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Schedule H, Part I, Line 3c CRITERIA USED FOR DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE
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UNLESS ELIGIBLE FOR PRESUMPTIVE FINANCIAL ASSISTANCE, THE FOLLOWING ELIGIBILITY CRITERIA MUST BE MET IN ORDER FOR A PATIENT TO QUALIFY FOR FINANCIAL ASSISTANCE: * NO MINIMUM ACCOUNT BALANCE SHALL BE REQUIRED FOR A PATIENT TO QUALIFY FOR FINANCIAL ASSISTANCE. * THE PATIENT'S FAMILY INCOME MUST BE AT OR BELOW 300% OF THE FPG. * THE PATIENT MUST COMPLY WITH PATIENT COOPERATION STANDARDS AS DESCRIBED [IN THE FAP] TO THE EXTENT THEY WILL: 1) ALLOW THE HOSPITAL FACILITY TO PURSUE REIMBURSEMENT FROM ANY THIRD-PARTY COVERAGE THAT MAY BE IDENTIFIED TO THE HOSPITAL FACILITY, IN ACCORDANCE WITH WAC 246-453-020(1); 2) ALLOW THE HOSPITAL FACILITY TO MAKE EVERY REASONABLE EFFORT TO DETERMINE THE EXISTENCE OR NONEXISTENCE OF THIRD-PARTY SPONSORSHIP THAT MIGHT COVER IN FULL OR IN PART THE CHARGES FOR SERVICES PROVIDED TO EACH PATIENT, IN ACCORDANCE WITH WAC 246-453-020(4); AND 3) NOT IMPOSE APPLICATION PROCEDURES FOR CHARITY CARE SPONSORSHIP WHICH PLACE AN UNREASONABLE BURDEN UPON THE RESPONSIBLE PARTY, TAKING INTO ACCOUNT ANY PHYSICAL, MENTAL, INTELLECTUAL, OR SENSORY DEFICIENCIES OR LANGUAGE BARRIERS WHICH MAY HINDER THE RESPONSIBLE PARTY'S CAPABILITY OF COMPLYING WITH THE APPLICATION PROCEDURES, IN ACCORDANCE WITH WAC 246-453-020(5). * THE PATIENT MUST SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION. FOR PATIENTS AND GUARANTORS WHO ARE UNABLE TO PROVIDE REQUIRED DOCUMENTATION, A HOSPITAL FACILITY MAY GRANT PRESUMPTIVE FINANCIAL ASSISTANCE BASED ON INFORMATION OBTAINED FROM OTHER RESOURCES. IN PARTICULAR, PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE: * RECIPIENT OF STATE-FUNDED PRESCRIPTION PROGRAMS; * HOMELESS OR ONE WHO RECEIVED CARE FROM A HOMELESS CLINIC; * PARTICIPATION IN WOMEN, INFANTS AND CHILDREN PROGRAMS (WIC); * FOOD STAMP ELIGIBILITY; * SUBSIDIZED SCHOOL LUNCH PROGRAM ELIGIBILITY; * ELIGIBILITY FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS (E.G., MEDICAID SPEND-DOWN); * LOW INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS; OR * PATIENT IS DECEASED WITH NO KNOWN ESTATE. IN THE EVENT THE RESPONSIBLE PARTY'S IDENTIFICATION AS AN INDIGENT PERSON IS OBVIOUS TO HOSPITAL FACILITY PERSONNEL, AND THE HOSPITAL FACILITY PERSONNEL ARE ABLE TO ESTABLISH THE POSITION OF THE INCOME LEVEL WITHIN THE BROAD CRITERIA DESCRIBED IN WAC 246-453-040, BASED ON THE INDIVIDUAL LIFE CIRCUMSTANCES CONTAINED WITHIN POLICY 15 OR OTHERWISE, THE HOSPITAL FACILITY IS NOT OBLIGATED TO ESTABLISH THE EXACT INCOME LEVEL OR TO REQUEST DOCUMENTATION FROM THE RESPONSIBLE PARTY, UNLESS THE RESPONSIBLE PARTY REQUESTS FURTHER REVIEW. HOSPITAL FACILITIES SHALL MAKE EVERY REASONABLE EFFORT TO REACH INITIAL AND FINAL DETERMINATIONS OF ELIGIBILITY FOR FINANCIAL ASSISTANCE IN A TIMELY MANNER. NEVERTHELESS, HOSPITAL FACILITIES SHALL MAKE THOSE DETERMINATIONS AT ANY TIME, EVEN AFTER THE APPLICATION PERIOD, UPON LEARNING OF FACTS OR RECEIVING THE DOCUMENTATION DESCRIBED HEREIN, INDICATING THAT THE RESPONSIBLE PARTY'S INCOME IS EQUAL TO OR BELOW TWO HUNDRED PERCENT (200%) OF THE FEDERAL POVERTY GUIDELINES AS ADJUSTED FOR FAMILY SIZE.
