Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 613.00 - Health Safety Net Eligible Services › Section 613.08 - Other Requirements

Current through Register 1525, July 5, 2024
(1)
Provider Responsibilities
.
(a)
Nondiscrimination
. A Provider must not discriminate on
			 the basis of race, color, national origin, citizenship, alienage, religion,
			 creed, sex, sexual orientation, gender identity, age, or disability in its
			 policies or in its application of policies, concerning the acquisition and
			 verification of financial information, preadmission or pretreatment deposits,
			 payment plans, deferred or rejected admissions, or Low Income Patient
			 status.
(b)
Legal
			 Execution
. A Provider or agent thereof must not seek legal
			 execution against the personal residence or motor vehicle of a Low Income
			 Patient determined pursuant to
			 101 CMR
			 613.04 without the express approval of the
			 Provider's Board of Trustees. All approvals by the Board must be made on an
			 individual case basis.
(c)
Credit and Collection Policies
.
1.
Filing
			 Requirements
. Each Provider must electronically file a Credit and
			 Collection Policy that is reflective of its practices with the Health Safety
			 Net Office in each of the following circumstances:
a. a new Provider must file a copy of its
			 Credit and Collection Policy prior to Health Safety Net Office approval to
			 submit claims for payments;
b.
			 within 90 days of adoption of amendments to
			 101 CMR 613.00 that would
			 require a change in the Credit and Collection Policy;
c. when a Provider changes its Credit and
			 Collection Policy; or
d. when two
			 Providers merge and request to be paid as a single merged entity.
2.
Content
			 Requirements
. A Provider's Credit and Collection Policy must
			 contain
a. standard collection policies and
			 procedures;
b. policies and
			 procedures for collecting financial information from Patients;
c. for Acute Hospitals, a detailed emergency
			 care classification policy specifying
i. its
			 practices for classifying persons presenting themselves for unscheduled
			 treatment, the urgency of treatment associated with each identified
			 classification;
ii. the location(s)
			 at which Patients might present themselves; and
iii. any other relevant and necessary
			 instructions to Acute Hospital personnel that would see these
			 Patients.
iv. The policy must
			 include the classifications that qualify as Emergency Services and other
			 services including "elective" or "scheduled" services;
d. the policy on deposits and payment plans
			 for qualified Patients as described in 101 CMR 613.08(1)(g);
e. copies of billing invoices, award or
			 denial letters, and any other documents used to inform Patients of the
			 availability of assistance;
f.
			 description of any program by which the Acute Hospital offers discounts from
			 charges for the uninsured;
g. for
			 an Acute Hospital with Hospital Licensed Health Center, Satellite Clinic, or
			 school-based health center locations that provide Eligible Services, an
			 indication whether each location offers Patients a deductible payment plan for
			 outpatient services per
			 101 CMR
			 613.04(8)(c)5.;
			 and
h. direct URL(s) where the
			 Provider's Credit and Collection Policy, Provider Affiliate list (if
			 applicable), and other financial assistance policies are
			 posted.
(d)
Provider Affiliate List
. Acute Hospitals must
			 establish a list of all Provider Affiliates. The list must clearly indicate or
			 delineate which Provider Affiliates provide services that are eligible for
			 reimbursement by the Health Safety Net.
1.
			 For the purposes of this requirement, Acute Hospitals may use any method
			 adequate to identify Provider Affiliates. This may include, but is not limited
			 to:
a. listing the names of each individual
			 practitioner;
b. listing the names
			 of individual practitioners, practice groups, or any other entities that are
			 providing emergency or medically necessary care in the Acute Hospital by the
			 name used by such entities either to contract with the Acute Hospital or to
			 bill patients for care provided; or
c. list by reference to a department or a
			 type of service if the reference makes clear which Provider Affiliate services
			 are and are not eligible to be reimbursed by the Health Safety Net.
2. If a Provider Affiliate is
			 eligible to be reimbursed by the Health Safety Net in some circumstances but
			 not in others, the Acute Hospital must describe the circumstances in which the
			 emergency or other medically necessary care delivered by the Provider Affiliate
			 will and will not be eligible for reimbursement by the Health Safety
			 Net.
