PART I, LINE 3C:
|
TO BE ELIGIBLE FOR FREE CARE THE ORGANIZATION USES THE FEDERAL POVERTY GUIDELINE (FPG) FOR FAMILY INCOMES THAT ARE AT OR BELOW 400% OF FPG. IN ADDITION, THE FOLLOWING DISCOUNTS APPLY TO UNINSURED PATIENTS: 1) SPECIAL CIRCUMSTANCES CHARITY CARE: A COMPLETE OR PARTIAL WRITE-OFF IN CIRCUMSTANCES INCLUDING BUT NOT LIMITED TO BANKRUPTCY, HOMELESSNESS, DECEASED, INELIGIBLE FOR MEDICARE/MEDI-CAL, OR IF A COLLECTION AGENCY IDENTIFIES A PATIENT MEETING MGH'S CHARITY CARE ELIGIBILITY CRITERIA. 2) CATASTROPHIC CHARITY CARE: FULL WRITE-OFF WHEN THE FINANCIAL RESPONSIBILITY EXCEEDS 10% OF PATIENT'S FAMILY INCOME.3) UNINSURED PATIENT DISCOUNT: A WRITE-OFF OF A PORTION OF COVERED SERVICES NO GREATER THAN THE CURRENT AVERAGE COMMERCIAL FEE-FOR-SERVICE DISCOUNT WITH MANAGED CARE PAYERS FOR PATIENTS WHOSE BENEFITS UNDER INSURANCE OR A GOVERNMENT PROGRAM HAVE BEEN EXHAUSTED PRIOR TO ADMISSION. 4) PROMPT PAYMENT DISCOUNT: ADDITIONAL DISCOUNT FOR PATIENTS RECEIVING THE UNINSURED DISCOUNT OF AT LEAST 10% WHO PAYS ESTIMATED BILL PRIOR TO DISCHARGE.
|
PART I, LINE 7:
|
A COST-TO-CHARGE RATIO WAS USED TO DETERMINE THE AMOUNTS ON LINES 7A, 7B, AND 7C. COST ACCOUNTING WAS USED TO DETERMINE THE AMOUNTS ON LINES 7E, 7F, AND 7I.
|
PART II, COMMUNITY BUILDING ACTIVITIES:
|
ECONOMIC DEVELOPMENT: MGH IS A MEMBER OF THE SAN RAFAEL CHAMBER OF COMMERCE. THE SAN RAFAEL CHAMBER OF COMMERCE IS ONE OF MARIN COUNTY'S LEADING BUSINESS ADVOCATES. THEY ARE STRONG CHAMPIONS FOR LOCAL BUSINESS INTERESTS AND WORK VIGOROUSLY TO MAINTAIN A HEALTHY ECONOMY. ADDITIONALLY, DURING 2017, MGH CONTRIBUTED $10,000 TO THE MARIN ECONOMIC FORUM, A 501(C)(3) ORGANIZATION WHO STRIVES TO PROVIDE INFORMATION AND OPPORTUNITIES FOR IMPROVING MARIN COUNTY'S ECONOMIC VITALITY, WHILE SEEKING TO INCREASE SOCIAL EQUITY AND ENVIRONMENTAL PROTECTION.COALITION BUILDING: MGH WORKS WITH THE AGRICULTURAL INSTITUTE OF MARIN AND HEALTH COUNCIL OF MARIN TO PROMOTE HEALTHY INITIATIVES IN THE COMMUNITY. EXPENSES COULD NOT BE QUANTIFIED.COMMUNITY HEALTH IMPROVEMENT ADVOCACY: MGH PARTICIPATES ON A COMMUNITY COMMITTEE THROUGH THE MARIN MOBILITY CONSORTIUM FOUNDATION THAT IS WORKING TO DEVELOP A PROGRAM TO COORDINATE RIDES FOR SENIORS, DISABLED, AND PARATRANSIT PERSONS. ADDITIONALLY, MGH PROVIDED A $5,000 GRANT TO THE SAN FRANCISCO BAY AREA CHAPTED OF THE SUSAN G. KOMEN FOUNDATION.
