efile Public Visual Render
ObjectId: 201632289349301223 - Submission: 2016-08-15
TIN: 06-1422973
SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
Attach to Form 990.
Information about Schedule H (Form 990) and its instructions is at
www.irs.gov/form990
.
OMB No. 1545-0047
20
14
Open to Public Inspection
Name of the organization
MOUNT SINAI REHABILITATION HOSPITAL INC
Employer identification number
06-1422973
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a
.
.
.
.
1a
Yes
b
If "Yes," was it a written policy?
.......................
1b
Yes
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
Applied uniformly to all hospital facilities
Applied uniformly to most hospital facilities
Generally tailored to individual hospital facilities
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines
(FPG)
as a factor in determining eligibility for providing
free
care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for
free
care:
3a
Yes
100%
150%
200%
Other
%
b
Did the organization use FPG as a factor in determining eligibility for providing
discounted
care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care:
.
.
.
.
.
.
.
.
3b
Yes
200%
250%
300%
350%
400%
Other
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria
used for determining eligibility for free or discounted care. Include in the description whether the organization
used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or
discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? .
.
.
.
.
.
.
.
.
.
.
.
.
4
Yes
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year?
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
5a
Yes
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?
.
.
.
.
.
.
5b
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care? .
.
.
.
.
.
.
.
.
.
.
.
.
5c
6a
Did the organization prepare a community benefit report during the tax year?
.
.
.
.
.
.
.
.
.
6a
Yes
b
If "Yes," did the organization make it available to the public?
.
.
.
.
.
.
.
.
.
.
.
.
.
6b
Yes
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a)
Number of activities or programs (optional)
(b)
Persons served (optional)
(c)
Total community benefit expense
(d)
Direct offsetting revenue
(e)
Net community benefit expense
(f)
Percent of total expense
a
Financial Assistance at cost
(from Worksheet 1)
.
.
.
62,907
62,907
0.190 %
b
Medicaid (from Worksheet 3, column a) .
.
.
.
.
674,732
674,732
2.050 %
c
Costs of other means-tested government programs (from Worksheet 3, column b)
.
.
d
Total
Financial Assistance and Means-Tested Government Programs .
.
.
.
.
737,639
737,639
2.240 %
Other Benefits
e
Community health improvement services and community benefit operations (from Worksheet 4).
2
175
29,303
29,303
0.090 %
f
Health professions education (from Worksheet 5)
.
.
.
1
20
48,260
48,260
0.150 %
g
Subsidized health services (from Worksheet 6)
.
.
.
.
h
Research (from Worksheet 7)
.
1
450,000
375,000
75,000
0.230 %
i
Cash and in-kind contributions for community benefit (from Worksheet 8)
.
.
.
.
1
40,961
40,961
0.120 %
j
Total.
Other Benefits
.
.
5
195
568,524
375,000
193,524
0.590 %
k
Total.
Add lines 7d and 7j
.
5
195
1,306,163
375,000
931,163
2.830 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50192T
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part II
Community Building Activities
Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a)
Number of activities or programs (optional)
(b)
Persons served (optional)
(c)
Total community building expense
(d)
Direct offsetting
revenue
(e)
Net community building expense
(f)
Percent of total expense
1
Physical improvements and housing
2
Economic development
3
Community support
57,004
57,004
0.170 %
4
Environmental improvements
5
Leadership development and training for community members
6
Coalition building
7
Community health improvement advocacy
8
Workforce development
9
Other
10
Total
57,004
57,004
0.170 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15?
..........................
1
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount.
......
2
77,232
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit.
......
3
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME)
.....
5
8,427,957
6
Enter Medicare allowable costs of care relating to payments on line 5
.....
6
7,948,541
7
Subtract line 6 from line 5. This is the surplus (or shortfall)
........
7
479,416
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:
Cost accounting system
Cost to charge ratio
Other
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year?
..........
9a
Yes
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI
.........................
9b
Yes
Part IV
Management Companies and Joint Ventures
(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a)
Name of entity
(b)
Description of primary
activity of entity
(c)
Organization's
profit % or stock
ownership %
(d)
Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e)
Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?
