Current through Register Vol. 63, No. 9, September 1, 2024
(1)
Prescreening and presumptive eligibility rules are effective July 1,
2024.
(2) Hospitals must document
their prescreening process in their financial assistance policy. Process
documentation must disclose the software products and all other third-party
services used to evaluate patient household income for prescreening.
(3) The prescreening process and presumptive
eligibility determination is not considered an application for financial
assistance and does not disqualify a patient from seeking financial
assistance.
(4) The prescreening
process must use the financial assistance eligibility standards published in
the hospital's financial assistance policy and in accordance with the minimum
standards specified in ORS
442.614. Any adjustment to
patient cost due to the prescreening process must meet the minimum standards
specified in ORS 442.614.
(5) Hospitals must complete prescreening for
financial assistance and make any resulting adjustments to patient cost prior
to sending the patient a billing statement.
(6) Prior to taking any other prescreening
actions, the hospital must determine if during the previous nine (9) month
period, the patient has applied for financial assistance and the hospital has
determined that the patient is eligible for financial assistance based on
documentation provided by the patient. If yes, the patient must receive a
patient cost adjustment in accordance with ORS
442.614, prior to receiving a
billing statement.
(7) Hospitals
must prescreen for presumptive eligibility for financial assistance whenever
the patient meets any of the following criteria:
(a) Is uninsured; or
(b) Is enrolled in a state medical assistance
program; or
(c) Will owe the
hospital $500 or more after all adjustments from insurance or third-party
payers, if applicable, have been made.
(8) Hospitals may prescreen patients who do
not meet any of the criteria in (7) above at the hospital's discretion or as
established in the hospital's financial assistance policy.
(9) A hospital must not require a patient to
present documentation or other verification related to any eligibility criteria
as a condition of prescreening or a requirement for adjustment to the patient
costs as a result of prescreening. A hospital may accept voluntary submission
of information or documentation that would assist the hospital in the
prescreening process as long as the hospital does not compel the patient to
provide the information.
(10)
Hospitals may use existing patient data in the prescreening process, including
but not limited to:
(a) Existing patient
records;
(b) Information routinely
collected during patient registration or admission;
(c) Information voluntarily supplied by the
patient;
(d) Previous financial
assistance adjustments; and
(e)
Existing eligibility for assistance programs. Examples include, but are not
limited to: Medicaid, Supplemental Nutrition Assistance Program (SNAP),
Temporary Assistance for Needy Families (TANF), Women, Infants and Children
(WIC), free lunch or breakfast programs, low-income home energy assistance
programs, or any other programs which are means tested and would reasonably
reflect the approximate patient household income.
(f) If a hospital's initial prescreening
method fails to return information about the patient, the hospital must make a
good faith effort to determine the patient's presumptive eligibility status
based on other information available to the hospital.
(11) A hospital may use third-party income
verification software tools or services or contract with a third party to
conduct the prescreening if:
(a) The process
does not cause any negative impact on the patient's credit score;
(b) Evaluations must be based on eligibility
criteria established in the hospital's written financial assistance policy.
Evaluations by non-profit hospitals must be based on household income only, and
cannot consider household assets or any assessment, evaluation or score that
predicts the patient's propensity or ability to pay; and
(c) If a third-party service or software tool
fails to return information about the patient, or specifies the patient's
income is unknown, the hospital make a good faith effort to determine the
patient's presumptive eligibility status based on information available to the
hospital.
(12) Hospitals
must document methods utilized under (10) and (11) they took to prescreen the
patient.
(13) A hospital must
notify the patient in writing of the results of the prescreening process,
regardless of outcome. The notification must meet the following standards:
(a) Be written in plain language and either
the preferred language of the patient or otherwise in alignment with the
translation standards specified in ORS
442.614;
(b) Delivered by a minimum of one of the
following means:
(A) Letter;
(B) Email, if agreed to by the patient as an
acceptable form of communication;
(C) Message or notification on an online
patient portal if the patient is a registered user of the patient
portal;
(D) A prominently displayed
notice on the billing statement;
(E) An insert accompanying a billing
statement; or
(F) In-person
acknowledgement signed by the patient.
(c) Clearly state the outcome of the
prescreening using plain language for each of the following outcomes:
(A) Presumptively eligible for full financial
assistance;
(B) Presumptively
eligible for partial financial assistance;
(C) Not presumptively eligible for financial
assistance; or
(D) Unable to
determine presumptive eligibility status.
(d) If the prescreening process determines
that the patient is not presumptively eligible, or their eligibility cannot be
determined, or the patient cost adjustment was less than 100% of the patient
cost amount, the hospital must further state the following information:
(A) That the patient may still apply for
financial assistance, or additional financial assistance, by using the standard
hospital financial assistance application;
(B) How a patient may request and receive a
physical application or access an online application;
(C) How a patient may request assistance in
completing the financial assistance application; and
(D) That the patient is eligible to apply for
financial assistance for at least 240 days following the first billing
statement for the services provided or at least 12 months after the patient
pays for the services provided, or for any additional time period beyond these
minimums as specified in the hospital's financial assistance
policies.
Statutory/Other Authority: ORS
442.615
Statutes/Other Implemented: ORS
442.614 &
442.615