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Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation
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11041456
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Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
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Worksheet 2 was utilized to compute the cost-to-charge ratio for the year ended 6/30/19 using the following formula: Operating expense (less non-patient care activities, Medicare provider taxes, community benefit expense and community building expense) divided by gross patient revenue (less gross charges for community benefit programs). Based on that formula, 452,651,317/$2,430,039,597 results in a 18.63% cost-to-charge ratio. Total bad debt expense reported on Form 990 Part IX, line 25, Column A was $11,041,456.
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Schedule H, Part II Community Building Activities
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Refer to Schedule H, Part VI.
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Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
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Costing methodology for amounts reported on line 2 is determined using the organization's cost/charge ratio of 18.63%. When discounts are extended to self-pay patients, these patient account discounts are recorded as a reduction in revenue, not as bad debt expense.
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Schedule H, Part III, Line 3 Bad Debt Expense Methodology
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Harrison Medical Center does not believe that any portion of bad debt expense could reasonably be attributed to patients who qualify for financial assistance since amounts due from those individuals' accounts will be reclassified from bad debt expense to charity care within 30 days following the date that the patient is determined to qualify for charity care.
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Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
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Harrison Medical Center does not issue separate company audited financial statements. However, the organization is included in the consolidated financial statements of CommonSpirit Health. The consolidated footnote reads as follows: CommonSpirit relies on the results of detailed reviews of historical write-offs and collections in estimating the collectability of accounts receivable. Updates to the hindsight analysis is performed at least quarterly using primarily a rolling eighteen-month collection history and write-off data. Subsequent changes to estimates of the transaction price are generally recorded as adjustments to net patient revenue in the period of change. Subsequent changes that are determined to be the result of an adverse change in a third-party payor's ability to pay are recorded as bad debt expense in purchased services and other in the accompanying consolidated statements of operations and change in net assets. Bad debt expense for 2019 was not significant.
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Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
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Using essentially the same Medicare cost report principles as to the allocation of general services costs and "apportionment" methods, the "CHI Workbook" calculates a payers' gross allowable costs by service (so as to facilitate a corresponding comparison between gross allowable costs and ultimate payments received). The term "gross allowable costs" means costs before any deductibles or co-insurance are subtracted.Harrison Medical Center's ultimate reimbursement will be reduced by any applicable copayment/ deductible. Where Medicare is the secondary insurer, amounts due from the insured's primary payer were not subtracted from Medicare allowable costs because the amounts are typically immaterial. Although not presented on the Medicare cost report, in order to facilitate a more accurate understanding of the "true" cost of services (for "shortfall" purposes) the CHI Workbook allows a health care facility not to offset costs that Medicare considers to be non-allowable, but for which the facility can legitimately argue are related to the care of the facility's patients. In addition, although not reportable on the Medicare cost report, the CHI workbook includes the cost of services that are paid via a set fee-schedule rather than being reimbursed based on costs (e.g. outpatient clinical laboratory). Finally, the CHI Workbook allows a facility to include other health care services performed by a separate facility (such as a physician practice) that are maintained on separate books and records (as opposed to the main facility's books and records which has its costs of service included within a cost report). True costs of Medicare computed using this methodology: Total Medicare Revenue: $160,942,077 Total Medicare costs: $191,613,547 Surplus or Shortfall: ($30,671,470) Harrison Medical Center believes that excluding Medicare losses from community benefit makes the overall community benefit report more credible for these reasons: Unlike subsidized areas such as burn units or behavioral-health services, Medicare is not a differentiating feature of tax-exempt health care organizations. In fact, for-profit hospitals focus on attracting patients with Medicare coverage, especially in the case of well-paid services that include cardiac and orthopedics. Significant effort and resources are devoted to ensuring that hospitals are reimbursed appropriately by the Medicare program. The Medicare Payment Advisory Commission (MedPAC), an independent Congressional agency, carefully studies Medicare payment and the access to care that Medicare beneficiaries receive. The commission recommends payment adjustments to Congress accordingly. Though Medicare losses are not included by Catholic hospitals as community benefit, the Catholic Health Association guidelines allow hospitals to count as community benefit some programs that specifically serve the Medicare population. For instance, if hospitals operate programs for patients with Medicare benefits that respond to identified community needs, generate losses for the hospital, and meet other criteria, these programs can be included in the CHA framework in Category C as ''subsidized health services''. Medicare losses are different from Medicaid losses, which are counted in the CHA community benefit framework, because Medicaid reimbursements generally do not receive the level of attention paid to Medicare reimbursement. Medicaid payment is largely driven by what states can afford to pay, and is typically substantially less than what Medicare pays.
