Pennsylvania Hospitals Must Notify Patients of Charity Care Eligibility

By Christopher Wolfington

Hospitals in Pennsylvania are now required to notify their patients of their eligibility for charity care due to a new definition on uncompensated care published by the Pennsylvania Department of Human Services.

Over a year prior to the new definition, the Pittsburgh Post-Gazette reported that hospitals in Pennsylvania have been using presumptive eligibility – a method that enables hospitals to quality patients for charity care status without the patient’s knowledge or cooperation – in order to shift patient’s unpaid bad debt accounts to charity care. This common practice has driven a rise in charity care spending among Pennsylvania hospitals for over a decade.

Unlike previous methods of approving patients for charity care, which depended on the patient already participating in a government program such as subsidized housing or food stamps, presumptive eligibility is determined an algorithm similar to that of a credit score. The patient’s name, address and Social Security number are used to gather all of their available financial data to determine their eligibility.

The issue with hospitals using presumptive eligibility is that it can be done without the patient’s permission or knowledge and thus allows the hospitals to neglect to notify their patients. This negatively affects the patient, as many have stated that they would be unlikely to return for follow-up care from a hospital if they believed they still owed money.

In order to resolve this issue, the Pennsylvania DHS has published a new definition of charity care on December 27, 2017 that explicitly requires Pennsylvania hospitals to notify their patients when they are eligible for charity care. The rule applies even if the hospital determined the patient’s charity care eligibility without their cooperation.

According to Sally Kozak, DHS’s acting deputy secretary for the Office of Medical Assistance Programs, “It has always been the department’s expectation that the hospitals would notify the patient of their charity care status. This [new definition] clarifies that.”

The new definition is part of the DHS’s Medical Assistance Bulletin detailing how hospitals must provide charity care to be eligible for Pennsylvania’s Tobacco Settlement program. The program reimburses hospitals who apply for a percentage of their charity care expenses. Thus, notifying patients of their eligibility is a requirement in order to receive these funds.