1
Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
Other (Describe)
Facility reporting group
1
MOUNT SINAI REHABILITATION HOSPITAL
490 BLUE HILLS AVENUE
HARTFORD
,
CT
06112
X
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility Information
(continued)
Section B. Facility Policies and Practices
(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
MOUNT SINAI REHABILITATION HOSPITAL
Name of hospital facility or letter of facility reporting group
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):
1
Yes
No
Community Health Needs Assessment
1
Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?.
.........................
1
No
2
Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C.
..............
2
No
3
During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12.
.....................
3
Yes
If "Yes," indicate what the CHNA report describes (check all that apply):
a
A definition of the community served by the hospital facility
b
Demographics of the community
c
Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d
How data was obtained
e
The significant health needs of the community
f
Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g
The process for identifying and prioritizing community health needs and services to meet the community health needs
h
The process for consulting with persons representing the community’s interests
i
Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j
Other (describe in Section C)
4
Indicate the tax year the hospital facility last conducted a CHNA: 20
12
5
In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted
.................
5
Yes
6a
Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C
..................................
6a
Yes
b
Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C.
.............................
6b
No
7
Did the hospital facility make its CHNA report widely available to the public?
..............
7
Yes
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
Hospital facility’s website (list url):
SAINTFRANCISCARE.ORG
b
Other website (list url):
CT.GOV.DPH.COM
c
Made a paper copy available for public inspection without charge at the hospital facility
d
Other (describe in Section C)
8
Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11.
..............
8
Yes
9
Indicate the tax year the hospital facility last adopted an implementation strategy: 20
13
10
Is the hospital facility's most recently adopted implementation strategy posted on a website?
.........
10
Yes
a
If "Yes" (list url):
SEE PART V, SECTION C
b
If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return?
......
10b
No
11
Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a
Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?
...............................
12a
No
b
If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax?
........
12b
c
If "Yes" to line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility Information
(continued)
MOUNT SINAI REHABILITATION HOSPITAL
Name of hospital facility or letter of facility reporting group
Financial Assistance Policy (FAP)
Yes
No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13
Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?
13
Yes
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of
200.000000000000
%
and FPG family income limit for eligibility for discounted care of
250.000000000000
%
b
Income level other than FPG (describe in Section C)
c
Asset level
d
Medical indigency
e
Insurance status
f
Underinsurance discount
g
Residency
h
Other (describe in Section C)
14
Explained the basis for calculating amounts charged to patients?
.................
14
Yes
15
Explained the method for applying for financial assistance?
...................
15
Yes
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
Described the information the hospital facility may require an individual to provide as part of his or her application.
b
Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application.
c
Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process.
d
Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications.
e
Other (describe in Section C)
16
Included measures to publicize the policy within the community served by the hospital facility?
........
16
Yes
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
The FAP was widely available on a website (list url):
SEE PART V, SECTION C
b
The FAP application form was widely available on a website (list url):
SEE PART V, SECTION C
c
A plain language summary of the FAP was widely available on a website (list url):
SEE PART V, SECTION C
d
The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)
e
The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)
f
A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)
g
Notice of availability of the FAP was conspicuously displayed throughout the hospital facility
h
Notified members of the community who are most likely to require financial assistance about availability of the FAP
i
Other (describe in Section C)
Billing and Collections
17
Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?
..................................
17
Yes
18
Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
Reporting to credit agency(ies)
b
Selling an individual’s debt to another party
c
Actions that require a legal or judicial process
d
Other similar actions (describe in Section C)
e
None of these actions or other similar actions were permitted
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility Information
(continued)
MOUNT SINAI REHABILITATION HOSPITAL
Name of hospital facility or letter of facility reporting group
Financial Assistance Policy (FAP)
Yes
No
19
Did the hospital facility or other authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?
............
19
No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
Reporting to credit agency(ies)
b
Selling an individual’s debt to another party
c
Actions that require a legal or judicial process
d
Other similar actions (describe in Section C)
20
Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):
a
Notified individuals of the financial assistance policy on admission
b
Notified individuals of the financial assistance policy prior to discharge
c
Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills
d
Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy
e
Other (describe in Section C)
f
None of these efforts were made
Policy Relating to Emergency Medical Care
21
Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?
..................
21
Yes
If "No," indicate why:
a
The hospital facility did not provide care for any emergency medical conditions
b
The hospital facility’s policy was not in writing
c
The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)
d
Other (describe in Section C)
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22
Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that
can be charged
b
The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c
The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d
Other (describe in Section C)
23
During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care?
...............................
23
No
If "Yes," explain in Section C.
24
During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual?
