Crista Whitman Gantz
LINC Client Services Attorney
Sadly, individuals with cancer often face significant financial hardship due to the cost of treatment and related medical expenses. This is in part due to the fact that many individuals continue to lack health insurance, particularly in places like Virginia, where Medicaid has not been expanded. Others may be underinsured with health coverage that is inadequate to alleviate the financial hardship associated with the cost of their medical care. Many of these financially vulnerable individuals receive treatment at nonprofit hospitals, particularly for their emergency care needs.
Section 501(r), added to the IRS Code by the Patient Protection and Affordable Care Act (ACA), imposes new requirements on 501(c)(3) organizations (nonprofits) that operate one or more hospital facilities. The rules and regulations put limits on some billing and charging practices, and call for transparency when it comes to care and eligibility for financial assistance. The rules also require these tax-exempt facilities to seek input from the community to identify and attempt to address community health needs. Each 501(c)(3) hospital organization is required to meet four general requirements on a facility-by-facility basis:
- establish written financial assistance and emergency medical care policies,
- limit amounts charged for emergency or other medically necessary care to individuals eligible for assistance under the hospital’s financial assistance policy,
- make reasonable efforts to determine whether an individual is eligible for assistance under the hospital’s financial assistance policy before engaging in extraordinary collection actions against the individual, and
- conduct a community health needs assessment (CHNA) and adopt an implementation strategy at least once every three years.
This article focuses primarily on the first three requirements because of the impact they may have on cancer patients receiving medical care at non-profit hospital facilities. Continue reading