Charity care policy
Services eligible for charity care
The following healthcare services are eligible for charity care:
- Charity care is granted for medically necessary services only. Arbor Health, Morton Hospital recognizes appropriate hospital based services as defined by WAC 246-453-010(7) as "those hospital services which are reasonably calculated to diagnose, correct, cure, alleviate, or prevent the worsening of conditions that endanger life, or cause suffering or pain, or result in illness or infirmity, or threaten to cause or aggravate a handicap, or cause physical deformity or malfunction, and there is no other equally effective more conservative or substantially less costly course of treatment available or suitable for the person requesting the service. For the purpose of this section, "course of treatment" may include mere observation or, where appropriate, no treatment at all. For affiliated clinics and physician services, these are medically necessary services as defined by Arbor Health, Morton Hospital policy.
- Elective procedures are ineligible for charity care.
- Patients who reside outside the Arbor Health, Morton Hospital defined area are not eligible for charity care, except under extenuating circumstances, which may include but are not limited to:
- The patient requires emergent services while visiting the Arbor Health, Morton Hospital service area and meets the eligibility requirements outlined in this policy.
Eligibility for charity care
Charity care is secondary to all other financial resources available to the guarantor, including but not limited to insurance, third-party liability payers, government programs and outside agency programs. In situations where appropriate primary payment sources are not available, guarantors may apply for charity care based on the eligibility requirements in this policy.
The Arbor Health, Morton Hospital, service area is defined as Lewis County East of a line running North and South at Gore Road and the additional areas of Ashford (ZIP code 98304), Elbe (ZIP code 99330), Eatonville (ZIP code 98328), Kaposwin (ZIP code 98344), Orting (ZIP code 98360), and Graham (ZIP code 98338).
- The full amount of hospital charges will be determined to be charity care for any guarantor whose gross family income is at or below 100% of the current federal poverty guideline level (consistent with WAC 246-453), provided that such persons are not eligible for other private or public health coverage sponsorship (see RCW 70.170.060(5).
- The Arbor Health, Morton Hospital, sliding fee scale will be used to determine the amount to be written off as charity care for guarantors with incomes between 101% and 300% of the current federal poverty level after all funding possibilities available to the guarantor have been exhausted or denied and personal financial resources have been reviewed for possible funding to pay for billing charges.
- Hospital charges may be written off as charity care for guarantors with family income in excess of 200% of the federal poverty level when circumstances indicate severe financial hardship or personal loss.
Eligibility for charity care shall be based on financial need at the time of the application date unless looking back more than 18 months. If we are looking back more than 18 months we will base the financial need on the date of service income. All resources of the family as defined by the WAC 246-453-010(17) are considered in determining the applicability of the Arbor Health, Morton Hospital, sliding fee scale. Calculation of the applicable charity care discount is based on the current IRS poverty level rate.
Eligibility on a completed application is valid for eligible services received within the subsequent ninety (90) days from application approval date. If their medical condition persists at the end of the 90 days they can reapply.
Eligibility determination process
- A person seeking charity care will be given a preliminary screening and if this screening does not disqualify him/her for charity care, an application will be provided with instructions on how to apply.
- As part of this screening process Arbor Health, Morton Hospital, will review whether the guarantor has exhausted or is not eligible for any third-party payment sources. Where the guarantor's identification as an indigent person is obvious to Arbor Health, Morton Hospital, a prima-facie determination of eligibility may be made and in these cases Arbor Health, Morton Hospital, may not require an application or supporting documentation. All prima-facie determinations require approval of the hospital CFO or designee.
- A guarantor who may be eligible to apply for charity care after the initial screening will be given fourteen (14) days or such time as may reasonably be necessary to provide documentation to Arbor Health, Morton Hospital, to support a charity determination. Based upon documentation provided with the charity application, Arbor Health, Morton Hospital, will determine if additional information is required or whether a charity determination can be made. The failure of a guarantor to reasonably complete appropriate application procedures shall be sufficient grounds for Arbor Health, Morton Hospital, to initiate collection efforts.
- An initial determination of sponsorship status and potential eligibility for charity care will be completed as closely as possible to the date of service or upon request by or on behalf of the patient.
- Charity care forms, instructions and written applications shall be furnished to patients when charity care is requested, when need is indicated or when financial screening indicates potential need. All applications, whether initiated by the patient or the hospital, will be accompanied by documentation to verify the family income amount indicated on the application form. Exception: prima facie write offs.
- Household: Family size is considered in the determination. Arbor Health, Morton Hospital, further clarifies the WAC definition of family size (related by blood, marriage, adoption) to include a family as parents, children and other members of the household that are claimed as dependents on federal income taxes for the most recent filed return, e.g., If an adult child files their own taxes but lives in the home, Arbor Health, Morton Hospital, will not look at the parents' income to evaluate their financial application.
- During the initial request period, the patient and the hospital may pursue other sources of funding, including Medical Assistance, Medicare or other known resources. The patient may be requested to apply for an applicable DSHS program/Washington Apple Health. Current determination, as well as future determination, may be dependent upon the patient following through with one of the above programs. The hospital may not require a patient applying for a determination of indigent status to seek bank or other load source funding.
- In the event that the responsible party is not able to provide any of the documentation described above, the hospital shall rely upon written and signed statements from the responsible party for making a final determination of eligibility for classification as an indigent person (WAC 246-453-030(04).
- All information relating to the application will be kept confidential. Copies of documents that support the application will be kept with the application form. Documents pertaining to charity care shall be retained for five (5) years.
- Arbor Health, Morton Hospital, will notify the guarantor of a final determination within fourteen (14) business days of receiving the necessary documentation.
- The guarantor my appeal the determination of ineligibility for charity care by providing relevant additional documentation to Arbor Health, Morton Hospital within thirty (30) days of the date on the notice of denial. Within the first fourteen days of this period, Arbor Health, Morton Hospital, will not refer the account at issue to an external collection agency. After the fourteen day period, if no appeal has been filed, the hospital may initiate collection activities.
- All appeals will be reviewed and if the determination on appeal affirms the denial, written notification will be sent to the guarantor and the Department of Health in accordance with state law. The final appeal process will conclude within thirty (30) days of the receipt of a denial by the applicant.
- Any one or a combination of the following documents shall be considered sufficient evidence upon which to base the final determination of charity care eligibility:
- "W-2" withholding statement.
- Pay stubs from all employment during the relevant time period.
- Income tax return from the most recently filed calendar year.
- Forms approving or denying eligibility for Medicaid and/or state-funded medical assistance.
- Forms approving or denying unemployment compensation.
- Written statement from employers or DSHS employees.
NOTE: Additional information may be requested if the documentation does not support the patient's financial assistance application; e.g., for seasonal workers, a W-2 income-tax return may not be requested, and pay stubs alone may be used in order to ensure proper rating of the patient.
Communication of charity care
Arbor Health, Morton Hospital's charity care policy shall be made publicly available in the following ways:
- Arbor Health, Morton Hospital will display Financial Assistance Availability signage at appropriate access areas.
- Arbor Health, Morton Hospital will provide written notice of its charity care policy to patients upon request.
To apply for charity care, please visit our financial assistance page.