H0078B0067A00936 LKK:EJH 06/13/23 #90 A00936
AMENDMENTS TO HOUSE BILL NO. 78
Sponsor: REPRESENTATIVE FRANKEL
Printer's No. 67
Amend Bill, page 1, line 1, by inserting after "Program;"
establishing requirements for hospital-based financial
assistance; and
Amend Bill, page 1, line 2, by striking out "; and making an
appropriation"
Amend Bill, page 1, line 14, by inserting after "provider"
or commercial debt collection agency
Amend Bill, page 2, by inserting between lines 1 and 2
"Eligible patient." An individual who meets all of the
following requirements:
(1) Is a resident of this Commonwealth.
(2) Can demonstrate an inability to pay the cost of
medical care even after the application of payments for
third-party health coverage.
(3) Provides financial information and documentation
showing that their income and assets make them eligible for
hospital-based financial assistance under the policies of the
hospital and of this act.
Amend Bill, page 2, by inserting between lines 13 and 14
"Hospital-based financial assistance." Financial assistance
provided by hospitals to patients that includes charity care or
discounted care where the cost of care ordinarily charged by a
hospital is provided free of charge or at a reduced rate or a
hospital relieves an eligible patient's medical bill in part or
in full based on eligibility criteria.
Amend Bill, page 2, line 14, by striking out "Debt" and
inserting
An obligation to pay money
Amend Bill, page 2, by inserting between lines 15 and 16
"Medical debt relief." The discharge of a patient's medical
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debt.
Amend Bill, page 2, by inserting between lines 19 and 20
"Primary language." A language that is the preferred
language for communication during at least 5% of the annual
patient visits by patients who do not have the proficiency in
English necessary to speak, read and write about health care-
related matters.
Amend Bill, page 2, line 22, by striking out all of said line
and inserting
"Public health coverage option." A program administered by
the Department of Human Services, including Medical Assistance
and the Children's Health Insurance Program, and by the
Pennsylvania Health Insurance Exchange Authority.
Amend Bill, page 2, line 29, by striking out "allocated" and
inserting
appropriated
Amend Bill, page 2, line 29, by inserting after "the"
department for the
Amend Bill, page 3, line 21, by inserting after "each"
commercial debt collection agency or
Amend Bill, page 3, lines 24 through 28, by striking out "If
a health care provider identifies the" in line 24, all of lines
25 through 27 and "resident, the" in line 28 and inserting
The
Amend Bill, page 3, line 29, by inserting after "the" where
it occurs the second time
commercial debt collection agency or
Amend Bill, page 3, line 30, by striking out the period after
"provider" and inserting
that identifies the accounts described in
subparagraph (i) as a bad debt expense.
Amend Bill, page 4, line 2, by inserting after "a"
commercial debt collection agency or
Amend Bill, page 4, line 7, by inserting after "provider"
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or commercial debt collection agency
Amend Bill, page 4, line 11, by inserting after "receiving"
medical debt
Amend Bill, page 5, line 7, by striking out "Reports" and
inserting
Reporting on program
Amend Bill, page 5, line 19, by inserting after "received"
medical debt
Amend Bill, page 5, lines 23 through 25, by striking out all
of said lines and inserting
(4) The number of patients whose debt was discharged
that qualified for hospital-based financial assistance or a
public health coverage option.
(5) The number of eligible residents whose income was
calculated at 100%, 150% or 200% of the Federal poverty
level.
Amend Bill, page 5, line 26, by striking out "(5)" and
inserting
(6)
Amend Bill, page 6, lines 12 through 14, by striking out all
of said lines and inserting
Section 5. Hospital-based financial assistance forms and
policies.
(a) Forms.--The department shall develop the following forms
and make them available to hospitals and the general public:
(1) A uniform application for financial assistance that
shall be used in every hospital in this Commonwealth to
determine if an individual is an eligible patient.
(2) A uniform one-page template all hospitals shall use
to summarize eligibility information for financial
assistance. At a minimum, the summary shall include:
(i) Income eligibility guidelines for hospital-based
financial assistance expressed as both a percent of the
Federal Poverty Income Guidelines and a dollar amount
based on common household sizes.
(ii) Information about the limits on amounts and
type of assets.
(iii) Information on income eligibility guidelines
for a public health coverage option expressed as both a
percent of the Federal Poverty Income Guidelines and a
dollar amount based on common household sizes and how to
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apply for those coverage options.
(iv) Contact information for how to apply for
hospital-based financial assistance and how to get help
applying for hospital-based financial assistance.
(3) A brief uniform statement of the availability of
hospital-based financial assistance and of the application
for hospital-based financial assistance to be stated
prominently on hospital materials.
(b) Development of form.--The department shall include input
from hospitals and the general public in developing the forms
described in subsection (a)(1).
(c) Accessibility of forms.--Each form outlined in
subsection (a) shall be:
(1) Written in plain language at a sixth grade reading
level.
(2) Translated by the department into all primary
languages identified by a hospital.
(3) Made accessible by the hospital to individuals with
visual impairments upon request.
(4) Posted by hospitals online in a publicly accessible
format. A full copy of the hospital's financial assistance
policies shall also be published along with the summary in
subsection (a)(2).
(d) Disclosure to patients.--
(1) A hospital shall provide the form discussed in
subsection (a)(2) to all patients upon intake and discharge.
Additionally, a hospital shall place the uniform statement
provided for in subsection (a)(3) on all bills, billing
statements, good faith estimates, admittance forms and
discharge paperwork.
(2) A hospital shall provide a full copy of its
financial assistance policies upon request.
(3) A hospital shall provide assistance understanding
and completing a financial assistance application upon
request.
(e) Alignment with public health coverage options.--
(1) Hospitals shall use the income counting rules and
household composition rules consistent with 42 CFR 435.603
(relating to application of modified adjusted gross income
(MAGI)) and shall adjust their policies according to rules
within 180 days after the effective date of this paragraph.
(2) The Department of Human Services shall explore a
process for connecting the uniform application for financial
assistance with the department's electronic eligibility
system in order to evaluate an applicant's eligibility for a
public health coverage option.
(3) A patient seeking financial assistance may provide
the following financial information and documentation in
support of their application:
(i) paychecks or pay stubs;
(ii) unemployment documentation;
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(iii) Social Security income;
(iv) rent receipts;
(v) a letter from the patient's employer attesting
to the patient's gross income;
(vi) copies of recent tax returns; or
(vii) if none of the aforementioned information and
documentation are available, a written self-attestation
of the patient's income.
(4) Hospitals may provide hospital-based financial
assistance to any patient who is already enrolled in the
Supplemental Nutrition Assistance Program (SNAP), Special
Supplemental Nutrition Program for Women, Infants and
Children (WIC) or Low-Income Home Energy Assistance Program
(LIHEAP), based on presumptive eligibility through use of
electronic verification data.
(5) Upon submission of a completed application form, the
patient is not liable for any bills until the hospital has
rendered a decision on the application.
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