Ellington

Mary Jo went to the hospital recently and received a bill for more than $15,000. She was uninsured and unable to pay more than about $20 per week. It would take her about 15 years to pay off this debt.

Many hospitals are established as private nonprofit entities and are expected to give back charity care to the community in exchange for their tax-exempt status.

Under the new health-reform law Congress passed this year, non-profit hospitals will have to meet new indigent-care requirements. The Patient Protection and Affordable Care Act amended Section 501(c)(3) of the Internal Revenue Code. It now requires nonprofit hospitals to publish guidelines for financial assistance, explain who is eligible and how a person can apply for assistance.

To qualify for nonprofit status, a hospital must:
• Develop written financial assistance policies;
• Limit what they charge for services;
• Observe fair-billing and debt-collection practices;
• Conduct regular community-needs assessments.

With the exception of the needs assessment, these requirements go into effect this year. The U.S. Treasury Department is charged with enforcing the new provisions and has authority to issue further guidance and regulations as needed to make sure they are correctly implemented. The hospitals will report to the IRS on their annual 990 forms.

The Mississippi Human Services Agenda wrote all the private nonprofit hospitals in Mississippi asking them how they intended to comply with this new requirement. Only three hospitals responded to our survey, and we were directed to their websites for specifics on their financial assistance/charity care policies.

The web-published sliding scale showed discounts from the hospital charges, based on income. Because most hospitals accept a discount from insurance companies of 30 percent to 40 percent as payment in full, we can see that the hospitals are using their sliding scale to grant some patients the same discount they give insurance companies.

Two hospitals used this sliding scale:

Percent of Poverty $ for Family of 4 Discount from charges
Below poverty $22,050 100 percent
100-119 percent $26,240 100 percent
120-139 percent $30,650 90 percent
140-169 percent $37,265 80 percent
170-199 percent $43,880 70 percent
200-299 percent $62,930 40 percent

Persons would have to bring documents with them to verify their income when they enter the hospital and declare that they are uninsured.

If all our state's nonprofit hospitals would make the effort to obey the law and let people know they may be eligible for discounts on their hospital care (and how they can qualify for this benefit), we would be much better off. People should let their local nonprofit hospitals know that they expect them to follow the law and treat the needy with equity.

Rims Barber is director of the Mississippi Human Services Agenda. He can be reached at 601-355-7495. The Mississippi Forum distributed this column on his behalf.