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OVERVIEW: Ohio’s Hospital Care Assurance Program (HCAP) provides partial reimbursement to hospitals for uncompensated care they provide to low-income individuals. Hospitals that receive HCAP funding are required to provide free, basic, medically necessary care to eligible individuals. Patients may apply to have their care covered by HCAP funds.
Hospital Care Assurance Program (HCAP) (effective until October 16, 2011)
Ohio Revised Code Annotated §§ 5112.01 to 5112.99
Provision of Basic, Medically Necessary Hospital-Level Services
Ohio Administrative Code 5101:3-2-07.17
The Department of Job and Family Services is responsible for administering the Hospital Care Assurance Program (hereinafter “HCAP”), including adopting rules, distributing funds to hospitals, collecting financial reports from hospitals and establishing the annual hospital assessment rates. Ohio Rev. Code Ann. §§ 5112.03, 5112.04, 5112.06 and 5112.08.
DEFINITIONS AND DISTINCTIONS:
Bad debt, charity care and courtesy care are given the same meanings as those terms are given under the regulations adopted under Title XVIII of the Social Security Act (e.g. Medicare). Ohio Rev. Code Ann. § 5112.01(B).
For purposes of determining HCAP eligibility, “family” includes the patient, his or her spouse and all children under age eighteen who live at home. Ohio Admin. Code 5101:3-2-07.17(B)(1). “Income” includes total salaries, wages and cash receipts before taxes. It is calculated using the patient’s income for the three months and twelve months preceding the date hospital services were provided. Ohio Admin. Code 5101:3-2-07.17(B)(2).
Uncompensated care includes both bad debt and charity care. Ohio Rev. Code Ann. § 5112(K).
FREE CARE AS A COMMUNITY BENEFIT: N/A
HCAP is available to Ohio residents who do not receive Medicaid and whose individual or family income is at or below 100 percent of the Federal Poverty Guidelines. Ohio Admin. Code 5101:3-2-07.17(B). Current recipients of the disability assistance program also qualify. Id.
When eligibility has been determined for outpatient services, it remains effective for ninety (90) days. Eligibility for inpatient services must be determined separately for each hospital admission, unless the patient is readmitted within forty-five (45) days for the same condition. Ohio Admin. Code 5101:3-2-07.17(B)(3).
Funding for HCAP comes from a variety of sources. One source is the Indigent Care Pool, which is made up of the sum of the following:
- The total assessments paid by hospitals into the pool minus that portion of the assessments that are deposited into the legislative budget services fund and into the health care services administration fund;
- The total amount of intergovernmental transfers made by governmental hospitals minus the portion of those transfers that are deposited into the legislative budget fund and into the health care services administration fund; and
- The total amount of federal matching funds that are available as a result of funds distributed to hospitals by the Department of Job and Family Services. Ohio Rev. Code Ann. § 5112.01(E).
The Director of Job and Family Services is charged with establishing a methodology to pay hospitals that is sufficient to expend all money in the Indigent Care Pool. The amount to be allocated is based on any combination of the following indicators of indigent care:
- Total costs, volume, or proportion of services to Medicaid recipients;
- Total costs, volume, or proportion of services to low-income patients in addition to Medicaid recipients;
- The amount of uncompensated care provided by the hospital;
- Other factors that the Director deems appropriate. Ohio Rev. Code Ann. § 5112.08(B).
In addition, HCAP is partially funded by an annual assessment imposed on all hospitals in Ohio. Each hospital’s assessment is based on total facility costs. No hospital may be assessed more than two (2) percent of its total facility costs. Ohio Rev. Code Ann. § 5112.06(A).
In distributing HCAP funds, precedence is given to those hospitals that provide a disproportionately high share of indigent care in relation to the total care provided by the hospital or in relation to other hospitals. Ohio Rev. Code Ann. § 5112.08(C).
