Connecticut

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OVERVIEW: Connecticut law does not mandate the provision of free care. However, it does require hospitals to file their policies on charity care, reduced cost care, and debt collection practices annually with the State Office of Health Care Access. State law also sets some limitations around hospital billing and collections practices. One such limitation requires hospitals to screen patients for eligibility under the hospital’s charity care policy and/or the hospital’s “bed fund,” private donations made to the hospital—often decades ago—to cover the cost of care to individuals who are unable to pay. Furthermore, while hospital bed funds are specific to individual hospitals, it is important to note that the State does set some additional requirements, particularly around notification and application, for hospitals that have these funds.

CITATION:
Collections by hospitals from uninsured patients
Connecticut General Statutes § 19a-673

Uncompensated care. Audits. Annual reports
Connecticut General Statutes § 19a-649

Hospital Bed Fund
Connecticut General Statutes § 19a-509b

Primary Care Direct Services Program
Connecticut General Statutes § 19a-7d

Budget review regulations for short-term acute care hospitals
Conn. Agencies Reg. § 19a-160-101

TERMINOLOGY:
Charity care and reduced cost services
Free care
Hospital bed fund
Uninsured patient

REGULATORY OVERSIGHT:
The Office of Health Care Access (hereinafter “the Office”) is charged with adopting regulations on hospital admitting, billing and collection policies and procedures and with establishing uniform debt collection standards for hospitals. Conn. Gen. Stat. §§ 19a-662(2); 19a-673a. The Office has the authority to instruct a hospital to modify its billing and collections policies and procedures where it finds them to be inadequate. Conn. Gen. Stat. § 19a-662(2). The Office of Health Care Access, in consultation with the Commissioner of Social Services, also reviews and evaluates the amount of uncompensated care hospitals provide on an annual basis. Conn. Gen. Stat. 19a-649(a).

DEFINITIONS AND DISTINCTIONS:
“Free care” appears in the Office of Health Care Access’s Budget Review regulations, where it is defined as follows: “[t]he difference between the amount of expected reimbursement from charity patients, as defined by hospital board policy, for hospital services rendered, and the amount of the hospital's published charges for such services.” Courtesy discounts and charges for health care services provided to employees are expressly excluded from the definition of free care. Conn. Agencies Reg. § 19a-160-101(22).

“Hospital bed funds” are donated funds that are earmarked to assist low-income persons with their inpatient and outpatient hospital expenses. Conn. Gen. Stat. § 19a-509b(a)(1).

"Uncompensated care" is defined as the “total amount of charity care and bad debts determined by using the hospital's published charges and consistent with the hospital's policies regarding charity care and bad debts which have been approved by, and are on file at, the [Office of Health Care Access].” Conn. Gen. Stat. § 19a-659(6); as amended by H.B. 5912.

An “uninsured patient,” for purposes of determining when a hospital can begin collections efforts, is defined as a patient whose income does not exceed 250 percent of the Federal Poverty Guidelines; who has applied and been denied eligibility for government-sponsored medical assistance programs, including Medicaid and Medicare; and who is ineligible for coverage through “other mechanisms” (e.g., workers’ compensation). Conn. Gen. Stat. § 19a-673(4).

FREE CARE AS A COMMUNITY BENEFIT: N/A

ELIGIBILITY REQUIREMENTS: N/A

FINANCING SOURCE: N/A

SERVICES COVERED: N/A

NOTIFICATION REQUIREMENTS:
If a hospital holds or administers a “hospital bed fund,” it must post information in English and Spanish regarding the availability of these funds in “conspicuous public places,” including the admissions office, emergency room, social services department, and patient accounts/billing office. Conn. Gen. Stat. § 19a-509b(b)(1). The notice must include the following:

Notice that the fund exists;
The name of the hospital program that administers the fund;
The person to contact in order to get application information; and
A one-page summary of the funds and the application process available to the general public in both English and Spanish. Conn. Gen. Stat. §§ 19a-509b(b)(1); 19a-509b(c).

The one-page summary of the hospital bed fund must 1) clearly distinguish the Hospital Bed Fund from other sources of financial assistance and 2) describe any other “charity care or reduced cost services for the indigent” it includes in its uncompensated care report to the Office of Health Care Access. Id. Hospitals must make the one-page summary available at any time during admission or review of a patient’s financial resources when it becomes apparent that a patient will have limited funds to pay for the portion of their hospitalization that will not be covered by insurance. Conn. Gen. Stat. § 19a-509b(c). This one-page summary shall also be included by collection agents in all bills and collection notices they send. Conn. Gen. Stat. §§ 19a-509b(d).

