미시간대학병원정책 01-03-003 재정지원정책 UMHS Policy 01-03-003 Financial Assistance Policy (Korean) ( 이전에는자선진료정책과절차에관한병원고객서비스라고불림 ) (Previously the Professional and Hospital Customer Service Charity Care Policy and Procedure) 발행 : 최종검토 1985 년 2 월최종수정 : 2015 년 12 월 2015 년 12 월 Issued: 2/1985 Last Reviewed: 12/2015 Last Revised: 12/2015 I. 정책강령 POLICY STATEMENT 미시간대학병원의재정지원정책 ( 간혹 M-Support 엠 - 써포트혹은 자선진료라불림 ) 은재정지원을받을자격요건을갖춘환자들을 파악하기위해서설립되었습니다. 재정지원은병원진료비를지불할수 없는환자들에게제공되며, 주로미국연방빈곤지침을기준삼아 결정됩니다. 재정지원은최후의수단으로간주됩니다 ; 보험혜택을 받을수있는모든가능한방법혹은환자에게제공될수있는모든 도움이최우선적으로고려되어야합니다. 재정지원신청시, 적절한 증빙서류를반드시첨부해야합니다.UMHS Financial Assistance Policy (sometime referred to as M-Support or Charity Care) has been established to identify patients who may qualify for financial assistance. Financial Assistance is offered to patients who are not able to pay for health care as determined primarily by the U.S. Federal Poverty Guidelines. Financial Assistance is considered a last resort; all options for obtaining third party coverage or identifying resources available to the patient should be considered first. Proper documentation must accompany all requests for Financial Assistance.
II. III. 정책목적 POLICY PURPOSE 미시간대학병원은병원비를지불할형편이안되서필요한진료를 받지못하는미시간주주민들을돕기위해최선을다하고 있습니다.The University of Michigan Health System (UMHS) is committed to serving residents of the State of Michigan who cannot obtain necessary medical care because of their inability to pay. 재정지원지침 FINANCIAL ASSISTANCE GUIDELINES A. 자격규정및자격요건 : Eligibility and Qualifications: 1. 환자의지불능력은가능한한치료를제공하기전에 확인되어야합니다. 단, EMTALA 법 ( 응급의료진료및 분만법 ) 에비추어, 응급진료상황일경우에는이에서 제외됩니다. 미시간대학병원은본재정지원프로그램의 자격요건정책이제시하는조건에상관없이, 응급상태인 (EMTALA - 응급진료및분만법의규정내에서 ) 모든 환자에게차별없이치료를제공합니다.The patient s ability to pay should be determined prior to providing the service whenever possible, the exception being emergency services where we are required to provide emergent medical care according to EMTALA laws. The UMHS provides care for emergency medical conditions (within the meaning of EMTALA) without discrimination to individuals regardless of their eligibility under this Financial Assistance eligibility policy. 2. 가계소득으로본연방빈곤선지침- 환자의가계소득이그해, 연방빈곤선지침에서정한가계소득의 250% 를초과하지않을경우, 병원비 100%( 전액 ) 을지원받을수있습니다. 환자의가계소득이그해, 연방빈곤선지침에서정한가계소득의 250% 에서 400% 사이인경우, 병원비의
55% 를지원받을수있습니다. 수혜자격이확인되면, 병원은응급환자나의학적으로반드시필요한치료를 받아야하는환자에게 일반적으로청구되는금액 (AGB) 이상의병원비를청구하지않습니다. 미국국세청지침에 따라, 일반적으로청구되는금액과 (AGB) 그금액의백분율 산출 (AGB percentage) 기준은, 2014 년 12 월 31 일연방 관보에서명시한룩백 (look-back) 방법이며, 자선을베푸는 병원에대한추가조건항에기재되어있습니다. 연방 빈곤선지침의 250% 이하인비보험환자에게청구하는 병원비는 State of Michigan s Healthy Michigan ( 미시간 주의건강한미시간 ) 에서허용하는메디케어의 115% 이상을넘지않도록제한되어있습니다.Federal Poverty Level Guidelines for Household Income - A patient may qualify for a 100% adjustment of charges if the patient s household income does not exceed 250% of the established Federal poverty level guidelines set forth for the current year. A patient may qualify for a 55% adjustment of charges if the patient s household income is between 250% and 400% of the established Federal Poverty Level guidelines set forth for the current year. Following a determination of eligibility, an individual will not be charged more than amounts generally billed (AGB) for emergency or other medically necessary care. The basis for calculating the AGB and AGB percentages, per the IRS guidelines, is the look-back method as described in the Federal Register of December 31, 2014, Additional Requirements for Charitable Hospitals. Charges for uninsured patients below 250% of the Federal Poverty Level will be limited to no more than 115% of the Medicare allowable per State of Michigan s Healthy Michigan requirements. 3. 추가기준 - 환자가재정지원을받으려면연방빈곤선 지침뿐만아니라아래의조건에도부합해야