Each hospital that receives payment under HCAP must provide basic, medically necessary hospital-level services without charge. Ohio Admin. Code 5101:3-2-07.17. “Basic, medically necessary hospital level services” are defined as all inpatient and outpatient services covered under Medicaid, excluding transplant services. Ohio Admin. Code 5101:3-2-07.17(A)(1). Appendix A of Ohio Administrative Code 5101:3-2-02 contains an updated list of Medicaid-covered UB-92 Revenue Codes, which hospitals should use as an indicator of what would constitute a HCAP-covered service.
Notice must be posted in appropriate areas of the hospital, including but not limited to the admissions area, the business office, and the emergency room. The notice must at least do the following:
- State the rights of individuals to receive without charge, basic, medically necessary hospital-level services;
- Be clear and written in simple terms understandable to the population served by the hospital;
- Be printed in English and other languages that are common to the population of the area served;
- Be clearly readable at a distance of twenty (20) feet. Ohio Admin. Code 5101:3-2-07.17(D).
The hospital must also make reasonable efforts to communicate the contents of the notice to those people it has reason to believe cannot read the notice. Ohio Admin. Code 5101:3-2-07.17(D).
Patients applying for HCAP must complete an application which, at a minimum, documents income, family size and eligibility for Medicaid. It must be signed, unless the patient is physically unable to do so. Ohio Admin. Code 5101:3-2-07.17(B)(4). The hospital must accept an application until three years from the date the follow-up notice has elapsed. Ohio Admin. Code 5101:3-2-07.17(B)(5). A hospital may require a patient to apply for Medicaid before processing a patient’s HCAP application. Ohio Admin. Code 5101:3-2-07.17(B)(7).
GRIEVANCE/APPEAL PROCESS: N/A
On or before July 1, each hospital must submit to the Department of Job and Family Services a financial statement for the preceding calendar year that accurately reflects the income, expenses, assets, liabilities, and net worth of the hospital. The financial statement must also show bad debt and charity care separately from courtesy care and contractual allowances. Ohio Rev. Code Ann. § 5112.04(A).
Each hospital must also submit a cost report to the Department of Job and Family Services within 180 days of the end of its cost reporting period. Ohio Rev. Code Ann. § 5112.04(B).
Each hospital must report annually to the Department of Job and Family Services information on the number and identity of patients receiving free care under HCAP, as well as the number and categorical identity of patients served under HCAP. Ohio Rev. Code Ann. § 5112.17(D); Ohio Admin. Code 5101:3-2-07.17(F). Any information filed under these sections that includes patient-identifying material is not considered a public record. Ohio Rev. Code Ann. § 5112.21.
PENALTIES FOR NONCOMPLIANCE:
The Director of Job and Family Services may impose a penalty on hospital for each day it fails to file its financial statement or cost report, unless the hospital can show good cause. Ohio Rev. Code Ann. § 5112.99(A) and (C). The Director may also impose a 10 percent penalty on any hospital that fails to pay its annual assessment. Ohio Rev. Code Ann. § 5112.99(B).
Limitations on collection activities. Hospitals may send bills to patients if all of the following apply:
- The hospital has an established post-billing procedure for determining the patient's income and canceling the charges if the patient is found to qualify for services under HCAP.
- The initial bill, and at least the first follow-up bill, is accompanied by a written statement that does all of the following:
- Explains that individuals with income at or below the federal poverty guidelines are eligible for services without charge;
- Specifies the federal poverty guideline for individuals and families of various sizes at the time the bill is sent; and
- Describes the procedure for determining a patient's income and canceling charges if the patient is found to qualify for services under the HCAP.
- If the written statement is printed on the back of the bill, the hospital must reference the statement on the front of the bill. Ohio Rev. Code Ann. § 5112.17(C); Ohio Admin. Code 5101:3-2-07.17(C).
A hospital providing care to an individual under this Program is subrogated to the rights of any individual to receive compensation or benefits from any person or governmental entity for the hospital goods and services rendered. Ohio Rev. Code Ann. § 5112.17(C); Ohio Admin. Code 5101:3-2-07.17(C).