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Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
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The organization's billing and collections policy applies to all individuals presenting for emergency or other medically necessary care. The policy contains provisions for collecting amounts due from those patients who the organization knows to qualify for financial assistance either through the traditional financial assistance application process or through presumptive eligibility processes. Before engaging in extraordinary collection actions (ECAs) to obtain payment for EMCare, Hospital Facilities must make reasonable efforts through its billing and collections processes, pursuant to Treas. Reg. §1.501(r)-6(c), to determine whether an individual is eligible for Financial Assistance. In no event will an ECA be initiated prior to 120 days from the date the Facility provides the first post-discharge billing statement (i.e., during the Notification Period) unless all reasonable efforts have been made. Hospital Facilities will not refer accounts for collection where the patient has initially applied for Financial Assistance, and the Hospital Facility has not yet made reasonable efforts with respect to the account. For patients and Guarantors who are unable to provide required documentation, a Hospital Facility may grant Presumptive Financial Assistance based on information obtained from other resources. Patients who qualify for Medicaid are presumed to qualify for full charity write off. Any charges for days or services written off (excluding Medicaid denials related to timeliness of billing, insufficient medical record documentation, missing invoices, authorization, or eligibility issues) as a result of a Medicaid are booked as charity. Some Medicaid plans offer coverage for a limited or restricted list of services. If a patient is eligible for Medicaid, any charges for days or services not covered by the patient's coverage may be written off to charity without a completed application. This does not include any Share of Cost (SOC) or other patient cost-sharing amounts such as deductibles or copayments, as such costs are determined by the state to be an amount that the patient must pay before the patient is eligible for Medicaid. Health and Human Services (HSS) uses the term "Spend Down" instead of Share of Cost. All collection activities conducted by the Facility, a Designated Supplier, or its third-party collection agents will be in conformance with all federal and state laws governing debt collection practices. All third-party agreements governing collection and recovery activities must include a provision requiring compliance with the hospital facilities' financial assistance and billing and collections policy and indemnification for failures as a result of its noncompliance. This includes, but is not limited to, agreements between third parties who subsequently sell or refer debt of the Hospital Facility.