APPLICATION PROCESS:
Patients who cannot pay any outstanding medical bill at the hospital must be allowed to apply, and to reapply, for hospital bed funds. Conn. Gen. Stat. § 19a-509b(e). Hospitals with these funds in place are required to train their staff about the existence of the fund(s), eligibility requirements, and application procedures. Conn. Gen. Stat. § 19a-509b(b)(2).

Patients who apply for these funds must receive written notice of their award or rejection, along with the reason for a rejection. Conn. Gen. Stat. § 19a-509b(e).

GRIEVANCE/APPEAL PROCESS: N/A

REPORTING REQUIREMENTS:
Hospital Billing and Debt Collection Practices. Hospitals must submit their admission, billing and collections procedures and protocols to the Office of Health Care Access for approval. Conn. Gen. Stat. § 19a-662(2). Hospitals must also file an annual debt collection report with the Office of Health Care Access that includes the following information:

Whether the hospital uses a collection agent to assist in debt collection;
The name of any collection agents used;
The hospital’s debt collection policies and procedures, including the compensation of collection agents; and
The recovery rates on accounts assigned to collection agents, except for Medicare accounts, for the hospital’s most recent fiscal year. Conn. Gen. Stat. § 19a-673c.

Hospital Bed Funds Reporting. Hospitals that hold or administer a “hospital bed fund” have additional reporting requirements. Each year, these hospitals are required to compile and permanently maintain the following information pertaining to its hospital bed fund:

The number of applicants for these fund;
The number of patients receiving grants under these fund;
The actual dollar amount provided to a patient under these fund;
The fair market value of the principal of the hospital bed fund;
The total earnings attributable to the fund;
The dollar amount reinvested as capital; and
The dollar amount of earnings available for patient care. Conn. Gen. Stat. § 19a-509b(f).

Though the “hospital bed funds” referenced repeatedly in the statutes are, in essence, gifts made to individual hospitals, Connecticut law requires hospitals that operate these funds to keep an accounting of how the monies in them are spent. Conn. Gen. Stat. § 19a-509b(f). The hospitals must make these reports available to the Office of Health Care Access upon request. Id.

Uncompensated Care Reporting. Hospitals must annually file a copy of their charity care and reduced cost care policies as well as a copy of their debt collection practices with the Office of Health Care Access. Conn. Gen. Stat. 19a-649(a). In addition to filing these policies, hospitals must obtain and file an independent audit of their “charges, payments and discharges by primary payer” along with the amount of uncompensated care they provide. Id. These reports must include the following:

The number of applicants for charity care and reduced cost services;
The number of approved applicants; and
The total and average charges and costs of the amount of charity care and reduced cost services provided. Conn. Gen. Stat. 19a-649(b).

PENALTIES FOR NONCOMPLIANCE:
Failing to follow the hospital’s own policies and procedures regarding admissions, billing, or collections, along with failure to modify its plan, if instructed to do so, may result in a reduction in the disproportionate share funds the hospital receives. Conn. Gen. Stat. § 19a-662(2).

The Office of Health Care Access shall require hospitals that engage in “inefficient or inappropriate provision of uncompensated care services” to submit a cost reduction plan. Conn. Gen. Stat. § 19a-662(1). Failure to do so may results in the hospital’s forfeiting all or part of its disproportionate share payments. Id.

Hospitals must file their current pricemaster with a detailed schedule of all charges with the Office of Health Care Access. Conn. Gen. Stat. § 19a-681(a). If the billing detail on a patient bill does not agree with the pricemaster on file with the Office for the date of service specified on the bill, the hospital will be subject to a civil penalty of $500, payable to the state, per occurrence. Conn. Gen. Stat. § 19a-681(b), as amended by S.B. 622 (2008). The Office of Health Care Access may issue an order requiring the hospital to adjust the patient’s bill so that it matches the pricemaster. Id.

OTHER:
Limitations on hospital collections. Hospitals are barred from initiating a collections action against a patient or her estate or referring a patient account to a collection agent until the hospital has determined whether the patient is an “uninsured patient,” as defined in Section 19a-673 of the General Statutes (see above), who is ineligible for hospital bed funds. Conn. Gen. Stat. § 19a-673b(a). However, hospitals may still initiate actions against a patient or her estate to collect coinsurance, deductibles, or fees arising from hospital care where those amounts “may be eligible for reimbursement through awards, settlements or judgments arising from claims, suits or proceedings” or where payment is made directly to the patient. Id. at (b).

Hospitals, collection agencies, and their agents engaging in collection efforts against a patient must cease their efforts if, at any point in the debt collection process, they become aware that the patient is eligible for hospital bed funds, free or reduced price hospital services, or other programs that would relieve the patient’s liability for debt. Conn. Gen. Stat.§ 19a-673d. In those instances, the patient’s file must be referred to the hospital for a determination of eligibility, and all collection efforts must cease until that determination is made. Id.

Connecticut

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