|
PART III, LINE 2:
|
THE RATIO OF PATIENT CARE COST TO CHARGES IS APPLIED TO THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS TO CALCULATE THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS THAT IS REPORTED ON LINE 2. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS AN ADJUSTMENT TO REVENUE, NOT BAD DEBT EXPENSE.
|
PART III, LINE 4:
|
MGH'S AUDITED FINANCIAL STATEMENTS DOES NOT HAVE A SEPARATE BAD DEBT EXPENSE FOOTNOTE. HOWEVER, THE FOOTNOTE WHICH ADDRESSES "NET PATIENT ACCOUNTS RECEIVABLE AND "ALLOWANCE FOR DOUBTFUL ACCOUNTS" CAN BE FOUND ON PAGES 9 AND 10 OF THE AUDITED FINANCIAL STATEMENTS.
|
PART III, LINE 8:
|
THE ORGANIZATION DID NOT COUNT THE MEDICARE SHORTFALL AS A COMMUNITY BENEFIT. ALL MEDICARE REVENUE AND COST WAS INCLUDED IN THE ORGANIZATION'S MEDICARE COST REPORT. MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO.
|
PART III, LINE 9B:
|
COLLECTION PRACTICES ARE CONSISTENT FOR ALL PATIENTS AND COMPLY WITH APPLICABLE PROVISIONS OF CALIFORNIA LAW. DURING PRE-ADMISSION OR REGISTRATION, THE HOSPITAL PROVIDES ALL PATIENTS WITH INFORMATION REGARDING AVAILABILITY OF FINANCIAL ASSISTANCE. AN UNINSURED PATIENT WHO INDICATES THE FINANCIAL INABILITY TO PAY A BILL IS EVALUATED FOR FINANCIAL ASSISTANCE. PATIENTS ARE GIVEN AN APPLICATION WHICH DOCUMENTS THE PATIENT'S OVERALL FINANCIAL SITUATION. IF AN UNINSURED PATIENT DOES NOT COMPLETE THE APPLICATION FORM WITHIN 30 DAYS OF DELIVERY, THE HOSPITAL WILL NOTIFY THE PATIENT THAT THE APPLICATION HAS NOT BEEN RECEIVED AND WILL PROVIDE THE PATIENT AN ADDITIONAL 30 DAYS TO COMPLETE THE APPLICATION. IF A PATIENT HAS APPLIED FOR CHARITY CARE AND HAS BEEN APPROVED TO RECEIVE CHARITY CARE, OR IS COOPERATING WITH THE HOSPITAL'S EFFORTS TO SETTLE AN OUTSTANDING BILL WITHIN A REASONABLE TIME PERIOD, THE HOSPITAL WILL NOT PURSUE COLLECTIONS.
|
PART VI, LINE 2:
|
IN ADDITION TO THE TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT, HEALTH NEEDS ARE MONITORED AS FOLLOWS: (I) MARIN HEALTHCARE DISTRICT BOARD MEETINGS, WHICH INCLUDE PUBLIC COMMENTS AND WHICH THE MGH CEO ATTENDS AND SHARES COMMUNITY INPUT WITH HOSPITAL STAFF AS APPROPRIATE; (II) MGH BOARD MEMBERS ARE ALL COMMUNITY RESIDENTS AND SHARE COMMUNITY HEALTH CONCERNS WHEN APPROPRIATE; (III) COMMUNITY COMMENTS ON THE TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY ARE COLLECTED ON THE MGH WEBSITE AND ARE MONITORED BY THE COMMUNITY RELATIONS DEPARTMENT.
