Making Rules, Playing Fair

Rules are important. Just ask my grandsons.

When we play baseball together in their backyard, we begin each game with a review of the rules. Sometimes I discover that, since we last played, the rules have changed. They say, “We made a new rule. Sometimes you just have to change the rules.”

They are quite right.

Illinois is about to adopt some new rules for Hospital Financial Assistance, i.e., charity care, under the Fair Patient Billing Act as amended in 2012. The amendment called for all Illinois hospitals to use a universal application and presumptive eligibility process for low-income, un-insured, and under-insured persons who need hospital services. This was a great legislative victory for the Fair Care Coalition, of which PCG is an active member. The coalition had worked long and hard to get the state to hold non-profit hospitals accountable for the charity care they were constitutionally required to provide in exchange for their property-tax exemptions.

Despite the constitutional mandate, many non-profit hospitals had made it difficult for community residents to access charity care. Application processes were convoluted, and many patients were never given the opportunity to apply for charity care. Instead, they received substantial bills for hospital services even though they clearly did not have the financial means to pay them.

It’s stories like these that demonstrate the importance of creating a universal application and criteria for presumptive eligibility that will be used by all Illinois hospitals. Presumptive eligibility means that a person who has already been determined to be eligible for needs-based assistance, such as the Supplemental Nutrition Assistance Program (food stamps), is presumed eligible for hospital financial assistance.

On March 8, 2013 the proposed rules were published after a six-month rule-making process during which the Fair Care Coalition and other groups made extensive recommendations on the rules to the Illinois Attorney General.

The proposed rules contain a number of positive elements: not requiring a Social Security number to qualify for free or discounted care and having the application available in every primary language of at least 5 per cent of patients served by the hospital. PCG also applauds the clear definition for hospital financial assistance which specifies that bad debt and un-collectable charges cannot be recorded as financial assistance.

On the other hand, we at PCG believe that a stronger description of the presumptive eligibility process is crucial. The criteria for presumptive eligibility should be communicated to patients before they are discharged from the hospital, and decisions determining eligibility made before they are billed. The proposed rules do not specify such a process or timeline.

We are now in a 45-day public-comment period, during which an open hearing will be held on April 17, 2013. Members of the Joint Committee on Administrative Rules (JCAR) will hear testimony from advocates and, most importantly, from community people who will benefit from this new process. Written comments can also be submitted to JCAR. This is the general public’s opportunity to communicate some of the strategic changes that can still improve the rules.

The Fair Care campaign has been long and arduous, and rule-making is just not as exciting as participating in rallies or advocating with legislators at the Capitol. Regardless, administrative rules are a crucial part of the legislative process, one we dare not ignore if we are to achieve a fair and equitable hospital care system across the state. Please consider adding your voice to this important process.

At long last, Illinois has the chance to play fair for all the un-insured and under-insured Illinoisans who need financial assistance for their hospital care.

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