FAP English Financial Assistance Program Policy

Policy Title: Policy Owner Job Title:

Financial Assistance Program Director of Patient Revenue

Scope: Renown Health and its affiliated entities, including Renown Regional Medical Center, Renown South Meadows Medical Center, Renown Women’ s Health, and Rehabilitation Hospital, adopt the following policy and procedure. Services provided by Women’ s Health Ryland qualify for National Health Service Corp sliding fee discount program solely based on family size and income; asset testing and Medicaid denial letter are not required.

Definitions: 1. FAP- Financial Assistance Program

2. FPG- Federal Poverty Guidelines 3. FPL- Federal Poverty Level

4. Household or Family Income- Includes the patient, the patient’ s spouse or legal partner, and all the patient’ s children, natural or adopted, under the age of 18. If the patient is under the age of 18( defined as a“ minor”), the family shall include the patient, the patient’ s natural or adoptive parent( s) and the patient’ s children, natural or adopted under the age of 18. Under age 18 patient’ s living parents must be counted as part of the patient’ s“ family” regardless of whether they live in that patient’ s home. Any patient 18 years or over is considered the basis for his / her own“ family”. If the patient is pregnant, household size will be determined by expected number of newborns plus the mother.

5. Asset – Assets are everything you own that has any monetary value; plus any money you are owed. 6. Guarantor – Individual financially responsible for a patient’ s account

7. Hospital-Specific Amounts Generally Billed( AGB)- For each Hospital, a percentage derived by dividing the sum all claims for Medically Necessary services provided at such Hospital paid during the Relevant Period by Medicare fee-for-service and all private insurances as primary payers, together with any associated portions of these claims paid by Medicare beneficiaries or insured individuals in the form of co-payments, co-insurance, or deductibles, by Usual and Customary Charges for Medically Necessary Services.( Total Reimbursement ÷ Total Charges = Hospital Specific AGB Percentage) See Treasury Regulation 1.501( r)-5( b)( 4)