Under a new definition of charity care published by Pennsylvania officials Dec. 27, hospitals in the state must notify patients of charity care eligibility, even if the hospital determined it without the patient's assistance or knowledge, according to the Pittsburgh Post-Gazette.
Over the last decade, a growing number of hospitals in Pennsylvania and across the nation have been quietly turning their bad debt into charity care by using a technology dubbed "presumptive eligibility," a new way of identifying patients eligible for charity care. Presumptive eligibility uses credit-score-like technology, demographic information and social media data to determine if patients qualify for free care rather than being charged for a medical service, being unable to pay the medical bill and having the expense passed onto the hospital as bad debt.
While patient advocate groups believe presumptive eligibility technology helps remove some financial burden from patients, they argue many hospitals were not informing patients that they were qualified for charity care using this tool. Instead, patients were left in the dark about their financial responsibility — a move advocates say was potentially detrimental to patients, as they may have strayed away from follow-up care if they believed they still owed money.
Hospitals gave various reasons for concealing patient charity care eligibility, arguing the law did not require it in the past and it was too much of a financial burden on the hospital to track down and inform the patient, according to the Post-Gazette.
However, the state's new definition now requires hospitals to notify patients of their eligibility.
The new definition is included in a state Medical Assistance Bulletin published by the Pennsylvania Department of Human Services that outlines procedures hospitals must follow to be eligible for funding from Pennsylvania's Tobacco Settlement program, which reimburses hospitals for some of their charity care.
"It has always been the department's expectation that the hospitals would notify the patient of their charity care status," said Sally Kozak, Pennsylvania DHS' acting deputy secretary for the office of medical assistance programs. "This clarifies that."