...........................
24
No
If "Yes," explain in Section C.
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility Information
(continued)
Section C. Supplemental Information for Part V, Section B.
Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference
Explanation
MOUNT SINAI REHABILITATION HOSPITAL
PART V, SECTION B, LINE 3J: THE HOSPITAL AUGMENTED THE CHNA COMPLETED IN PARTNERSHIP WITH THE OTHER HOSPITALS IN HARTFORD WITH INFORMATION FROM QUESTIONNAIRES WITH PATIENTS; FOCUS GROUPS WITH COMMUNITY MEMBERS AND INTERVIEWS WITH HEALTH CARE PROVIDERS SO AS TO GAIN A MORE COMPREHENSIVE PICTURE OF THE NEEDS AS WELL AS THE PRIORITIES.
MOUNT SINAI REHABILITATION HOSPITAL
PART V, SECTION B, LINE 5: KEY INFORMANTS WHO REPRESENT THE COMMUNITY WERE INTERVIEWED AS A PART OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. THIS GROUP INCLUDED LEADERS OF NON-PROFIT ORGANIZATIONS; HUMAN SERVICE ORGANIZATIONS; CHURCH LEADERS AND OTHERS. SPECIFICALLY THE GROUPS CONSULTED INCLUDED: CT ASSOCIATION OF HUMAN SERVICES, THE VILLAGE, MALTA HOUSE OF CARE, INC., LATINO COMMUNITY SERVICES, CT VOICES FOR CHILDREN, BOYS AND GIRLS CLUBS, CASEY FAMILY SERVICES, INTERVAL HOUSE, GAY AND LESBIAN HEALTH COLLECTIVE, MY SISTER'S PLACE, GREATER HARTFORD INTERFAITH COALITION AND VARIOUS OTHERS.
MOUNT SINAI REHABILITATION HOSPITAL
PART V, SECTION B, LINE 6A: THE CHNA WAS COMPLETED IN PARTNERSHIP WITH HARTFORD HOSPITAL; CONNECTICUT CHILDREN'S MEDICAL CENTER, UCONN MEDICAL CENTER AND THE CITY OF HARTFORD HEALTH AND HUMAN SERVICES DEPARTMENT. ADDITIONALLY A CONSULTANT WAS USED TO COMPLETE SOME OF THE DATA COLLECTION AND ANALYSIS.
MOUNT SINAI REHABILITATION HOSPITAL
PART V, SECTION B, LINE 11: THE IMPLEMENTATION STRATEGY WHICH ADDRESSES THE NEEDS FOUND IN THE CHNA HIGHLIGHTS FOUR AREAS OF WORK THAT WILL FOCUS OUR STRATEGIC INITIATIVES TO ADDRESS THE NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT, THEY INCLUDE: COMMUNICATION; STRUCTURAL ISSUES THAT IMPACT ACCESS TO CARE; CLINICAL AREAS OF NEED; AND SOCIAL DETERMINANTS OF HEALTH. DURING THIS PAST YEAR DISEASE PREVENTION HAS TAKEN ON A MORE SIGNIFICANT ROLE IN OUR STRATEGY (IN PART DUE TO COMMUNITY INPUT) AND HAS RESULTED IN A MORE SPECIFIC FOCUS FOR OUR CLINICAL CARE STRATEGIES.INITIATIVES ARE ALREADY IN PLACE TO IMPROVE COMMUNICATION BETWEEN PATIENTS AND PROVIDERS, THESE INCLUDE: - RELATIONSHIP BASED CARE- CENTER FOR HEALTH EQUITY STRATEGIC PLANNING- LANGUAGE SERVICES PROGRAM- DIVERSITY COLLABORATIVE TEAMINITIATIVES THAT ADDRESS THE STRUCTURAL BARRIERS TO ACCESSING CARE INCLUDE: - CONNECTICUT INSTITUTE FOR PRIMARY CARE INNOVATION- COMMUNITY AND POPULATION HEALTH MODEL- NAVIGATION SERVICES- EMERGENCY MEDICINE - PRIMARY CARE COORDINATIONFOR CLINICAL SERVICES THE HOSPITAL HAS DEVELOPED THREE AREAS OF FOCUS BASED ON CONTINUED MONITORING OF HEALTH OUTCOMES. THESE INCLUDE: - BEHAVIORAL HEALTH- PREVENTION SCREENING- DIABETES AND OBESITY PREVENTIONTHE SOCIAL DETERMINANTS OF HEALTH THAT WILL BE TARGETED BY SAINT FRANCIS IN PARTNERSHIP WITH COMMUNITY ORGANIZATIONS INCLUDE HOUSING, ACCESS TO HEALTHY FOOD, SECURITY AND EDUCATION. THE CORRESPONDING PARTNERSHIPS FOR THIS WORK INCLUDE THE COMMUNITY SOLUTIONS; THE HARTFORD FOOD SYSTEMS AND REACH COALITION; THE PEACE BUILDERS PROGRAM; AND THE HARTFORD ACADEMY FOR SCIENCE AND MATH.
