16 Del. C. § 9962: Minimum financial assistance standards [Effective upon fulfillment of contingency in 85 Del. Laws, c. 349, § 6(b)].

(a) (1) A hospital and a facility-based provider shall, at a minimum, provide financial assistance for the patient responsibility arising from medically necessary hospital services to financially qualified patients as follows:

a. Full financial assistance for medically necessary hospital services for financially qualified patients with household income at or below 300% of the federal poverty level.

b. Discounted financial assistance for medically necessary hospital services for financially qualified patients with household income greater than 300% and at or below 350% of the federal poverty level, in an amount that reduces the patient’s responsibility by no less than 75%.

c. Discounted financial assistance for medically necessary hospital services for financially qualified patients with household income greater than 350% and at or below 400% of the federal poverty level, in an amount that reduces the patient’s responsibility by no less than 50%.

(2) Notwithstanding any other provision of this subchapter, a hospital may choose to grant eligibility for the hospital’s financial assistance policies to patients with household incomes greater than 400% of the federal poverty level.

(b) (1) A hospital shall have a medical hardship policy that allows patients with incomes above the thresholds established in subsection (a) of this section, but who are experiencing medical hardship, to qualify for discounted financial assistance.

(2) The hospital may establish a household income ceiling on eligibility under the hospital’s medical hardship policy, but the ceiling may not be lower than 500% of the federal poverty level.

(3) Under the hospital’s medical hardship policy, the hospital shall discount the patient’s responsibility for medically necessary hospital services by no less than 50%.

(4) A patient previously denied financial assistance under subsection (a) of this section shall provide additional documentation supporting the medical hardship.

(5) A medical hardship determination is valid for 1 year from the date of the determination and applies to all hospital services furnished during the determination period.

(6) A facility-based provider shall honor a hospital’s medical hardship determination on the same terms as an eligibility determination under subsection (f) of this section.

(c) A hospital or facility-based provider may not condition the financial assistance provided under subsection (a) of this section on prior payment, enrollment in a payment plan, or exhaustion of other remedies.

(d) Financial assistance is available to a patient for the patient responsibility regardless of insurance if the patient meets the income thresholds established in subsection (a) of this section.

(e) Notwithstanding subsection (d) of this section, a hospital or facility-based provider may bill a financially qualified patient’s insurance for hospital services.

(f) (1) A patient deemed financially qualified is considered eligible for financial assistance for a minimum of 1 year from the date of the eligibility determination.

(2) On making such a determination, a hospital shall provide the patient with a written eligibility notice that includes all of the following:

a. The patient’s eligibility category.

b. The household income on which the determination is based.

c. The dates during which the determination is effective.

d. The supporting documentation provided by the patient on which the hospital based the determination.

(3) A facility-based provider shall accept the eligibility notice under paragraph (f)(2) of this section as sufficient documentation of the patient’s eligibility for hospital services furnished during the eligibility period and shall apply financial assistance to the patient’s bills for those services consistent with the patient’s eligibility category.

(g) A hospital or a facility-based provider that receives a patient holding a valid written eligibility notice issued by another hospital under subsection (f) of this section shall rely on that notice as sufficient documentation of the patient’s eligibility for financial assistance for services received during the eligibility period stated on the notice. A hospital shall provide financial assistance no less comprehensive than that reflected in subsection (a) of this section.

(h) (1) For purposes of this subsection, “pending” means an application for financial assistance or coverage has been completed by a patient and is under review by the hospital.

(2) While a determination of eligibility for financial assistance or coverage is pending, a hospital shall communicate to the patient in writing that the patient is not responsible for any bills the patient receives while the patient’s application is pending.

(3) A hospital or a facility-based provider that knows or has reason to know of a patient’s pending application for financial assistance or coverage may not do any of the following:

a. Refer the patient’s account to a collection agency.

b. Sell or assign the patient’s debt.

c. Provide information on the unpaid charges for health-care services to a consumer reporting agency.

d. Initiate a lawsuit or arbitration proceeding against the patient relative to unpaid charges for health-care services.

(i) Notice to patients. —

A hospital shall do all of the following:

(1) Post visually prominent notices of financial assistance availability in all patient registration and admission areas, and in all areas where patients are billed or pay for services. The notices must be available in all languages spoken by more than 5% of the population of the hospital’s service area, as determined by the most recent census data.

(2) Provide oral notice of the availability of financial assistance to each patient at the time of registration or admission. The oral notice must include information on how to apply for financial assistance and the availability of staff assistance with the application.

(3) Offer financial assistance screening and provide a financial assistance application to each patient who is uninsured, self-pays for any portion of the patient responsibility, or has a remaining balance of $500 or more after insurance.

(4) Include written notice of the availability of financial assistance and a copy of the hospital’s financial assistance application with each written request for payment sent to a patient described in paragraph (i)(3) of this section. The written notice must be in print or electronic form, as determined by the patient.

(5) Make the hospital’s financial assistance policy, application, and the written notice required under paragraph (i)(4) of this section available in all languages spoken by more than 5% of the population of the hospital’s service area, as determined by the most recent census data.

(j) A hospital shall submit reports to the Board in conjunction with reports required under Chapter 93A of this title in a form, manner, and frequency set by the Board. The reports must include all of the following:

(1) The number of financial assistance applications received by the hospital.

(2) The number of applications approved, denied, or closed and the reasons for the approval, denial, or closure.

(3) The number of presumptive eligibility screenings completed and the number of patients determined presumptively eligible.

(4) The average and median length of time to determine eligibility for completed financial assistance applications.

(5) The amount of financial assistance provided, measured at cost.

(6) The amount of financial assistance provided, measured as a percentage of hospital operating expenses.

(k) A patient seeking financial assistance or medical hardship shall apply for financial assistance.