합니다.Additional Criteria - In addition to the Federal Poverty Level guidelines, the patient must also meet the following criteria to be approved for a Financial Assistance adjustment: 의학적으로반드시필요한치료이어야합니다.Services must be medically necessary. 대학교에등록된학생은신청자가될수없습니다.The applicant cannot be a student enrolled in a college or university 신청자는반드시미시간주의주민이어야합니다.The applicant must be a resident of Michigan. 신청자는반드시메디케이드또는정부보조건강 보험을신청했다가거부당한사람이어야합니다.The applicant must have applied for either Medicaid or an insurance plan on the health insurance exchange and been denied. 신청자의유동자산이 $10,000 미만이어야합니다. 은퇴구좌인 I.R.A., T.S.A 혹은 401K 에는환자의 보유액이 $100,000 까지있어도됩니다.The applicant s liquid assets may not exceed $10,000 with the following exception: The patient may have up to $100,000 in a retirement account, I.R.A., T.S.A., or 401K. 4. 재정적으로메디케이드나보험혜택을받을자격을갖춘 환자는, 의학적으로반드시필요한치료인데보험적용이 되지않는서비스, 공동부담비 (co-pays), 그리고공제금액 (deductables) 등을자선진료 (Charity Care) 를통해재정 지원받을수있습니다. 이런경우, 2 번과 3 번에명시된 소득지침과기타기준을바탕으로결정됩니다.Patients who would qualify financially for Medicaid or insurance coverage may qualify for a Charity Care adjustment related to medically
necessary non-covered services, co-pays and deductibles based on the income guidelines and other criteria in numbers ii and iii. 5. 미시간대학병원의재정기준은충족하지만, 메디케이드의기준을충족하지못하는환자의경우, 기존 병력에대한보험금거부나고갈된보험금에대한재정 지원을받을수있습니다. 신청자는반드시모든재원이 고갈된후에신청해야하고, 경제적지원이필요하다는것을 증명해야합니다.Patients who meet the UMHS financial criteria but who would not qualify financially for Medicaid may qualify for a Financial Assistance adjustment related to denied benefits for a pre-existing condition, or exhausted benefits. The applicant must have exhausted all other financial resources and show financial need. 6. 코브라 (COBRA) 보험혜택을받을자격이되지만, 보험비가한달순수입의 25% 를초과하기때문에 부담스러워가입을거절한환자의경우, 재정지원을받을 수있을수도있습니다.Patients who are eligible for COBRA coverage but have declined the coverage because the cost is greater than 25% of their net monthly income may be eligible for Financial Assistance. 7. 미시간대학병원은허용공동보험금액과공제금액을 수금해야할계약상의의무가있습니다. 그러나, 환자가 재정적어려움을겪고있음을입증할수있는경우, 보험 처리후의남은병원비잔액에대한재정지원을받을수도 있습니다. 미시간대학병원혹은미시간대학병원을 대행하는감독기관이미시간주법과연방법에의거하여 환자의재정적어려움의유무를결정하게됩니다. 경제적
어려움이있는것으로규명된환자의병원비잔액은자선 진료로처리됩니다.UMHS has a contractual obligation to collect the allowable co-insurance and deductible amounts. However, a patient may be granted Financial Assistance for residual balances after insurance if a case can be made for financial hardship. UMHS will determine financial hardship in accordance with State and Federal laws, including oversight agencies acting in their behalf. The residual balances for patients determined to have financial hardship will be written off to charity care. 8. 미시간대학병원은미시간주와연방법규, 그리고 국세청의지침에따라비보험자의재정지원수준을 결정하는서류절차를진행합니다.UMHS will have a documented process by which financial assistance levels will be determined in conjunction with state and federal regulations and Internal Revenue Service guidelines regarding uninsured individuals. 9. 환자가연방빈곤선에부합되는지를판단할수있는 서류를제출하지못할경우에는, 추정적자선수치를 이용해서부분혹은전액자선진료대상이될수있습니다. 자격요건은 2 번에간략히설명되어있는기준만을근거로 합니다.Patients may qualify for full or partial charity using presumptive charity scoring when documentation to determine Federal Poverty Level is not readily available from the patient. Qualification will be based on criteria outlined in number 2 only. 10. 예외적인경우, 추가사례가자선진료로승인될수도 있습니다. 위에자세히열거된재정지원정책규정에서 예외로분류되려면, 재정지원예외그룹의승인을받아야 합니다. 예외그룹의회원은최고수익책임자혹은최고