DESCRIPTION:
MOUNT SINAI REHABILITATION HOSPITAL IS CONNECTICUT'S ONLY FREESTANDING ACUTE CARE REHABILITATION HOSPITAL. IT WAS FOUNDED IN 1923 AND MERGED WITH SAINT FRANCIS HOSPITAL AND MEDICAL CENTER IN 1995. THE MOUNT SINAI REHABILITATION HOSPITAL HAS 60 LICENSED BEDS AND PROVIDES SPECIALIZED SERVICES FOR REHABILITATION IN BOTH THE INPATIENT AND OUTPATIENT SETTING. ADDITIONALLY THE HOSPITAL PROVIDES A COMPREHENSIVE SET OF SERVICES FOR THOSE WHO SUFFER WITH MULTIPLE SCLEROSIS AT THE MANDELL CENTER. MOUNT SINAI REHABILITATION HOSPITAL SHARES RESOURCES WITH SAINT FRANCIS HOSPITAL IN A VARIETY OF AREAS INCLUDING THE DEPARTMENTS OF: HUMAN RESOURCES, FINANCE, ACCOUNTING, ADMINISTRATION, ENGINEERING AND PURCHASING. SUPPLEMENTAL INFORMATION ABOUT COMMUNITY BENEFITS REPORTED ON THE SCHEDULE H FOR SAINT FRANCIS HOSPITAL INCLUDES ACTIVITIES FROM THESE SHARED DEPARTMENTS.
MOUNT SINAI REHABILITATION HOSPITAL:
PART V, LINE 16A, FAP WEBSITE:HTTP://WWW.SAINTFRANCISCARE.COM/PAY_YOUR_HOSPITAL_BILL_ONLINE/BILLING_AND_FINANCIAL_SERVICES.ASPX
MOUNT SINAI REHABILITATION HOSPITAL:
PART V, LINE 16B, FAP APPLICATION WEBSITE:HTTP://WWW.SAINTFRANCISCARE.COM/PAY_YOUR_HOSPITAL_BILL_ONLINE/BILLING_AND_FINANCIAL_SERVICES.ASPX
MOUNT SINAI REHABILITATION HOSPITAL:
PART V, LINE 10A, IMPLEMENTATION STRATEGY WEBSITE:WWW.SAINTFRANCISCARE.COM/ABOUT_US/HOSPITAL_PUBLICATIONS.ASPX
PART V, SECTION B, LINE 16
FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY
MOUNT SINAI REHABILITATION HOSPITAL PART V, SECTION B, LINE 16A WEBSITE:
SEE PART V, SECTION C
MOUNT SINAI REHABILITATION HOSPITAL PART V, SECTION B, LINE 16B WEBSITE:
SEE PART V, SECTION C
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility Information
(continued)
Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?
Name and address
Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VI
Supplemental Information
Provide the following information.
1
Required descriptions.
Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2
Needs assessment.
Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3
Patient education of eligibility for assistance.
Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4
Community information.
Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5
Promotion of community health.
Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6
Affiliated health care system.
If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7
State filing of community benefit report.
If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference
Explanation
PART I, LINE 3C:
N/APART I, LINE 4: MOUNT SINAI REHABILITATION HOSPITAL ACCEPTS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. A PATIENT IS CLASSIFIED AS A CHARITY PATIENT BY REFERENCE TO THE ESTABLISHED POLICIES OF THE HOSPITAL. ESSENTIALLY, THESE POLICIES DEFINE CHARITY SERVICES AS THOSE SERVICES FOR WHICH NO PAYMENT IS ANTICIPATED. IN ASSESSING A PATIENT'S INABILITY TO PAY, THE HOSPITAL UTILIZES THE GENERALLY RECOGNIZED POVERTY INCOME LEVELS FOR THE STATE OF CONNECTICUT, BUT ALSO INCLUDES CERTAIN CASES WHERE INCURRED CHARGES ARE SIGNIFICANT WHEN COMPARED TO INCOMES. IN ADDITION, ALL SELF-PAY PATIENTS RECEIVE A 45% DISCOUNT FROM CHARGES WHICH IS NOT INCLUDED IN NET PATIENT SERVICE REVENUE FOR FINANCIAL REPORTING PURPOSES.
