To help patients who are struggling financially, the California legislature decided to tighten state requirements for hospitals to provide free or discounted care.
AB 1020, which went into effect in January, gives more people eligibility for discounted care and raises the income level below which hospitals should offer them to uninsured or high-cost patients. Also added a simple requirement: hospitals must post their financial aid policies prominently on their websites.
“You shouldn’t have to have a lawyer to get what hospitals are legally required to do,” said Tracy Douglas, a Bet Tzedek attorney who works on a medical-legal partnerships team at Harbor-UCLA Medical Center. “That’s what AB 1020 wanted to fix.”
But more than nine months after California’s law went into effect, some hospitals still hadn’t posted their charity policies in a prominent place on their websites, The Times found after reviewing websites for hospitals across the state. Several updated their pages or said they would do so after being contacted by The Times.
CHA Hollywood Presbyterian Medical Center in East Hollywood said in October that it has a statutory charity care policy, but “that policy is not on our public website.” When The Times pointed out that state law requires it to be prominently posted online, a hospital spokesman was quick to share the guideline, saying 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 support, including charitable care, but had no link to its policy at the end of October.
Its chief financial officer, Daniel Leon, said he has been working to revise its policy and expects to have it on its website within 45 days. Leon said patients would still be made aware of charitable care and payment discounts in a variety of ways, “including handouts at admission, signage in the lobby, signage on the website, and information from patient handbooks.”
Arrowhead Regional Medical Center in Colton added a link to its charity policy to its website after being contacted by a Times reporter. Kern Medical included a link to its Charity Care Policy on its Make a Payment page sometime in the last few weeks; Screenshots from the Internet Archive show that the link was not posted there at the end of September.
And Zuckerberg San Francisco General Hospital has a section of its website that encourages patients to contact financial advisors, but it didn’t publish a charity care policy there at the end of October.
When The Times asked where to find it, a ZSFG spokesperson provided a link to where it was posted on the California Department of Health’s website for access and information – another requirement under AB 1020 – but admitted that it was was not yet on the hospital’s website in mid-October. It recently added a link to access the policy on this page.
Bernadette Manigault, a senior attorney at Neighborhood Legal Services in Los Angeles County, said she was “surprised but not surprised” that some hospitals didn’t post their charitable care policies on their websites months after the law went into effect.
Prior to the passage of the new law, hospitals were already required to post notices of their financial assistance policies “clearly and prominently” in “publicly visible places,” including their billing offices, but legal aid groups had still encountered patients who were unaware.
It can be “incredibly hard to find for the average consumer,” Manigault said. “They have these guidelines — but you really have to know how to get there.”
In late October, The Times was also unable to find a charity policy on the websites of Southern California hospitals in Culver City and Hollywood after reviewing their “billing pages” and searching the websites. Nearly three weeks after a reporter asked where they were posted online, following repeated requests, a spokesperson provided links to surprise bill legal protection websites, which included a single link titled “Charity Care Policy” at the end. (It’s unclear when these links were first added; a spokesman for Southern California Hospitals did not respond to this question.) The hospital recently updated its billing pages to more clearly mention charitable giving policies.
The California Hospital Assn., which provided hospitals with a summary of the new rules, said it hadn’t heard from regulators or the hospitals themselves about widespread problems with AB 1020 compliance. His vice president for foreign affairs, Jan Emerson-Shea, said that when state regulators alerted hospitals to the requirements of the new law last winter, health facilities were facing a surge in COVID cases and continued to struggle with staff shortages.
Emerson-Shea said it’s possible that “unfortunately, some of these things have been overlooked … but I don’t think there are widespread issues in terms of hospitals not wanting to do that.”
Leon, Natividad’s chief financial officer, said the rules came into effect during the winter surge in COVID patients and “our priority was to take care of them”.
Liliana Viamari, spokeswoman for CHA Hollywood Presbyterian, said her website has already instructed families in need of financial assistance to contact their family attorneys, but the hospital was hit hard by COVID earlier in the year and also has new funding Employees from that point forward, “which causes this detail of the requirement to be overlooked.”
“These are by no means excuses … they should have been posted on our website,” Viamari said in an email. “We’re glad it was fixed.”
Helen Tran, senior attorney at the Western Center on Law and Poverty, said that when hospitals haven’t posted their charity rules on their websites, “it also worries me about what’s going on at the hospital” since AB 1020 also requires changes in others Hospital practices related to collection and discount eligibility.
“It’s the simplest requirement,” said Anthony Wright, executive director of Health Access California, a consumer protection coalition. “If they don’t, I worry about the other things.”
The Times also found that some hospitals had information on their websites that did not reflect the increased entitlement to discounted treatment under AB 1020. In early November, Loma Linda University Medical Center said on its website that patients earning 350% or less of the federal poverty line are eligible for rebate payments.
AB 1020 requires patients to be eligible for discounts if their income is at or below 400% of the federal limit and they also do not have insurance or have high medical expenses.
A spokesman for Loma Linda University Medical Center did not answer questions about whether the document posted online complied with its current policy, but said in a brief statement that it is state law for eligible patients to be notified that they may receive financial assistance, and “Site updates 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 family income is less than 350% of the federal poverty line and they meet other requirements. After being alerted to the issue by The Times, the hospital updated its link to a new policy with a 400% threshold, which a representative said was already being applied by its financial assistance advisors.
Aside from increasing eligibility for discounted care, AB 1020 also prohibits hospitals from selling patient debt unless they have determined that the indebted patient is not eligible for financial assistance or attempts to bill them or offer assistance, have not responded and are requesting that patients be sent Financial Assistance Applications before their bill is sent to the Collections.
Under the law, the California Department of Health Care Access and Information is scheduled to review hospital policies to see if they comply with the law by Jan. 1, 2023. Manigault said the law won’t have “full teeth” until 2024, when this State Department can start penalizing hospitals for violators.
Until then, complaints about hospitals not complying with the law are still being filed by the California Department of Health, which said it has no record of hospitals it has examined and found not to be compliant. Tran said her organization had filed complaints and the agency had failed to substantiate its findings of no wrongdoing.
Assembly Member Laura Friedman (D-Glendale), who introduced AB 1020, said: “The fact that some hospitals are still not making basic information available to patients and the public is frustrating and reinforces the need for the stricter oversight set out in AB 1020 is described.”
The new law expands on the Hospital Fair Pricing Act, passed by the California legislature in 2006, which required hospitals to maintain written charitable care policies for qualifying patients and establish minimum eligibility requirements. A study published in Health Affairs found that the prices paid by uninsured patients fell significantly between 2004 and 2012.
However, legal aid groups complained that in many cases, eligible patients were unaware that they had access to charity care.
A survey by Kaiser Health News three years ago found that nearly half of hospital nonprofits across the country routinely sent medical bills to patients whose incomes were low enough to qualify them for charity. The hospital data combed 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 warning and sent letters to hospitals after hearing complaints that hospitals were not following requirements to provide charity care guidelines in the language patients understand.
A spokesman said the bureau could neither confirm nor deny whether an investigation was underway in October, but “stands ready to enforce the law and use any means at our disposal to ensure patients and their families do not suffer unnecessarily.” high medical costs or being forced to choose between seeing a doctor or being able to pay bills.”
https://www.latimes.com/california/story/2022-11-29/charity-care-posting-requirement-california-hospitals Some hospitals didn’t put charity care rules on sites when required