HB 1616 — Concerning the charity care act.

H-2244.1Z-0386.1 SUBSTITUTE HOUSE BILL 1616 State of Washington 67th Legislature 2022 Regular Session By House Health Care & Wellness (originally sponsored by Representatives Simmons, Cody, Bateman, Valdez, Davis, Macri, Slatter, Pollet, and Taylor;

by request of Attorney General)General READPrefiled FIRST12/08/21. TIME 01/21/22.

Read first time 01/10/22.

Referred to Committee on Health Care & Wellness.

and amending RCW 70.170.020 and 70.170.060;70.170.060.

and creating a new section.

(4) "Charity care" means medically necessary hospital((hospital)) health care rendered to indigent persons at a hospital or clinic affiliated with a hospital 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.

(5) "Indigent persons" are those patients or their guarantors whose income is not more than 400 percent of the federal poverty level,standard, adjusted for family size,size. and who have exhausted any third- party coverage.

1 SHBHB 1616 (6) "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.

2 SHBHB 1616 Hospitals must follow reasonable procedures in making transfers to other hospitals including confirmation of acceptance of the transfer by the receiving hospital.

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, except to the extent the patient has third-party coverage for thosethose)) charges.)) charity care.

TheAt policya shallminimum, includehospitals' procedurescharity forcare identifyingpolicies patientsshall whogrant maycharity be eligible for health care coverageper through medical assistance programs under chapter 74.09 RCW or the Washingtonfollowing healthguidelines: benefit exchange and actively assisting patients to apply for any available coverage.

A(a) hospitalAll ispatients notand obligatedtheir toguarantors providewhose charityincome careis undernot thismore sectionthan to300 anypercent patientof orthe patient'sfederal guarantorpoverty ifstandard, theadjusted hospitalfor hasfamily identifiedsize, theshall patientbe asdeemed potentiallycharity eligiblecare patients for retroactivethe healthfull careamount coverageof throughtheir p.hospital charges;

3(b) SHBAll 1616patients medicaland assistancetheir programsguarantors underwhose chapterincome 74.09is RCWbetween 301 and the350 patientpercent orof the patient'sfederal guarantorpoverty refusesstandard, toadjusted apply for suchfamily coverage.p.

(a)3 AtHB a1616 minimum,size, anshall acutebe careentitled hospitalto owned or operated by a health75 systempercent thatdiscount ownsfor or operates three or more acute hospitals licensed under chapter 70.41 RCW, an acute care hospital with over 300 licensed beds located in the mostfull populousamount countyof intheir Washington, or an acute care hospital withcharges; over 200 licensed beds located in a county with at least 450,000 residents and located on Washington's southern border shall grant charity care per the following guidelines:

(i)(c) All patients and their guarantors whose income is notbetween more351 thanpercent 300and 400 percent of the federal poverty level,standard, adjusted for family size, shall be deemedentitled charityto carea patients50 percent discount for the full amount of the patient responsibility portion of their hospital charges;charges.

(ii) All patients and their guarantors whose income is between 301 and 350 percent of the federal poverty level, adjusted for family size, shall be entitled to a 75 percent discount for the full amount of the patient responsibility portion of their hospital charges, which may be reduced by amounts reasonably related to assets considered pursuant to (c) of this subsection;

(iii) All patients and their guarantors whose income is between 351 and 400 percent of the federal poverty level, adjusted for family size, shall be entitled to a 50 percent discount for the full amount of the patient responsibility portion of their hospital charges, which may be reduced by amounts reasonably related to assets considered pursuant to (c) of this subsection.

(b) At a minimum, a hospital not subject to (a) of this subsection shall grant charity care per the following guidelines:

(i) All patients and their guarantors whose income is not more than 200 percent of the federal poverty level, adjusted for family size, shall be deemed charity care patients for the full amount of the patient responsibility portion of their hospital charges;

(ii) All patients and their guarantors whose income is between 201 and 300 percent of the federal poverty level, adjusted for family size, shall be entitled to a 75 percent discount for the full amount of the patient responsibility portion of their hospital charges, which may be reduced by amounts reasonably related to assets considered pursuant to (c) of this subsection;

(iii) All patients and their guarantors whose income is between 301 and 350 percent of the federal poverty level, adjusted for family p.

4 SHB 1616 size, shall be entitled to a 50 percent discount for the full amount of the patient responsibility portion of their hospital charges, which may be reduced by amounts reasonably related to assets considered pursuant to (c) of this subsection;

and (iv) All patients and their guarantors whose income is between 351 and 400 percent of the federal poverty level, adjusted for family size, shall be entitled to a 25 percent discount for the full amount of the patient responsibility portion of their hospital charges, which may be reduced by amounts reasonably related to assets considered pursuant to (c) of this subsection.

(c)(i) If a hospital considers the existence, availability, and value of assets in order to reduce the discount extended, it must establish and make publicly available a policy on asset considerations and corresponding discount reductions.

(ii) If a hospital considers assets, the following types of assets shall be excluded from consideration:

(A) At a minimum, the first $5,000 of monetary assets;

(B) Any equity in a primary residence;

(C) Retirement plans other than 401(k) plans;

and (D) One motor vehicle used for the transportation needs of the patient or any family member of the patient.

(iii) In considering assets, a hospital may not impose procedures which place an unreasonable burden on the responsible party.

Information requests from the hospital to the responsible party for the verification of assets shall be limited to that which is reasonably necessary and readily available to substantiate the responsible party's qualification for charity sponsorship and may not be used to discourage application for such sponsorship.

Only those facts relevant to eligibility may be verified and duplicate forms of verification may not be demanded.

(A) In considering monetary assets, one current account statement shall be considered sufficient for a hospital to verify a patient asset.

(B) In the event that no documentation for an asset is available, a hospital shall rely upon a written and signed statement from the responsible party.

(iv) Asset information obtained by the hospital in evaluating a patient for charity care eligibility shall not be used for collection activities.

p.

5 SHB 1616 (v) Nothing in this section prevents a hospital from considering assets as required by the centers for medicare and medicaid services related to medicare cost reporting.

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 relevantp. and appropriate staff who perform functions relating to registration, admissions, or billing.

4 HB 1616 relevant and appropriate staff who perform functions relating to registration, admissions, or billing.