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Schedule H, Part V, Section B, Line 16a FAP website
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A - HARRISON MEDICAL CENTER: Line 16a URL: www.chifranciscan.org/billing-insurance-and-finances/financial-assistance-discounts-for-patients;
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Schedule H, Part V, Section B, Line 16b FAP Application website
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A - HARRISON MEDICAL CENTER: Line 16b URL: www.chifranciscan.org/billing-insurance-and-finances/financial-assistance-discounts-for-patients;
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Schedule H, Part V, Section B, Line 16c FAP plain language summary website
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A - HARRISON MEDICAL CENTER: Line 16c URL: www.chifranciscan.org/billing-insurance-and-finances/financial-assistance-discounts-for-patients;
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Schedule H, Part VI, Line 2 Needs assessment
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OVER THE LAST CENTURY, HARRISON HAS EVOLVED FROM A SMALL COMMUNITY HOSPITAL WITH ACCESS FOR ALL INTO THE PENINSULA'S BUSIEST MEDICAL CENTER. OUR BOARD OF COMMUNITY LEADERS HAS CONTINUED TO RENEW THAT COMMITMENT TO SUPERIOR MEDICAL CARE AND SERVICE FOR THE REGION. THE MISSION THAT GUIDES US IS AS COMPELLING TODAY AS EVER: TO MAKE A POSITIVE DIFFERENCE IN PEOPLE'S LIVES THROUGH EXCEPTIONAL HEALTH CARE. AS WE'VE GROWN, WE'VE RAISED THE BAR. WE MOVED PATIENTS TO THE TOP OF THE ORGANIZATION CHART INTENT ON EXCELLENCE IN SAFETY, QUALITY AND SERVICE. WE HAVE MADE GREAT STRIDES EARNING RECOGNITION FOR PROVIDING EXCELLENT CARE. WE EXPANDED OUR PRESENCE TO MORE COMMUNITIES AND ENHANCED OUR SERVICES AND IMPROVED FACILITIES, TECHNOLOGY AND INFRASTRUCTURE. TODAY WE ARE CARING FOR PATIENTS FROM KITSAP, NORTH MASON, CLALLAM AND JEFFERSON COUNTIES WITH LOCATIONS IN BREMERTON, SILVERDALE, PORT ORCHARD, BAINBRIDGE ISLAND, BELFAIR, POULSBO AND FORKS. NOW HARRISON OFFERS A COMPREHENSIVE RANGE OF SPECIALTIES, SERVICES AND PROGRAMS, INCLUDING A 24-7 EMERGENCY DEPARTMENT THAT IS OPEN TO ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. CARE IS PROVIDED BY A STAFF OF 2,300 AND A MEDICAL STAFF OF 415, WHO ARE PART OF FRANCISCAN MEDICAL GROUP, THE ORTHOPAEDIC ALLIANCE AND OTHER PARTNER ORGANIZATIONS. AS A RESULT OF OUR OPEN MEDICAL STAFF, MANY OF THE REGION'S FINEST PROFESSIONALS CHOOSE TO WORK WITH HARRISON. OUR TEAM OF DOCTORS, ADVANCED PRACTICE CLINICIANS, NURSES AND STAFF IS DEDICATED TO MAKING A POSITIVE DIFFERENCE HELPING PEOPLE HEAL AND ENJOY HEALTH. EACH YEAR OUR SERVICES AND PROGRAMS ARE EXPANDED TO PROMOTE A HEALTHY COMMUNITY.
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Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
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Notification about the availability of Financial Assistance from CHI Hospital Organizations shall be disseminated by various means, which may include, but not be limited to: * Conspicuous publication of notices in patient bills; * Notices posted in emergency rooms, urgent care centers, admitting/registration departments, business offices, and at other public places as a Hospital Facility may elect; and * Publication of a summary of this Policy on the Hospital Facility's website, www.catholichealth.net, and at other places within the communities served by the Hospital Facility as it may elect. Such notices and summary information shall include a contact number and shall be provided in English, Spanish, and other primary languages spoken by the population served by an individual Hospital Facility, as applicable. Referral of patients for Financial Assistance may be made by any member of the CHI Hospital Organization non-medical or medical staff, including physicians, nurses, financial counselors, social workers, case managers, chaplains, and religious sponsors. A request for assistance may be made by the patient or a family member, close friend, or associate of the patient, subject to applicable privacy laws. In addition, Hospital registration clerks are trained to provide consultation to those who have no insurance or potentially inadequate insurance concerning their financial options including application for Medicaid and for assistance under the Financial Assistance Policy. Counselors assist Medicare eligible patients in enrollment by providing referrals to the appropriate government agencies. Once it is determined that the patient does not qualify for any third party funding, the patient is verbally notified about the existence of Financial Assistance Application and additional screening takes place by a Hospital employee to determine if the patient is eligible for charity service prior to discharge. Upon registration (and once all EMTALA requirements are met), patients who are identified as uninsured (and not covered by Medicare or Medicaid) are provided with a packet of information that addresses the Financial Assistance Policy, the plain language summary of that policy, and an application for assistance. Hospital registration clerks read the organization's medical assistance policy to those who appear to be incapable of reading, and provide translators for non-English-speaking individuals. Patients that have been discharged prior to charity screening, such as emergency room patients, receive a written notification of possible eligibility for services. If the patient is determined not to be eligible for government assistance, he/she may notify the hospital that they seek charity assistance. The appropriate charity form is sent to the patient/guarantor for completion and then returned to the hospital for evaluation and qualification. Once determination of eligibility is made, the patient is sent a notice informing him/her if they qualify for full, partial, or no charity care services. Hospital Facilities must make reasonable efforts through its billing and collections processes, pursuant to Treas. Reg. §1.501(r)-6(c), to determine whether any individual is eligible for Financial Assistance.