3. Acute Hospitals must take
			 reasonable steps to ensure that their Provider Affiliate lists are accurate by
			 updating their Provider Affiliate lists at least quarterly to add new or
			 missing information, correct erroneous information, and delete obsolete
			 information.
4. The requirements
			 set forth in 101 CMR 613.08(d)1. through 3. are effective as of the first day
			 of the Acute Hospital's fiscal year beginning after December 31,
			 2016.
(e)
Notices
.
1. In the
			 following circumstances, a Provider must notify the individual of the
			 availability of financial assistance programs to a Patient expected to incur
			 charges, exclusive of personal convenience items or services, whose services
			 may not be paid in full by third party coverage:
a. during the Patient's initial registration
			 with the Provider;
b. on all
			 billing invoices; and
c. when a
			 Provider becomes aware of a change in the Patient's eligibility or health
			 insurance coverage.
2. In
			 the following circumstances, a Provider or its designee must notify the
			 individual about Eligible Services and programs of public assistance, including
			 MassHealth, the Premium Assistance Payment Program Operated by the Health
			 Connector, the Children's Medical Security Plan, and Medical Hardship:
a. during the Patient's initial registration
			 with the Provider;
b. on all billing
			 invoices; and
c. when a Provider
			 becomes aware of a change in the Patient's eligibility or health insurance
			 coverage.
3. A Provider
			 must include a brief notice about the availability of financial assistance in
			 all written Collection Actions. The following language is suggested, but not
			 required, to meet the notice requirements of
			 101
			 CMR 613.08(1)(e): "If you
			 are unable to pay this bill, please call [phone number]. Financial assistance
			 is available."
4. A Provider must
			 notify the Patient that the Provider offers a payment plan as described in
			 101
			 CMR 613.08(1)(f), if the
			 Patient is determined to be a Low Income Patient or qualifies for Medical
			 Hardship.
(f)
Distribution of Financial Assistance Program
			 Information
.
1. Providers must
			 post signs in the inpatient, clinic, and emergency admissions/ registration
			 areas and in business office areas that are customarily used by Patients that
			 conspicuously inform Patients of the availability of financial assistance
			 programs and the Provider location at which to apply for such programs. Signs
			 must be large enough to be clearly visible and legible by Patients visiting
			 these areas. All signs and notices must be translated into languages other than
			 English if such languages are the primary language of 10% or more of the
			 residents in the Provider's service area. Signs must notify Patients of the
			 availability of financial assistance and of other programs of public
			 assistance. The following language is suggested, but not required:
a. "Are you unable to pay your hospital
			 bills? Please contact a counselor to assist you with various alternatives."; or
b. "Financial assistance is
			 available through this institution. Please contact____________."
2. Providers must make their
			 Credit and Collection Policies filed in accordance with
			 101
			 CMR 613.08(1)(c)1. and
			 Provider Affiliate lists (if applicable), as described in
			 101
			 CMR 613.08(1)(d), available
			 on the Provider's website.
(g)
Deposits and Payment
			 Plans
.
1. A Provider may not
			 require preadmission and/or pretreatment deposits from individuals that require
			 Emergency Services or that are determined to be Low Income Patients.
2. A Provider may request a deposit from
			 individuals determined to be Low Income Patients. Such deposits must be limited
			 to 20% of the deductible amount, up to $500. All remaining balances are subject
			 to the payment plan conditions established in
			 101
			 CMR 613.08(1)(g).
3. A Provider may request a deposit from
			 Patients eligible for Medical Hardship. Deposits are limited to 20% of the
			 Medical Hardship contribution up to $1,000. All remaining balances are subject
			 to the payment plan conditions established in
			 101
			 CMR 613.08(1)(f).
4. A Patient with a balance of $1,000 or
			 less, after initial deposit, must be offered at least a one-year, interest-free
			 payment plan with a minimum monthly payment of no more than $25. A Patient with
			 a balance of more than $1,000, after initial deposit, must be offered at least
			 a two-year, interest-free payment plan.
(h)
Patient
			 Responsibilities
. Providers must advise Patients of the rights and
			 responsibilities described in
			 101
			 CMR 613.08(2)  in all cases
			 where the Patient interacts with registration personnel.