PART I, LINE 6A:
MOUNT SINAI REHABILITATION HOSPITAL PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT JOINTLY WITH SAINT FRANCIS HOSPITAL & MEDICAL CENTER, A RELATED ENTITY. THIS REPORT IS AVAILABLE ON THE SAINT FRANCIS HOSPITAL WEBSITE.
PART I, LINE 7:
MOUNT SINAI REHABILITATION HOSPITAL USES A COST ACCOUNTING SYSTEM WITHIN THE DECISION SUPPORT SYSTEM PRODUCT. IT IS A FULLY ABSORBED COSTING SYSTEM USING REMAPS OF EXPENSE AND REVENUES WHERE NEEDED. INDIRECT, OR OVERHEAD, COSTS ARE ALLOCATED USING STATISTICS IN ORDER TO ALLOCATE THE COSTS TO THE REVENUE PRODUCING DEPARTMENTS. THE METHOD OF ALLOCATING DOLLARS TO THE CHARGE ITEMS IS CURRENTLY PRIMARILY BASED ON A RCC METHOD USING OUR CHARGE ITEM PRICE AS THE DRIVER. WE HAVE INTERSPERSED SOME NATIONAL RVU'S FROM THE CMS FEE SCHEDULE TO MANY DEPARTMENTS AS WELL AS USING COSTS TO HELP ALLOCATE OUR PHARMACY AND SUPPLY EXPENSES. ALL CHARGE ITEMS OBTAIN A COST AND ALL PATIENT SEGMENTS ARE FULLY COSTED.
PART I, LINE 7G:
N/A
PART I, LINE 7, COLUMN (F):
THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 261,895.
PART II, COMMUNITY BUILDING ACTIVITIES:
THE HOSPITAL IS INVOLVED IN A VARIETY OF COMMUNITY BUILDING ACTIVITIES WHICH ADDRESS THE ROOT CAUSES OF HEALTH PROBLEMS. SOME ARE SPECIFIC TO THE COMMUNITY SERVED AND OTHERS ARE MORE GLOBAL IN APPROACH, SUCH AS ADVOCACY WORK AND BOARD MEMBERSHIP IN LOCAL ORGANIZATIONS THAT PROVIDE CRITICAL SERVICES TO THOSE IN NEED. COALITION BUILDINGEXECUTIVE STAFF AT MOUNT SINAI IS EXPECTED TO PARTICIPATE IN COMMUNITY IMPROVEMENT ACTIVITIES SUCH AS SERVING ON BOARDS, ASSISTING SMALL NON-PROFITS WITH FUNDRAISING ACTIVITIES, PROVIDING EXPERTISE AND IN-KIND SUPPORT AND PROVIDING MEETING SPACE FREE OF CHARGE. THIS DATA IS INCLUDED IN THE SAINT FRANCIS SCHEDULE H GIVEN THE OVERLAP OF EXECUTIVE MANAGEMENT ROLES. WORKFORCE DEVELOPMENTIN THE AREA OF WORKFORCE DEVELOPMENT MOUNT SINAI OFFERS TRAINING OF OCCUPATIONAL HEALTH THERAPIST; PHYSICAL THERAPISTS AND NURSING STAFF IN THE AREA OF REHABILITATION. INTERNSHIP OPPORTUNITIES FOR COLLEGE STUDENTS AS WELL AS HIGH SCHOOL STUDENTS DURING THE SUMMER MONTHS TO EXPOSE THEM TO CAREERS IN REHABILITATION ARE ON-GOING. MASTERS AND PHD LEVEL STUDENTS ARE ALSO RECRUITED TO PARTICIPATE IN A VARIETY OF PROJECTS SO THAT THEY BETTER UNDERSTAND THE OPPORTUNITIES AVAILABLE IN THE WORKPLACE.
