To help patients in financial difficulty, California lawmakers have moved to strengthen state requirements for hospitals to provide free or reduced-cost care.
AB 1020, which took effect in January, makes more people eligible for discounted care, raising the income levels below which hospitals are supposed to offer it to uninsured patients or those facing high costs . And he also added a simple requirement: hospitals must prominently display their financial aid policies on their websites.
“You shouldn’t need a lawyer to get what hospitals are required to give by law,” said Tracy Douglas, a Bet Tzedek attorney who works on a Harbor-UCLA medical-legal partnership team. Medical Center. “That’s what the AB 1020 aimed to solve.”
Yet more than nine months after the California law took effect, some hospitals still had not posted their charitable care policies in easily visible places on their websites, the Times found after reviewing the websites. state hospitals. Several updated their pages or said they would after being contacted by The Times.
CHA Hollywood Presbyterian Medical Center, located in East Hollywood, said in October that it had a charitable care policy as required by law, but “this policy is not on our public website.” When The Times pointed out that state law required it to be posted prominently online, a hospital spokesperson quickly shared the policy and said it would be posted within days.
Natividad, a public hospital in Salinas, briefly mentioned in the billing section of its website that it provides financial assistance, including charitable care, but did not have a link to its policy as of late October.
Its chief financial officer, Daniel Leon, said he has been working on revising its policy and expects it to be posted on its website within 45 days. Leon said patients were nonetheless informed of the charity care and payment reductions in several ways, “including materials at admission, signage in the lobby, signage on the website, and information on the patient manual”.
Arrowhead Regional Medical Center in Colton added a link to its charitable care policy on its website after being contacted by a Times reporter. Kern Medical has also added a link to its Charitable Care Policy on its “Make a Payment” page over the past few weeks; Internet Archive screenshots show that the link was not posted there at the end of September.
And Zuckerberg General Hospital in San Francisco has a section on its website that encourages patients to contact financial advisers, but its charitable care policy was not posted there as of late October.
When The Times asked where to locate it, a ZSFG spokesperson provided a link to where it was posted on the California Healthcare Access and Information website – another requirement in under AB 1020 – but acknowledged it was not yet on the hospital’s website. mid-October. He recently added a link to access the policy on this page.
Bernadette Manigault, senior attorney for Los Angeles County Neighborhood Legal Services, said she was “surprised but not surprised” that some hospitals hadn’t posted their charitable care policies on their websites months after the entry into force of the law.
Prior to the passage of the new law, hospitals were already required to “clearly and prominently” post notices of their financial assistance policies in “places visible to the public,” including their billing offices, but Legal aid groups had still encountered patients who were ignorant.
It can be “incredibly hard to find for the average consumer,” Manigault said. “They have these policies – but you really have to know how to get there.”
In late October, The Times was also unable to find a charitable care policy on the websites of Southern California hospitals in Culver City and Hollywood after checking its “billing” pages and searching for them. Site (s. Nearly three weeks after a reporter asked where they had been posted online, after repeated requests, a spokesperson provided links to webpages on legal protections against surprise bills, which included a single link titled “Charity Care Policy” at the bottom. (It’s unclear when these links were first added; a spokesperson for Southern California Hospitals did not answer this question.) The hospital recently updated its billing pages to mention more prominently charity care policies.
The California Hospital Assn., which provided hospitals with a summary of the new rules, said it had not heard from regulators or hospitals themselves of widespread AB 1020 compliance issues. External Affairs Jan Emerson-Shea said when state regulators alerted hospitals to the requirements of the new law last winter, healthcare facilities were facing a surge in COVID cases and continuing to do faced with staff shortages.
Emerson-Shea said it’s possible that “some of these things have unfortunately been overlooked…but I don’t think there are widespread issues with hospitals not wanting to do that.”
Leon, Natividad’s chief financial officer, said the rules came into effect during the winter surge of COVID patients, and “our priority was to take care of them”.
Liliana Viamari, spokesperson for CHA Hollywood Presbyterian, said her website had previously asked families in need of financial assistance to contact her family advocates, but the hospital was hit hard by COVID early on. of the year and also had new funding. staff starting at that time, “making this detail of the requirement forget”.
“These apologies are in no way…they should have been posted on our website,” Viamari said in an email. “We are happy that this has been corrected.”
Helen Tran, senior counsel at the Western Center on Law and Poverty, said that while hospitals haven’t posted their charitable care rules on their websites, “I’m also concerned about what’s going on inside the hospital. ‘hospital’, as AB 1020 also requires changes in other hospital practices regarding debt collection and discount eligibility.
“It’s the simplest of requirements,” said Anthony Wright, executive director of Health Access California, a consumer advocacy coalition. “If they don’t do that, then I worry about the other things.”
The Times also found that some hospitals had information on their websites that did not reflect the increased eligibility for discounted care under AB 1020. In early November, Loma Linda University Medical Center reported stated on its website that patients earning 350% or less of the federal poverty level could be eligible for discount payments.
AB 1020 requires patients to be eligible for discounts if their income is at or below 400% of the federal threshold and they are uninsured or have high medical costs.
A spokesperson for Loma Linda University Medical Center did not respond to questions about whether the document that was posted online was its current policy, but said in a brief statement that it was in compliance. to state law, eligible patients were told they could get financial assistance. , and “website updates are in progress”.
The Salinas Valley Memorial Healthcare System also said, in a financial assistance policy posted on its website in late October, that patients could be eligible if their household income was below 350% of the federal poverty level and they met other conditions. After being alerted to the problem by The Times, the hospital updated its link to a new policy with a 400% threshold, which a representative said had already been used by its financial aid counselors.
In addition to increasing eligibility for discounted care, AB 1020 also prohibits hospitals from selling patient debt unless they have determined that indebted patients are ineligible for financial assistance or have not responded to attempts to bill them or offer assistance and require patients to be sent requests for financial assistance before their bills are sent to collections.
Under the law, the California Department of Health Care Access and Information is supposed to review hospital policies to see if they comply with the law by January 1, 2023. when that department State can start penalizing hospitals for violations.
Until then, complaints about hospitals’ failure to comply with the law are still being filed by the California Department of Public Health, which said it had no record of the hospitals it investigated and found. improper. Tran said his organization had filed complaints and the agency had not substantiated its findings of no wrongdoing.
Assemblywoman Laura Friedman (D-Glendale), who introduced AB 1020, said “the fact that some hospitals are still failing to make basic information available to patients and the public is frustrating and reinforces the need for more robust monitoring outlined in AB 1020.”
The new law expands on the Hospital Fair Pricing Act passed by California lawmakers in 2006, which required hospitals to maintain written policies on charitable care for qualified patients and set minimum requirements for who should be eligible for to apply. A study published in Health Affairs found that between 2004 and 2012, prices paid by uninsured patients dropped significantly.
Yet legal aid groups complained that in many cases eligible patients were unaware they could access charity care.
A Kaiser Health News survey three years ago found that across the country, nearly half of nonprofit hospital organizations routinely send medical bills to patients whose incomes are low enough to qualify them for charitable care. Hospital data compiled by Kaiser Health News included facilities in California.
In June, months after AB 1020 went into effect, California Atty. General Rob Bonta issued a consumer alert and sent letters to hospitals after hearing complaints that hospitals were not meeting requirements to provide charitable care policies in language patients understand.
A spokesperson said the bureau was unable to confirm or deny whether an investigation was ongoing in October, but “stands ready to enforce the law and use all the tools we have to help us.” ensure that patients and their families do not have to suffer unnecessarily”. high medical bills or being forced to choose between going to a doctor or being able to pay bills.
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