City of Houston Charity Care Assistance Program Overview

Slide Note

Houston Fire Department provides Emergency Medical Service (EMS) Ambulance Services in the City under the Houston City Code of Ordinance Chapter 4. The Ambulance Supplement Payment Program (ASPP) offers reimbursement for ambulance services provided to Medicaid and uninsured patients. Changes to Federal Regulation require implementing a Charity Care Assistance Policy to continue participation. The Policy outlines criteria for uninsured patients to apply for assistance, with guidelines set for review and decision-making. Highlights to the Ordinance include adherence to healthcare financial management principles and exclusion of bad debts.

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City of Houston Charity Care Assistance Program Budget & Fiscal Affairs Committee December 3, 2019 Presented by Chief Samuel Pe a, Fire Chief Arif Rasheed, Deputy Director (FIN) 1 1

Overview Houston Fire Department (HFD) provides Emergency Medical Service(EMS) Ambulance Services within the City as authorized by the Houston City Code of Ordinance Chapter 4. Services are provided for a fee per City Code Sec 4-13. Additionally the city receives reimbursement from Ambulance Supplemental Payment Program (ASPP) under the 1115 Medicaid waiver program. 2

Ambulance Supplement Payment Program(ASPP) ASPP Program was designed to provide additional reimbursement to ambulance service providers that serve Medicaid and uninsured patients. The Program allows for reimbursement of the cost for providing EMS Ambulance Services not paid by Medicaid based on a formula for each federal fiscal year. 3

Changes to Federal Regulation The ASPP Program had been set to expire on December 31, 2017. However, CMS granted the State of Texas an extension for another five years through September 2022. The extension requires changes in the reimbursement methodology. Reimbursement will be based on the City s cost of providing ambulance services under Charity Care upon approval of the Ordinance Amendment. To meet this requirement and continue participation, the City is required to implement a Charity Care Assistance Policy in accordance with Rule 355.8210(b)(3) of the Texas Administrative Code, Title 1. 4

Charity Care Assistance Policy (CCA) Finance and Fire Departments with guidance from Legal Department are developing a Charity Care Assistance Policy. Uninsured patients who meet the eligible criteria outlined in the CCA will be eligible to apply and receive assistance. Presumptive eligibility criteria will be used if unable to contact the patients. The billing vendor will be responsible for reviewing and qualifying the CCA applicant based on the guidelines of the policy. Applicants will be notified of the decision made and will be able to appeal the decision within 30 days if any changes occurs. 5

Highlights to the Ordinance Changes Adding new section addressing Charity Care Assistance Policy. Give Finance director or designee authority to implement Charity Care Assistance Policy. The policy will: o Adhere to Healthcare Financial Management Association Principles and Practices Board Statement 15 (December 2012). o Be in compliance with any standards or limitations required by Texas Administrative Code, Title I. o Exclude bad debt, courtesy allowances and discounts, if any, given to patients who are not eligible for charity care or financial assistance from the City. 6