PART III, LINE 4:
MOUNT SINAI REHABILITATION HOSPITAL ACCEPTS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. A PATIENT IS CLASSIFIED AS A CHARITY PATIENT BY REFERENCE TO THE ESTABLISHED POLICIES OF THE HOSPITAL. ESSENTIALLY, THESE POLICIES DEFINE CHARITY SERVICES AS THOSE SERVICES FOR WHICH NO PAYMENT IS ANTICIPATED. IN ASSESSING A PATIENT'S INABILITY TO PAY, THE HOSPITAL UTILIZES THE GENERALLY RECOGNIZED POVERTY INCOME LEVELS FOR THE STATE OF CONNECTICUT, BUT ALSO INCLUDES CERTAIN CASES WHERE INCURRED CHARGES ARE SIGNIFICANT WHEN COMPARED TO INCOMES. IN ADDITION, ALL SELF-PAY PATIENTS RECEIVE A 45% DISCOUNT FROM CHARGES, WHICH IS NOT INCLUDED IN NET PATIENT SERVICE REVENUE FOR FINANCIAL REPORTING PURPOSES.
PART III, LINE 8:
N/A FOR SHORTFALL REPORTED IN LINE 7.MEDICARE ALLOWABLE COSTS OF CARE ON LINE 6 WERE DETERMINED FROM THE MEDICARE COST REPORTS.
PART III, LINE 9B:
SEE PART III, LINE 4
PART III, LINE 2:
BAD DEBT EXPENSE WAS CALCULATED USING THE PROVIDERS BAD DEBT EXPENSE FROM FINANCIAL STATEMENTS, NET OF ACCOUNTS WRITTEN OFF AT CHARGES.
PART VI, LINE 2:
MOUNT SINAI REHABILITATION HOSPITAL PARTICIPATED IN A COMMUNITY HEALTH ASSESSMENT WITH THE THREE OTHER HOSPITALS LOCATED IN HARTFORD, SAINT FRANCIS HOSPITAL AND MEDICAL CENTER, CONNECTICUT CHILDREN'S MEDICAL CENTER, AND HARTFORD HOSPITAL AND THE CITY OF HARTFORD HEALTH AND HUMAN SERVICES DEPARTMENT TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT. MEETINGS OF THE "COMMUNITY NEEDS ASSESSMENT WORKGROUP" TOOK PLACE OVER A 6 MONTH PERIOD EVERY TWO WEEKS TO DISCUSS THE DESIGN AND IMPLEMENTATION OF THE NEEDS ASSESSMENT. AN INVENTORY OF LOCAL RESOURCES WAS CONDUCTED TO DETERMINE HOW BEST UTILIZE RESOURCES AT THE LOCAL COLLEGES AND UNIVERSITIES, LOCAL COMMUNITY ORGANIZATION, CITY GOVERNMENT AND THE HOSPITALS THEMSELVES. THE NEXT CHNA IS DUE TO BE COMPLETED BY THE END OF FY16. DATA COLLECTION FOR THIS BEGAN IN JUNE OF 2015 AND WILL INCLUDE INPUT FROM COMMUNITY MEMBERS; KEY INFORMANTS; PROGRAM PARTICIPANTS AND HEALTHCARE PROVIDERS.SECONDARY DATA PROFILE FINDINGS:HARTFORD IS A VERY DIVERSE (42% HISPANIC AND 37% AFRICAN AMERICAN), YOUNG (49% BETWEEN THE AGES OF 15-45), POOR (32% OF ALL PEOPLE BELOW THE POVERTY LEVEL) AND UNDER EDUCATED (32% OF 25 YEAR OLDS DID NOT GRADUATE FROM HIGH SCHOOL) CITY. THE UNEMPLOYMENT RATE IS 18% AND SAFETY IS A MAJOR CONCERN FOR RESIDENTS WITH RATES OF LARCENY, DRUG ABUSE, ASSAULT AND MURDER ALL HIGHER THAN STATE LEVELS. HEALTH ISSUES OF THE CITY'S RESIDENTS INCLUDE HIGH RATES OF DIABETES, OBESITY, ASTHMA, DRUG ABUSE AND MENTAL ILLNESS. RATES OF HEART DISEASE AND CANCER ARE ON AVERAGE LOWER THAN THE REST OF THE STATE WHICH IS LIKELY DUE TO THE AGE OF THE CITY'S RESIDENTS. KEY INFORMANT INTERVIEW FINDINGS:RESULTS FROM THE KEY INFORMANT INTERVIEWS SERVED TO CLARIFY THE ISSUES THAT THOSE WORKING IN THE COMMUNITY SEE AS KEY COMMUNITY NEEDS. INTERESTINGLY, THE INFORMATION ON THE MOST IMPORTANT HEALTH ISSUES WAS RIGHT ON TARGET WITH DIABETES, OBESITY, MENTAL ILLNESS AND DRUG ABUSE ALL INCLUDED IN THE TOP 5 KEY HEALTH ISSUES. ADDITIONALLY, KEY INFORMANTS FELT THAT NEIGHBORHOOD SAFETY WAS A MAJOR CONCERN AS IS THE QUALITY OF HOUSING AND THE LIMITED NUMBER OF JOB OPPORTUNITIES.
