Hospital Financial Assistance

Final Rule as Published in the Illinois Register on Aug. 2, 2013

The Illinois Office of Attorney General's (OAG) final rule on financial assistance rule leaves intact the basic framework and elements of the financial assistance application form, development of presumptive eligibility policy and hospital reporting outlined in the proposed rule.

Changes Between Proposed Rule and Final Rule
Major changes made from the proposed rule include:

  • Makes January 1, 2014 the effective date for hospital compliance for application and presumptive eligibility;
  • Corrects the reference that applications must be returned within 60 days from service date, rather than date of receipt. Allows extensions at hospital’s discretion;
  • Includes family information in the application;
  • Adds a section stating that if a patient meets presumptive eligibility criteria, the patient does not need to complete the application’s monthly expense section.
  • Shifts one presumptive eligibility category for rural and CAH hospitals from the mandated list to the consideration list.
  • Requires the presumptive eligibility policy be applied to an uninsured patient as soon as possible and before issuance of a bill.

Effective Date
Hospital financial assistance application requirements (Section 4500.30) and the presumptive eligibility criteria (Section 4500.40) will be implemented no later than January 1, 2014.

Statement on Application Form
As part of the required “Opening Statement,” the sentence that provided instruction that the form was to be returned within 60 days after receipt of the form has been corrected to reference 60 days following date of discharge or receipt of outpatient care. Hospitals may increase the timeframe for return of the form, but may not decrease it.

An additional sentence must be added to the form: Patient acknowledges that he or she has made a good faith effort to provide all information requested in the application to assist the hospital in determining whether the patient is eligible for financial assistance.

Family Information
In the application form’s “Patient Information” section, the name, address and telephone numbers of the spouse, partner, parent or guardian can be listed in cases where they are a guarantor for the patient. The hospital may choose not to include this information.

Gross family income includes cases where a spouse or partner is guarantor for the patient or where a parent or guardian is guarantor for a minor. The Hospital Uninsured Patient Discount Act requires free care and discounts to uninsured patients with family incomes at varying levels of the federal poverty level (FPL), so all family income may be considered for application of that mandated requirement.

Presumptive Eligibility
The financial assistance application must contain a note that if a patient meets the presumptive eligibility criteria or is otherwise presumptively eligible by virtue of the patient’s family income, the patient is not required to complete the application’s section on monthly expenses.

For rural and Critical Access Hospitals only: One of the previously mandated presumptive eligibility categories, enrollment in an organized community-based program, has now been moved to the list of criteria that could be considered. The reasoning was that some programs could have eligibility thresholds greater than the Hospital Uninsured Patient Discount Act free care threshold of 125% of FPL.

The presumptive eligibility criteria set forth in a hospitals policy needs to be applied to an uninsured patient as soon as possible after receipt of healthcare services from the hospital by the patient and prior to the issuance of any bill for such service by the hospital.

Additional Agreement
During the Joint Committee on Administrative Rule meeting, the OAG agreed to consult with affected organizations concerning the billing processes and application of presumptive eligibility criteria and to revisit this topic as needed in the future.