domingo, 25 de mayo de 2014

California Law Enhances Access to Affordable Care by Limiting Amount Hospitals Can Collect From Low-Income Uninsured and Underinsured Patients | AHRQ Innovations Exchange

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California Law Enhances Access to Affordable Care by Limiting Amount Hospitals Can Collect From Low-Income Uninsured and Underinsured Patients | AHRQ Innovations Exchange

Agency for Healthcare Research Quality

Towards Affordable Care: Policies To Reduce Price Variability

Towards Affordable Care: Policies To Reduce Price Variability

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California Law Enhances Access to Affordable Care by Limiting Amount Hospitals Can Collect From Low-Income Uninsured and Underinsured Patients

Snapshot

Summary

Enacted by the California State legislature, the Hospital Fair Pricing Act limits the amount all licensed, general acute-care hospitals (including nonprofit, for-profit, and public hospitals) can collect from low- and moderate-income uninsured and underinsured patients to the highest rate paid by a government program (typically Medicare). Under the law, hospitals must develop and disseminate written policies related to these discounted prices and free care, including eligibility requirements, decision-review processes, and debt-collection practices. They still send out initial bills based on full charges, leaving it to patients to apply for the discounted or free care. For those who apply, hospitals cannot initiate debt-collection activities for a period of time, and they must retroactively reimburse eligible patients who overpay based on the initial bill. The legislation has enhanced access to affordable medical care for low- and moderate-income patients who lack adequate insurance, with the vast majority of hospitals now offering discounted rates and/or free care to these individuals. Due in large part to the law, nearly 4 million individuals are now eligible for free care and another 1.3 million qualify for discounted prices. Overall, 60 percent of uninsured patients' emergency department visits qualified for free care and another 20 percent of their emergency department visits qualified for discounted rates.

Evidence Rating (What is this?)

Suggestive: The evidence consists of a post-implementation evaluation of hospital pricing practices with respect to uninsured and underinsured patients, including the proportion offering discounts and free care to those in various income groups. 

Developing Organizations

Health Access California

Use By Other Organizations

Maryland, New Jersey, and New York have laws that require hospitals to notify patients of their financial assistance/free care policies; set financial thresholds for the provision of discounted or free care; and limit the amount charged to low-income uninsured and underinsured patients.

Date First Implemented

2008

Patient Population

Vulnerable Populations > Impoverished; Medically uninsured; Insurance Status > Uninsured

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