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Working together for a positive hospital experience

Ohio Hospital Care Assurance Plan (HCAP)

PURPOSE: To assist patients unable to pay for basic, medically necessary hospital-level care by providing the opportunity to obtain financial assistance through the Ohio Hospital Care Assurance Plan
POLICY: To provide quality health care to patients who are unable to pay for all or a portion of their medically necessary services and who meet requirements established by the State of Ohio for the Hospital Care Assurance Plan
A patient is eligible for basic, medically necessary hospital-level services under the provisions of section 5112 of the Revised Code if the following criteria are met on the date services were provided:
• The patient is a current resident of Ohio
• The patient is not a Medicaid recipient
• The patient's individual or family income is at or below the current poverty guidelines
"Basic, medically necessary hospital level services" are defined as all inpatient and outpatient services covered under the Medicaid program in Chapter 5101:3-2 of the Administrative Code.
"Family Unit" includes the parent(s), their spouse(s), and all their children, natural or adoptive, under the age of eighteen who live in the home.

1. Notify all patients of their right to receive basic, medically necessary hospital-level services without charge if they meet the eligibility criteria.   This information is printed on the back of all statements.  
2. All Self-Pay and underinsured patients will be screened for possible HCAP eligibility if possible.
3. When HCAP screening indicates the patient may qualify for the Hospital Care Assurance Program, the Patient Financial Assistance application, instructions, and a postage paid envelope directed to the Financial Counselor will be offered to the patient.  Instructions must stress that application must be completed, signed, and returned within two weeks.
4. Upon return of the application and proof of income, the Financial Counselor will verify income for the preceding 3 months prior to the date of  hospital service.   If proof of income is not available, the completed and signed application will be accepted.  
5. Use the HCAP guidelines to determine if the family income level qualifies for HCAP assistance.
6. If patient's income exceeds the maximum allowed for HCAP, the Healthcare Financial Assistance Guidelines pay scale will be reviewed for possible eligibility for Charity Care.
7. If patient is not eligible for either HCAP or Charity Care, send denial letter.
TITLE: Ohio Hospital Care Assurance Plan (HCAP)
8. If patient income level qualifies for HCAP:
a. Adjust the eligible charges from the account using transaction code 5544770 "HCAP adjustment"
b. Send Financial Assistance Eligibility Statement to the patient that indicates the amount covered by HCAP, and any balance for which the patient is responsible.
c. If patient is eligible for HCAP and has made a previous payment refer to the HCAP Refund Policy.

9. Applications and documentation of income will be retained for three (3) years after submission of the Employment Verification Sheet.
10. The current poverty level threshold is posted in the Federal Register.  The HCAP eligibility thresholds are adjusted annually based upon changes in the Federal Poverty level.
11.   UCB early out vendor will also be screening for HCAP from the self pay population they receive.
12. No account will be eligible if legal action has already been taken to collect the debt.
13. Frequency of applications for any outpatient services received, eligibility determination is good for 90 days from initial date of service.   Inpatient applications can be used to cover related outpatient services for 90 days following the first day of admission.
Created By:  Joe Williford     Date: August 2013
Approved By: Karol Bortel                                                         Date: August 2013
Reviewed : Feb 2007     Reviewed: April 2016
Reviewed:  May 2009,  May 2012    Reviewed: November 2017
Revised: March 2014