|
PART VI, LINE 3:
|
COMMUNICATION OF FINANCIAL ASSISTANCE AVAILABILITY A. INFORMATION PROVIDED TO PATIENTS: 1. PREADMISSION OR REGISTRATION: DURING PREADMISSION OR REGISTRATION (OR AS SOON THEREAFTER AS PRACTICABLE) HOSPITAL SHALL PROVIDE: (I) ALL PATIENTS WITH INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE AND THEIR RIGHT TO REQUEST AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR SERVICES (IMPORTANT BILLING INFORMATION FOR UNINSURED PATIENTS). (II) PATIENTS WHO THE HOSPITAL IDENTIFY MAY BE UNINSURED WITH A FINANCIAL ASSISTANCE APPLICATION SUBSTANTIALLY SIMILAR TO THE MARIN GENERAL HOSPITAL STANDARDIZED FINANCIAL ASSISTANCE APPLICATION, "STATEMENT OF FINANCIAL CONDITION". 2. EMERGENCY SERVICES: IN THE CASE OF EMERGENCY SERVICES, HOSPITAL SHALL PROVIDE THE ABOVE INFORMATION AS SOON AS PRACTICABLE AFTER STABILIZATION OF THE PATIENT'S EMERGENCY MEDICAL CONDITION OR UPON DISCHARGE. 3. ALL OTHER TIMES: UPON REQUEST, HOSPITAL SHALL PROVIDE PATIENTS WITH INFORMATION ABOUT THEIR RIGHT TO REQUEST AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR SERVICES, MGH FINANCIAL ASSISTANCE APPLICATION FORM, "STATEMENT OF FINANCIAL CONDITION". B. POSTINGS AND OTHER NOTICES: INFORMATION ABOUT FINANCIAL ASSISTANCE SHALL ALSO BE PROVIDED AS FOLLOWS: 1. BY POSTING NOTICES IN A VISIBLE MANNER IN LOCATIONS WHERE THERE IS A HIGH VOLUME OF INPATIENT OR OUTPATIENT ADMITTING/REGISTRATION, INCLUDING BUT NOT LIMITED TO THE EMERGENCY DEPARTMENT, BILLING OFFICES, ADMITTING OFFICE, AND OTHER HOSPITAL OUTPATIENT SERVICE SETTINGS. 2. BY POSTING INFORMATION ABOUT FINANCIAL ASSISTANCE ON THE MGH WEBSITE. 3. BY INCLUDING INFORMATION ABOUT FINANCIAL ASSISTANCE IN BILLS THAT ARE SENT TO UNINSURED PATIENTS. 4. BY INCLUDING LANGUAGE ON BILLS SENT TO UNINSURED PATIENTS AS SPECIFICALLY SET FORTH IN THE MANAGEMENT OF PATIENT ACCOUNTS RECEIVABLE COLLECTION PRACTICES, HOSPITAL THIRD-PARTY LIENS, AND DISPUTE INITIATION POLICY. C. APPLICATIONS PROVIDED AT DISCHARGE: IF NOT PREVIOUSLY PROVIDED, HOSPITAL SHALL PROVIDE UNINSURED PATIENTS WITH APPLICATIONS FOR MEDI-CAL, HEALTHY FAMILIES, CALIFORNIA CHILDREN'S SERVICES, OR ANY OTHER POTENTIALLY APPLICABLE GOVERNMENT PROGRAM AT THE TIME OF DISCHARGE. D. LANGUAGES: ALL NOTICES/COMMUNICATIONS PROVIDED IN THIS SECTION SHALL BE AVAILABLE IN THE PRIMARY LANGUAGES OF MGH'S SERVICE AREA AND IN A MANNER CONSISTENT WITH ALL APPLICABLE FEDERAL AND STATE LAWS AND REGULATIONS. E. NOTIFICATION TO UNINSURED PATIENTS OF ESTIMATED FINANCIAL RESPONSIBILITY: BY LAW, UNINSURED PATIENTS ARE ENTITLED TO RECEIVE AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR HOSPITAL SERVICES. EXCEPT IN THE CASE OF EMERGENCY SERVICES, HOSPITAL SHALL NOTIFY PATIENTS WHO THE HOSPITAL IDENTIFIES MAY BE UNINSURED PATIENTS THAT THEY MAY OBTAIN AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR HOSPITAL SERVICES, AND PROVIDE ESTIMATES TO THOSE PATIENTS UPON REQUEST. ESTIMATES SHALL BE WRITTEN, AND BE PROVIDED DURING NORMAL BUSINESS HOURS. ESTIMATES SHALL REPRESENT THE AMOUNT THE HOSPITAL WILL REQUIRE THE PATIENT TO PAY FOR THE HEALTH CARE SERVICES, PROCEDURES, AND SUPPLIES THAT ARE REASONABLY EXPECTED TO BE PROVIDED TO THE PATIENT BY THE HOSPITAL, BASED UPON THE AVERAGE LENGTH OF STAY AND SERVICES PROVIDED FOR THE PATIENT'S DIAGNOSIS.
