16 Del. C. § 9964: Hospital financial assistance policies [Effective upon fulfillment of contingency in 85 Del. Laws, c. 349, § 6(b)].

In accordance with federal and state guidelines, a hospital shall publish the hospital’s financial assistance policy and application on the hospital’s website. In addition to other information required under this subchapter, a hospital shall include all of the following in the hospital’s financial assistance policy:

(1) Presumptive eligibility program. —

The criteria the hospital uses to presumptively determine an individual’s eligibility for financial assistance, which at a minimum must do all of the following:

a. Apply categories of presumptive eligibility established by regulation of the Board. The hospital may apply other categories that are no more restrictive in scope than those established by the Board.

b. Use methodologies for identifying presumptively eligibility patients consistent with regulations of the Board, which may include historical data from individuals approved through the hospital’s full application process, predictive modeling using publicly available data, or other methodologies the Board permits.

c. Not impose documentation or verification requirements beyond those required by the Board.

d. Publish information on the presumptive program and the basis for presumptive eligibility.

e. A statement that a presumptive financial assistance determination is valid for no less than 180 days.

(2) Patient application rights following presumptive determination. —

A patient may not be required to submit a full application for financial assistance if the patient qualifies for presumptive eligibility. A patient may choose to apply for financial assistance to extend the approval time period to 1 year.

(3) Application process. —

Requirements for hospitals screening a patient for financial assistance, which must include all of the following:

a. Allowances for a patient to apply for financial assistance, which must include all of the following:

1. The patient was screened for presumptive eligibility and was found not to be eligible.

2. Patients may apply for financial assistance at any time during the collections process, including after the patient account has been sold, referred to, or assigned to another entity. If the patient is determined eligible after the patient’s account has been sold, referred, or assigned to another entity, the hospital shall notify the entity that the debt is invalid.

3. A patient previously denied financial assistance may apply again for financial assistance if financial circumstances have changed or the patient incurred additional medical expenses.

b. The availability of staff assistance for a patient completing an application for financial assistance.

c. The ability for a patient to submit the patient’s financial assistant application in a variety of methods including electronically, by mail, or in person.

d. A determination and written notification to the patient on eligibility for financial assistance within 21 days of the completed application submission, including notification, if denied, of the opportunity to appeal.

e. An appeals process for a patient deemed ineligible for financial assistance in accordance with the process prescribed by the Board. A patient must have the ability to provide additional documentation supporting the patient’s appeal.

f. Practices the hospitals may not employ when administering the financial assistance process, including all of the following:

1. Requiring documentation or verification not included on the standardized list created by the Board.

2. Requiring documentation not reasonably available to the patient or not necessary to determine eligibility for financial assistance.

3. Deeming applications incomplete without providing written notice of the missing information and a reasonable opportunity to complete the form. The written notice must be in print or electronic form, as determined by the patient.

4. Closing or denying an application due to missed internal deadlines where the hospital possesses sufficient information to determine eligibility.

5. Engaging in any other practice, policy, or pattern of conduct that has the purpose or effect of delaying, deterring, or discouraging access to financial assistance.

(4) Requirements for Medicaid coordination when screening. —

When reliable information reasonably available to the hospital indicates that a patient is reasonably likely to be eligible for Medicaid coverage for the date of service, the hospital may initiate the Medicaid coordination process concurrently with financial assistance screening.

a. A hospital may not deny or delay financial assistance on the basis that a patient may be eligible for Medicaid or other public coverage unless the hospital has screened the patient for such coverage using information reasonably available to the hospital, has made reasonable efforts to assist the patient with enrollment in Medicaid or other public coverage, and has documented the results of that screening in the patient’s medical record.

b. Hospitals shall only document whether the patient appears to be eligible for Medicaid or other public coverage and not the reasons for eligibility or ineligibility.

c. A patient who is not eligible for Medicaid or other public coverage as a matter of federal or state law may not be required to undergo screening for Medicaid or other public coverage as a condition of financial assistance eligibility.

d. Nothing in this subchapter prohibits a hospital from assisting a patient with enrollment in Medicaid or other coverage, if the hospital’s assistance does not delay the application of financial assistance.

(5) Requirements if hospitals choose to permit provisional financial assistance pending determination of Medicaid or other public coverage, including all of the following:

a. That a hospital may not treat financial assistance as provisional for more than 180 days after the date of the eligibility determination unless the patient has a pending coverage application and the hospital documents that status in the patient’s medical record.

b. That any reconciliation must occur no later than 30 days after the hospital receives notice of coverage approval or denial, and the hospital must provide the patient a written reconciliation notice describing any adjustments.

c. That a patient may not be billed or sent to collections for any amount covered by financial assistance while reconciliation is pending, and any overpayment must be refunded within 30 days of reconciliation.

(6) Procedures for the refund of hospital service costs to a patient if the hospital failed to screen the patient for presumptive eligibility for financial assistance as required or previously determined, incorrectly, that the patient did not qualify for financial assistance based on information provided by the patient at the time of the incorrect determination.

a. The hospital shall refund any amounts paid, and waive any amounts owed, by the patient that are covered by the patient’s financial assistance eligibility, including reasonable costs incurred in securing financial assistance.

b. If the hospital sold the debt to a collection agency or authorized a collection agency to collect debts on behalf of the hospital, the hospital shall notify the collection agency that the debt is invalid.