PART VI, LINE 3:
PATIENTS' ABILITY TO PAY FOR HEALTH CARE IS ASSESSED DURING THE INTAKE PROCESS. IF IT BECOMES CLEAR THAT THE PATIENT DOES NOT HAVE COVERAGE OR HAS MINIMAL COVERAGE THEY ARE REFERRED TO A FINANCIAL COUNSELOR WHO REVIEWS THEIR CURRENT INCOME TO DETERMINE ELIGIBILITY FOR EITHER STATE ASSISTANCE OR HELP FROM MOUNT SINAI CHARITY CARE DOLLARS. IN AREAS OF THE HOSPITAL WHERE NEW PATIENTS ARRIVE: THE REHABILITATION CLINIC, THE MANDELL CENTER, AND THE ADMISSIONS AREA, SIGNAGE IS POSTED ABOUT THE FINANCIAL ASSISTANCE AVAILABLE TO ALL PATIENTS WHO QUALIFY. THIS INFORMATION OUTLINES, IN BOTH ENGLISH AND SPANISH, THE AVAILABILITY OF FINANCIAL COUNSELING AND ASSISTANCE FOR MEDICAL BILLS. ADDITIONALLY, A "PATIENT AND FAMILY INFORMATION NOTEBOOK" WHICH INCLUDES A CHAPTER ON THE AVAILABILITY OF FINANCIAL ASSISTANCE FOR PATIENTS WHO EITHER DO NOT HAVE COVERAGE OR ARE NOT COVERED FULLY BY THEIR HEALTH INSURANCE IS LOCATED IN EACH PATIENT ROOM. INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY IS ALSO INCLUDED IN DISCHARGE MATERIALS. MOUNT SINAI DOES NOT TURN PATIENTS AWAY DUE TO THEIR INABILITY TO PAY. FINALLY, PATIENTS WHO HAVE NOT BEEN FORTHCOMING IN THEIR NEED FOR FINANCIAL ASSISTANCE PRIOR TO THE DELIVERY OF HEALTH CARE SERVICES ARE PROVIDED WITH INFORMATION ABOUT OUR CHARITY CARE POLICY WHEN THEY RECEIVE A BILL FOR THE SERVICES RENDERED. THEY ARE ENCOURAGED TO TALK TO A FINANCIAL COUNSELOR TO DISCUSS A PAYMENT PLAN AND TO DETERMINE IF THEY ARE ELIGIBLE FOR STATE ASSISTANCE OR IF A PORTION OF THEIR BILL CAN BE "WRITTEN OFF" TO CHARITY CARE. THE FINANCIAL ASSISTANCE POLICY IS REVIEWED AT A MINIMUM ON AN ANNUAL BASIS AND MORE OFTEN AS NEEDED. CLARIFICATIONS ABOUT THE CHANGES IMPLEMENTED DUE TO THE AFFORDABLE CARE ACT WERE INCORPORATED INTO THE POLICY IN JANUARY 2014; FURTHER EDITS WERE INCLUDED AND APPROVED IN NOVEMBER OF 2015.
