The Group Health Sponsored Care Program (SCP) 2 0 0 5
OVERVIEW The GHC Sponsored Care Program (SCP) is for GHC patients in financial need. Patients are screened for SCP based on • Enrollment status • Medically necessary hospital visits at Central or Eastside Hospital • Household income • Liquid Assets • Exceptions SCP does not consider expenses or accumulated medical bills.
OVERVIEW SCP consists of two programs for low-income patients: Charity Care Assistance is for all patients - enrolled or not - who need help with bills for care received at licensed GHC hospitals (Eastside or Central), plus related follow-up care. Patients must have income at or less than 200% of the Federal Poverty Level. Health Care Assistance is a short-term program for GHC enrollees who need help with inpatient and outpatient fees, copays, prescription costs, (and other sub programs). Patients must have income at or less than 250% of the Federal Poverty Level and meet specific enrollment criteria. Assistance includes: • 6 past months of unpaid GHC bills • 6 months of future GHC copays and fees.
OVERVIEW Why does SCP exist? Charity Care laws exist in Washington which require hospital systems to provide free-of-charge care to indigent (<= 200% FPL) patients, regardless if they are enrollees or not. Also, if GHC and collection agencies can’t collect owed money from GHC enrollees, unpaid bills are usually written off to bad debt. SCP is the alternative for low-income patients. Once SCP reviews and approves an application, Group Health stops billing the patient and waives normal fees by writing them off to a charity care account rather than bad debt. This supports Group Health’s non-profit status and core mission values of Respect, Integrity and Stewardship.
NO SCP can waive GH bills less than 6 months old, and future GH bills for outpatient services & medications for 6 months. SCP can waive GH emergency and follow-up* bills for Central and East campus UCC, ED, outpatient and/or hospital inpatient care (if patient was admitted from ED). Has patient never been enrolled, or disenrolled for more than 6 months? Is patient currently enrolled in Group Health? YES NO NO YES Has patient been continuously enrolled at least 6 months in an individual, family or GH employee plan? (New enrollees must have paid at least 6 months’ dues). SCP cannot waive GHC dues. SCP can waive fees incurred up to 6 months prior to disenrollment. * Patient may schedule follow-up visits at a GHC primary care clinic. YES Then ask NO YES SCP can waive dues paid directly to GHC for up to 6 months back and 6 months forward. HEALTH CARE ASSISTANCE CHARITY CARE FLOWCHART DOES patient meet SCP Financial Guidelines? NO SCP assistance available.
RESOURCES The SCP Website includes: • Referral and eligibility criteria • SCP department processes • Details on what SCP waives • FAQS & Training resources. • SCP Forms for download • In-house resources (tipsheets, other department links, etc.) • Internet resources (for seniors, community, specialty health, etc.) • Make sure to visit at: http://incontext.ghc.org/scp/. • In InContext: check under ‘Departments/Patient Services’ or in ‘Departments/Alphabetic’.