재무책임자가임명합니다.Additional cases may be authorized as Charity Care on an exception basis. Any exceptions to the Financial Assistance policy provisions enumerated above require the approval of a Financial Assistance exception group. Members of the exception group will be appointed by the Chief Revenue Cycle Officer or the Chief Financial Officer. 11. 신청서와함께요구되는증명서류는아래와 같습니다 :Documentation requirements to be included with the application: 가장최근의연방소득세금보고서 (1040)Federal Income Tax Return for most recent tax year (Form 1040) 가장최근의임금및세금명세서 (w-2) 와 / 혹은기타 수입 (1099)Most recent Wage and Tax Statement (Form W- 2) and/or Miscellaneous Income (Form 1099) 가족구성원 각각의올해초부터현재까지받은최근급여명세서 사본Recent copy of pay stub with year-to-date earnings for each member of the household 그외다른수입의증거자료Proof of other income일반 계좌 / 예금계좌의현재은행잔고증명서Current bank statement of checking/savings accounts 유효한미시간주의운전면허증사본이나 미시간주에서발행한신분증사본Copy of valid Michigan driver s license or Michigan state identification card IRA/401K ( 은퇴연금잔고 ) 증명서IRA/401k statements Medicaid ( 메디케이드 ), Healthy Michigan ( 헬씨 미시간 - 주정부보조보험 ), 혹은 Marketplace ( 마켓 플레이스 - 보험시장 ) 에서온회신.Response from Medicaid, Healthy Michigan or Marketplace
12. 환자는미시간대학병원의재정지원웹사이트에있는 신청서를작성해서신청할수있습니다 : www.uofmhealth.org/financial-assistance. 재정지원 (M- Support 엠 - 써포트 ), 메디케이드 (Medicaid), 혹은의료보험 거래 (Health Insurance Exchange) 신청서작성시도움이 필요한환자는엠 - 써포트프로그램으로연락하십시오 ( 연락처는아래에있습니다 ).Patients can apply for Financial Assistance by completing an application available on the UMHS Financial Assistance website: www.uofmhealth.org/financialassistance. Patients can access assistance to complete an application for Financial Assistance (M-Support), Medicaid, or a health insurance exchange plan by contacting the M-Support Program (contact information below). B. 재정지원적용범위 FINANCIAL ASSISTANCE COVERAGE 1. 적용기간 - 환자는미지불잔액이얼마나 오래되었는지에상관없이, 모두소급적용되도록승인받을 수있습니다. 승인일자로부터 12 개월이후에는재정지원 적용이만료됩니다. 모든환자는반드시 12 개월마다 재신청을해야합니다.Coverage Period - The patient may be approved for coverage for all retroactive balances regardless of the age of the balance. Coverage will terminate twelve months after the approval date. Each patient must reapply every twelve months. 2. 재정지원적용은미시간대학병원의시설, 의료진, 공급자등이제공하는의학적으로반드시필요한모든 서비스가포함됩니다. 환자의치료를담당하고있는미시간 대학병원의의사에의해해당서비스가의학적으로반드시 필요한것이아니라고간주되거나, 미시간대학병원의
소속이아닌곳에서받은서비스까지재정지원이적용되는 것은아닙니다.Coverage includes all medically necessary services provided by UMHS facilities, providers and suppliers. Coverage does not extend to services that are not deemed medically necessary by the patient's UMHS treating physician(s) or to non-umhs services. 3. 승인을받은신청자는의학적으로반드시필요한약을 30 일치받게됩니다. 처방약은리필이남아있지않거나, 엠 - 써포트 (M-Support) 적용기간이만료될때까지매달한 번씩조제받을수있습니다.Approved applicants will receive a 30 day supply of medically necessary medication. The prescriptions can be refilled on a monthly basis until there are no refills remaining or until M-Support coverage is terminated. 4. 재정지원을받는기간중에, 환자가메디케이드나다른 보험해택자격을부여받거나, 환자의재정상태에변화가 생겼을경우에는, 반드시엠 - 써포트 (M-Support) 에통보해야 합니다. 이런변화로인해재정지원프로그램의수혜 자격이변경될수있습니다.During the Financial Assistance Coverage period, if a patient becomes eligible for Medicaid or other insurance coverage and/or if there is a change in the patient s status, the patient must inform the M-Support staff. This change may alter their eligibility with the Financial Assistance Program. C. 기타프로그램 : OTHER PROGRAMS: 그외에도, 환자는재정지원절차설명서에명시된별도취급 진료프로그램혜택도받을수있을수있습니다.Additional carveout programs may be available to a patient and are included in the Financial Assistance Procedure Manual.