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Schedule H, Part VI, Line 4 Community information
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Harrison Medical Center is the only hospital in Kitsap County and the entire county is identified as the primary service area. As of 2016, Kitsap County had an estimated population of 262,590 residents. On average, Kitsap County residents are slightly older than Washington State residents. Kitsap County is relatively homogenous: more than three-quarters of residents are White, non-Hispanic. Hispanics represent the second largest racial/ethnic group, and the Kitsap minority population has been increasing over time.
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Schedule H, Part VI, Line 5 Promotion of community health
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The organization's hospital facility(ies) promote health for the benefit of the community. Medical staff privileges in the hospital are available to all qualified physicians in the area, consistent with the size and nature of its facilities. The organization's hospital facility(ies) have an open medical staff. Its board of trustees is composed of prominent citizens in the community. Excess funds are generally applied to expansion and replacement of existing facilities and equipment, amortization of indebtedness, improvement in patient care, and medical training, education, and research. The facility(ies) treat persons paying their bills with the aid of public programs like Medicare and Medicaid. All patients presenting at the hospital for emergency and other medically necessary care are treated regardless of their ability to pay for such treatment. CHI Franciscan opens our facilities and hosts numerous groups and classes with donated space and classes open to all in our communities. CHI Franciscan sponsors support groups around grief, heart failure, stroke, cancer, substance use recovery, and more. CHI Franciscan provides significant financial contributions to non-profit organizations in our community that promote the health and well-being of our communities. This includes major participation and sponsorship in the American Heart Association, Susan G Komen Race for the Cure, Relay for Life and more. All CHI Franciscan facilities participate in and contribute to our local United Way affiliates to achieve their goal of supporting residents.
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Schedule H, Part VI, Line 6 Affiliated health care system
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The organization is affiliated with CommonSpirit Health. CommonSpirit Health was created by the alignment of Catholic Health Initiatives and Dignity Health as a single ministry in early 2019. CommonSpirit Health, a nonprofit, faith-based health system is committed to building healthier communities, advocating for those who are poor and vulnerable, and innovating how and where healing can happen - both inside its hospitals and out in the community. CommonSpirit Health owns and operates health care facilities in 21 states and comprises 142 hospitals, including three academic health centers, major teaching hospitals as well as 31 critical-access facilities; community health services organizations; accredited nursing colleges; home health agencies; living communities; a medical foundation and other affiliated medical groups; and other facilities and services that span the inpatient and outpatient continuum of care. In fiscal year 2019, CommonSpirit Health provided more than $2.1 billion in financial assistance and community benefit for programs and services for the poor, free clinics, education and research. Financial assistance and community benefit totaled more than $4.4 billion with the inclusion of the unpaid costs of Medicare. The health system, which generated operating revenues of $20.96 billion in fiscal year 2019, has total assets of approximately $40.6 billion. CommonSpirit Health provides strategic planning and management services as well as centralized "share services" for its Divisions. The provision of centralized management and shared services including areas such as accounting, human resources, payroll and supply chain provides economies of scale and purchasing power to the Divisions. The cost savings achieved through CommonSpirit Health's centralization enable Divisions to dedicate additional resources to high-quality health care and community outreach services to the most vulnerable members of our society.
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Schedule H, Part VI, Line 7 State filing of community benefit report
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WA
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