Patients must be told if they qualify for charity care

thatit was too much of a financial “burden” to track down andtell the patients.

But now, under the state’s new definition, hospitals will have to tell the patients.

The new definition is included in a state Medical Assistance Bulletin that outlines how hospitals must provide charity care in order to be eligible to receive funds from the state’s Tobacco Settlement program, which reimburses hospitals for some of their charity care expenses each year if they apply.

Not every hospital in the state receives money from thefund.

But almost every hospital pledges to abide by the state’s requirements to be eligible forthe funds.

In 2016, 190 of 210 eligible hospitals said they complied with the state’s requirements, and the state awarded about $54 million to 145 of those hospitals to reimburse them for some of their uncompensatedcare.

Hospitals have been using some form of presumptive eligibility for charity care for decades.

Under the original form, hospitals would approve someone for charity care if they were already participating — Julie Trocchio, Catholic Health Association in some government program — such as getting food stamps or living in subsidized housing — that had a similar financial standard for qualification.

But this new form of presumptive eligibility, which has been around for about a decade, is a 21st century version that uses a credit-scorelike algorithm that can determine whether a person qualifies for charity care if all the hospital has is your name and address, or your Social Securitynumber.

The algorithms, which are sold by more than a dozen vendors, use all the available financial data on you, an assessment of where you live and even social media data, to determine if you would qualify.

Hospitals have enthusiastically purchased presumptive eligibility tools, saying that it gives them the chance to prove something they’ve long believed: That most of the people who do not pay their hospital bills probably would qualify for charity care if they would apply for the program.

In a survey by the Post-Gazette, 23 of the 29 general acute care hospitals in the eight-country region of southwestern Pennsylvania, said, or have said in the past, that they are currently using presumptive eligibility tools.

This includes all eight UPMC hospitals in the region, all six AHN hospitals, all three Excela hospitals, Heritage Valley’s two hospitals, and St. Clair, Ohio Valley, Uniontown and Monongahela hospitals.

But 14 of those 23 hospitals still do not tell the patients that they are qualified for charity care through presumptive eligibility, including the AHN hospitals.

AHN and Ohio Valley said they were both still reviewing the new state definition, and Uniontown said it will begin notifying patients starting Feb. 1. St. Clair would not comment.

WashingtonHealth System said its two hospitals do not yet use presumptive eligibility,as did Highlands Hospital.

Butler Hospital and ACMH in Kittanning did not respond, and Advanced Surgical in Washington, Pa., doesnot provide charity care.

For more than a decade, UPMC, which was the first hospital system in the region to use presumptive eligibility, did not tell patients because it was not required and too much of a burden.

UPMC spokeswoman Susan Manko said UPMC decided to start notifying patients last July because of the IRS regulations affecting hospitals that became effective in 2016.

Heritage Valley, which has hospitals in Sewickley and Beaver, began using presumptive eligibility a year ago, and decided to notify patients from the start because of guidance it got both from CMS, the Centers for Medicaid and Medicare Services. and because of provisions in the federal Affordable Care Act.

“It just makes a lot of sense” to tell the patient, said Bryan Randall, Heritage Valley’s chief financial officer. “First, as an organization, why not take credit for providing that patient charity care. And for the patient, once they feel they’re relieved of that financial burden, they’ll think, ‘I’ll come back. They worked with me.’ And that’s what we want.”

Larry Rusnock, vice president/controller for Monongahela Valley Hospital, said when it adopted presumptive eligibility three years ago, it decided to notify patients so “we weren’t hounding them for bills.”

Even though the federal IRS, ACA and CMS rules and guidance about presumptive eligibility have each been out for more than a year, patient advocates say having the state finally weigh in is more likely to get hospitals to comply.

“The state’s ability to monitor and require compliance seems to happen more in real time than the federal government’s does,” said Jessica Curtis, a senior adviser with Community Catalyst, a national nonprofit based in Boston that researches charity care. “Plus, with the state [tobacco money fund], it’s carrot instead of stick where there’smoney involved.”

And ultimately, said Julie Trocchio, senior director of community benefit at the Catholic Health Association, and an expert on charity care, “I think telling patients is the right thing to do.”

“We don’t want patients or families not seeking care because they have a bill hanging over their heads,” she said.