|
PART VI, LINE 4:
|
COMMUNITY INFORMATION: MARIN GENERAL HOSPITAL DEFINES THE COMMUNITY SERVED BY THE HOSPITAL AS THOSE INDIVIDUALS RESIDING WITHIN ITS HOSPITAL SERVICE AREA. A HOSPITAL SERVICE AREA INCLUDES ALL RESIDENTS IN A DEFINED GEOGRAPHIC AREA SURROUNDING THE HOSPITAL AND DOES NOT EXCLUDE LOW-INCOME OR UNDERSERVED POPULATIONS. THE MARIN GENERAL HOSPITAL SERVICE AREA INCLUDES ALL OF MARIN COUNTY. THE CITIES INCLUDED ARE: BELVEDERE, CORTE MADERA, FAIRFAX, LARKSPUR, MILL VALLEY, NOVATO, ROSS, SAN ANSELMO, SAN RAFAEL, SAUSALITO, TIBURON, AND THE COASTAL TOWNS OF STINSON BEACH, BOLINAS, POINT REYES, INVERNESS, MARSHALL, AND TOMALES. CERTAIN SPECIALTY PROGRAMS, INCLUDING ITS TRAUMA SERVICE, SERVE A BROADER POPULATION, INCLUDING PATIENTS FROM SONOMA COUNTY, THE BROADER SAN FRANCISCO BAY AREA AND BEYOND.THE KEY DRIVERS OF HEALTH STATUS ARE INCOME, EDUCATION AND HEALTH INSURANCE. WHILE MARIN COUNTY COMPARES WELL WITH THE STATE, THERE ARE CLEAR VULNERABLE POPULATIONS WHOSE HEALTH STATUS IS MOST AT RISK: 19.4% OF RESIDENTS ARE LIVING BELOW 200% FEDERAL POVERTY LEVEL (FPL); 17.8% OF CHILDREN ARE LIVING BELOW 200% FPL; 8.9% OF RESIDENTS ARE UNINSURED; 7.6% OF RESIDENTS ARE WITHOUT A HIGH SCHOOL DIPLOMA; 15.5% OF RESIDENTS ARE HISPANIC/LATINO; 2.9% OF RESIDENTS ARE BLACK AND 5.6% OF RESIDENTS ARE ASIAN.MARIN COUNTY IS A HEALTHY AND AFFLUENT COUNTY, ESPECIALLY WHEN COMPARED TO CALIFORNIA AS A WHOLE. HOWEVER, MARIN IS ALSO AN AGING COUNTY WITH SUBSTANTIAL DISPARITIES IN SOCIOECONOMIC STATUS. THESE ISSUES PRESENT CHALLENGES FOR THE HEALTH OF MARIN COUNTY RESIDENTS.
|
PART VI, LINE 5:
|
MARIN GENERAL HOSPITAL IS THE ONLY FULL SERVICE ACUTE CARE HOSPITAL IN THE COUNTY AND THE ONLY HOSPITAL WITH AN OBSTETRICAL SERVICE OR IN PATIENT BEHAVIORAL HEALTH SERVICE. IT SERVES AS THE TRAUMA CENTER FOR MARIN COUNTY AND SURROUNDING AREAS. THE BOARD OF DIRECTORS IS COMPOSED OF UNCOMPENSATED COMMUNITY RESIDENTS. ALL FUNDS ARE USED TO IMPROVE HEALTH CARE SERVICES, MAINTAIN UP-TO-DATE FACILITIES, AND SUPPORT TRAINING PROGRAMS FOR HEALTH PROFESSIONALS IN AREAS SUCH AS NURSING, PHARMACY, RADIOLOGY, RESPIRATORY THERAPY, REHABILITATION SERVICES AND BEHAVIORAL HEALTH. THE MEDICAL STAFF IS OPEN TO ALL QUALIFIED PHYSICIANS.
|
PART VI, LINE 7, REPORTS FILED WITH STATES
|
CA
|