R)ll Medical

[Nhyiraba Valentin]

AFAP must specify all financial assistance available under the FAP, including all discounts and free care, and, if applicable, the amount(s) (for example, gross charges) to which any discount percentages will be applied. Consistent with the limitation on charges requirement described below, a FAP must indicate that, following a determination of FAP-eligibility, a FAP-eligible individual may not be charged more than Amounts Generally Billed (AGB) for emergency or medically necessary care.

A hospital facility's FAP must describe how an individual applies for financial assistance under the FAP. In addition, either the FAP or FAP application form (including accompanying instructions) must describe the information or documentation an individual may be required to provide as part of their FAP application and must also provide certain contact information.

A hospital facility may provide electronically (for example, on an electronic screen, by email, or by providing the direct Website address, or URL, of the Web page where the document or information is posted) any document or information that is required under the FAP rules to be provided in paper form to any individual who indicates he or she prefers to receive or access the document or information electronically.

The plain language summary of the FAP is a written statement that notifies an individual the hospital facility offers financial assistance under a FAP and that provides additional information in language that is clear, concise, and easy to understand. This must include:

To widely publicize its FAP, a hospital facility must accommodate all significant populations that have limited English proficiency (LEP) by translating the FAP documents into the primary language spoken by these populations. It must make the FAP documents available in the language spoken by each LEP language group that constitutes the lesser of 1,000 individuals or 5 percent of the community served by the hospital facility or the population likely to be affected or encountered by the hospital facility. A hospital facility may determine the percentage or number of LEP individuals in the hospital's community or that are likely to be affected or encountered by the hospital facility using any reasonable method.

The FAP translation should be made available in all the same ways the English version is available, for example, the website, distributed to organizations serving the community, and displayed and distributed in the facility.

A hospital facility's FAP must include a list of providers, other than the hospital facility itself, delivering emergency or medically necessary care in the hospital facility. It must specify which providers are covered by the hospital facility's FAP and which are not. Notice 2015-46 describes how a hospital facility specifies the providers and care covered by the FAP, updates the FAP, and addresses errors and omissions in the provider list.

A hospital facility must establish a written policy to provide, without discrimination, care for emergency medical conditions to individuals, regardless of whether they are FAP-eligible. Emergency medical conditions are defined in the Emergency Medical Treatment and Labor Act (EMTALA), Section 1867 of the Social Security Act.

An emergency medical care policy will generally satisfy this standard if it requires the hospital facility to provide the care for any emergency medical condition that the hospital facility is required to provide under Subchapter G of Chapter IV of Title 42 of the Code of Federal Regulations, which is the subchapter regarding the Centers for Medicare and Medicaid Services' (CMS) standards and certification that includes the regulations under the EMTALA.

A hospital facility's emergency medical care policy must prohibit the hospital facility from engaging in actions that discourage individuals from seeking emergency medical care. Such actions include demanding that emergency department patients pay before receiving treatment for emergency medical conditions or permitting debt collection activities in the emergency department (or in other areas of the hospital facility) where such activities could interfere with the provision, without discrimination, of emergency medical care regardless of where such activities occur.

A hospital organization will have established a FAP, a separate billing & collection policy, or an emergency medical care policy for a hospital facility only if an authorized body of the hospital facility has adopted the policy and the hospital facility has implemented the policy.

A hospital facility has implemented a policy if it consistently carries out the policy. Whether a policy is consistently carried out is determined based on all the facts and circumstances. However, if the authorized body of a hospital facility adopts a policy and provides reasonable resources for and exercises due diligence regarding its implementation, then the standard should be met.

A hospital organization may establish a FAP, billing and collections policy, and/or emergency medical care policy for a hospital facility that is identical to that of other hospital facilities or a joint policy that is shared with multiple hospital facilities provided that any joint policy clearly identifies each facility to which it applies. However, hospital facilities that have different AGB percentages or use different methods to determine AGB must include in their FAPs (or in the case of information related to AGB percentages, otherwise make readily obtainable in a separate document) different information regarding AGB to meet the requirement related to the FAP specifying the method used to determine AGB.

In addition to any other sanction available to a State, a State may provide for a reduction of any payment amount otherwise due with respect to a person who furnishes services under the plan in an amount equal to up to three times the amount of any payment sought to be collected by that person in violation of subsection (a)(25)(C).

Notwithstanding any other requirement of this subchapter, the Secretary may waive or modify any requirement of this subchapter with respect to the medical assistance program in American Samoa and the Northern Mariana Islands, other than a waiver of the Federal medical assistance percentage, the limitation in section 1308(f) of this title,,6 the requirement that payment may be made for medical assistance only with respect to amounts expended by American Samoa or the Northern Mariana Islands for care and services described in a numbered paragraph of section 1396d(a) of this title, or the requirement under subsection (qq)(1) (relating to data reporting).

Nothing in this subchapter (including sections 1396b(a) and 1396d(a) of this title) shall be construed as authorizing the Secretary to deny or limit payments to a State for expenditures, for medical assistance for items or services, attributable to taxes of general applicability imposed with respect to the provision of such items or services.

A State plan may provide for the making of determinations of disability or blindness for the purpose of determining eligibility for medical assistance under the State plan by the single State agency or its designee, and make medical assistance available to individuals whom it finds to be blind or disabled and who are determined otherwise eligible for such assistance during the period of time prior to which a final determination of disability or blindness is made by the Social Security Administration with respect to such an individual. In making such determinations, the State must apply the definitions of disability and blindness found in section 1382c(a) of this title.

The Secretary shall establish a system, for implementation by not later than July 1, 1991, which provides for a unique identifier for each physician who furnishes services for which payment may be made under a State plan approved under this subchapter.

Beginning with fiscal year 2001 with respect to services furnished on or after January 1, 2001, and each succeeding fiscal year, the State plan shall provide for payment for services described in section 1396d(a)(2)(C) of this title furnished by a Federally-qualified health center and services described in section 1396d(a)(2)(B) of this title furnished by a rural health clinic in accordance with the provisions of this subsection.

In any case in which an entity first qualifies as a Federally-qualified health center or rural health clinic after fiscal year 2000, the State plan shall provide for payment for services described in section 1396d(a)(2)(C) of this title furnished by the center or services described in section 1396d(a)(2)(B) of this title furnished by the clinic in the first fiscal year in which the center or clinic so qualifies in an amount (calculated on a per visit basis) that is equal to 100 percent of the costs of furnishing such services during such fiscal year based on the rates established under this subsection for the fiscal year for other such centers or clinics located in the same or adjacent area with a similar case load or, in the absence of such a center or clinic, in accordance with the regulations and methodology referred to in paragraph (2) or based on such other tests of reasonableness as the Secretary may specify. For each fiscal year following the fiscal year in which the entity first qualifies as a Federally-qualified health center or rural health clinic, the State plan shall provide for the payment amount to be calculated in accordance with paragraph (3).

The supplemental payment required under subparagraph (A) shall be made pursuant to a payment schedule agreed to by the State and the Federally-qualified health center or rural health clinic, but in no case less frequently than every 4 months.

Subject to the succeeding paragraphs of this subsection, during the period that begins on March 23, 2010, and ends on the date on which the Secretary determines that an Exchange established by the State under section 18031 of this title is fully operational, as a condition for receiving any Federal payments under section 1396b(a) of this title for calendar quarters occurring during such period, a State shall not have in effect eligibility standards, methodologies, or procedures under the State plan under this subchapter or under any waiver of such plan that is in effect during that period, that are more restrictive than the eligibility standards, methodologies, or procedures, respectively, under the plan or waiver that are in effect on March 23, 2010.

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