PART VI, LINE 4:
MOUNT SINAI REHABILITATION HOSPITAL SERVES PATIENTS FROM ALL OVER CONNECTICUT, AND ON OCCASION NATIONALLY DUE TO THE STRONG REPUTATION OF THE REHABILITATION PROGRAM AND THE MULTIPLE SCLEROSIS MANDELL CENTER. THE MAJORITY OF PATIENTS, HOWEVER, COME FROM HARTFORD COUNTY, WHICH INCLUDES THE STATE CAPITAL, HARTFORD, AND THIRTY-FIVE SURROUNDING URBAN AND SUBURBAN COMMUNITIES. HARTFORD IS THE CAPITAL OF THE STATE OF CONNECTICUT AND THE SEVENTH LARGEST CITY IN NEW ENGLAND. IT IS ONE OF THE OLDEST CITIES IN THE COUNTRY AND AT ONE POINT WAS ONE OF THE WEALTHIEST. THE POPULATION IN HARTFORD IS 125,000 WITH A PROPORTIONALLY YOUNGER AGE DISTRIBUTION THAN THE US OVERALL. THIS IMPACTS NUMEROUS ASPECTS OF HEALTH INCLUDING RATES OF SOME TYPES OF CANCER, VIOLENCE AND LEVELS OF UNINTENDED INJURY. OVER 70% OF CHILDREN IN THE HARTFORD PUBLIC SCHOOLS RECEIVED FREE OR REDUCED PRICE LUNCH. THE RATE OF INFANTS BORN LOW-BIRTH WEIGHT (LESS THAN 2500 G) IS 9.4%, WELL OVER THE NATIONAL AVERAGE OF 6.8%. HARTFORD IS AN URBAN COMMUNITY, THE MAJORITY OF HARTFORD RESIDENTS ARE MINORITIES WITH 42% LATINO, 37% AFRICAN AMERICAN, 17% WHITE AND 4% OTHER RACES. ACUTE REHABILITATION SERVICE ARE AVAILABLE IN HARTFORD AT NURSING HOME FACILITIES BUT MOUNT SINAI IS THE ONLY LICENSED REHABILITATION HOSPITAL IN THE AREA.
PART VI, LINE 5:
THE HOSPITAL IS INVOLVED IN A VARIETY OF INITIATIVES THAT FOCUS ON IMPROVING THE HEALTH OF THE COMMUNITY OVERALL. COLLABORATIVE EFFORTS WITH A VARIETY OF LOCAL COMMUNITY FOUNDATIONS AND NON-PROFIT ORGANIZATIONS ARE NUMEROUS. THE MT. SINAI REHABILITATION - ROWING DISABLED PERSONS INCLUDING VETERANS IS VERY WELL KNOWN IN THE HARTFORD REGION AND HAS ENABLED NUMEROUS PATIENTS TO REGAIN PHYSICAL AND SOCIAL CONFIDENCE. NUMEROUS RESOURCES ARE DONATED BY THE HOSPITAL AND PARTNERING ORGANIZATIONS INCLUDING RIVERFRONT RECAPTURE, THE JAYCEES FOUNDATION, THE CHRISTOPHER REEVES FOUNDATION AND OTHERS. THE GOLFERS IN MOTION PROGRAM IS DESIGNED TO RE-INTRODUCE GOLF INTO THE LIVES OF THOSE WHO HAVE SUFFERED AN INJURY OR ILLNESS RESULTING IN DISABILITY. THE PROGRAM HAD DEVELOPED ADAPTIVE EQUIPMENT AND SPECIALIZED REHABILITATION SERVICES TO ENABLE GOLFERS TO RETURN TO THE COURSE AND BEGIN TO NORMALIZE THEIR LIVES. A PROGRAM FOR SUPPORTING CAREGIVERS IS NOW IN PLACE THAT PROVIDES TRAINING AND SUPPORT TO FAMILY MEMBERS WHO ARE TAKING CARE OF THOSE WITH CHRONIC ILLNESS; DEMENTIA OR OTHER LONG TERM HEALTH CHALLENGES.
PART VI, LINE 6:
THE ORGANIZATION IS NOT A PART OF AN AFFILIATED HEALTH CARE SYSTEM.PART VI, LINE 7: COMMUNITY BENEFITS ARE REPORTED TO THE STATE'S OFFICE OF THE HEALTH CARE ADVOCATE IN CONNECTICUT. A COMMUNITY BENEFIT REPORT IS PUBLISHED AND WIDELY DISTRIBUTED IN THE LOCAL COMMUNITY AND IT IS POSTED ON THE WEBSITE FOR FULL VIEWING.
PART VI, LINE 7, REPORTS FILED WITH STATES
CT
Schedule H (Form 990) 2014
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