance notification, Carrier may take any and all reasonable efforts to pursue collection including use of external collection services.
7. Resource Limitation. Compassionate Care will be included in the annual budget as approved by the Board of Trustees.
8. Other Benefits Apply First. Patients may be eligible for Financial Assistance only after applicable insurance coverage and government assistance programs, including but not limited to Medicaid, have first been explored (and applied, to the extent available). Non-compliance with insurance policy guidelines (i.e., appeals, referrals, and non-authorized services) or failure to pursue available government assistance programs may preclude Financial Assistance, as determined by Carrier Clinic® in its discretion.
9. Non-Discrimination. No patient will be denied Financial Assistance pursuant to this Policy on the basis of race, creed, nationality, origin, citizenship, or immigration status. Financial assistance will be provided to the patient and his or her financial guarantor who, after an individualized examination of circumstances surrounding ability to pay, is determined to be unable to pay all or a portion of billed services or out of pocket financial responsibilities.
10. All-Inclusive Policy. No Financial Assistance shall be provided by Carrier Clinic® to uninsured or underinsured patients outside the context of this policy.
11. EMTALA Obligations Not Affected. Notwithstanding the foregoing, Carrier Clinic® will provide, through its employed Licensed Independent Practitioners without discrimination, care for Emergency Medical Conditions (within the meaning of Section 1867 of the Social Security Act (42 USC 1395dd)) to all individuals seeking such care, regardless of their ability to pay or their eligibility for financial assistance under this policy. See Carrier’s [EMTALA Policy].
12. Policy approved by Governance. This policy and all updates are reviewed and approved by organizational leadership and Board of Trustees.

To learn more about the HMH Carrier Clinic Financial Assistance Policy, please select from the following links:

• Financial Assistance Policy (FAP)
• Plain Language Summary (PLS)
• Appendix A – Listing of eligible and non-eligible providers under FAP
• Billing and Collection Policy
• Application