IV. 재정지원정책통보 FINANCIAL ASSISTANCE POLICY NOTIFICATION 모든 병원은자체재정지원정책을지역사회에널리알리도록규정되어 있습니다. 이를시행하기위해, 미시간대학병원은외부웹사이트에본 재정지원정책의주요조항들을올리고, 미시간대학병원소속의모든 진료소에비치하는자료와환자통지서에엠 - 써포트프로그램 (M- Support) 에대한설명과아울러환자가어떻게재정지원을신청할수 있는지를널리알리도록최선을다할것입니다. 미시간대학병원의 목표는모든환자들이병원서비스를받을때, 병원에서제공하는 자료와재정상담가와의면담을통해재정지원프로그램에대해 인지하도록하는것입니다. 또한병원비청구및수금노력의일환으로, 재정지원프로그램에대한정보를구두및서면으로 배포합니다.Hospitals are required to widely publicize their financial assistance policy in the community served. UMHS will ensure that this requirement is met by including key provisions of this Financial Assistance policy on its external website and by making materials available throughout the UMHS patient care sites and the patient statements that inform patients of the M-Support Program and how patients may request financial assistance. It is an objective of UMHS to ensure that all patients be made aware of available financial assistance programs at the time of service through availability of materials and in many cases access to financial counselors. In addition, billing and collection efforts include processes for distributing information about the Financial Assistance Program both verbally and in writing. V. 재정정책운영 ADMINISTRATION A. 미시간대학병원의 Revenue Cycle 부서는, 병원비미지불시미시간대학병원이취할수있는조치를설명하는별도의병원비청구및수금정책을갖고있습니다. 이에는특별징수조치도포함됩니다. 미시간대학병원은환자가병원의재정지원혜택을받을수있는지를규명하기위한노력을충분히하기전에는, 특별
징수조치를취하지않을것입니다. 본정책은미시간대학 병원의 Revenue Cycle 부서나아래의연락처로문의하시면 받아보실수있습니다.The UMHS Revenue Cycle has separate billing and collection policies that describe the actions the UMHS may take in the event of nonpayment, including collection actions. The UMHS will not take extraordinary collection actions against an individual prior to making reasonable efforts to determine whether the individual is eligible for assistance under this Financial Assistance policy. These policies are available from the Revenue Cycle department of UMHS or by utilizing the contact information below. B. 본정책운영에대한상세한절차는미시간대학병원의 Revenue Cycle 부서에서작성한재정지원절차서에요약되어 있습니다.Detailed procedures to manage this policy are outlined in UMHS Revenue Cycle written Financial Assistance procedures. C. 재정지원금조정 - 지역의문서화된절차를따릅니다. 자선진료 지원금조정은, 친구나친척과의이해상충이있는직원이 신청하거나승인할수없습니다.Administration of Financial Assistance Adjustments Administration will follow local written procedures. Charity Care Assistance adjustments cannot be initiated or approved by an employee where a conflict of interest exists with that person, be they friend or relative. D. 미시간대학병원의합작사업체에서의적용 : Michigan Health Corporation ( 미시간건강법인 ) 을통한미시간대학병원합작 사업체들의재정지원정책은사업파트너들과함께 수립되었습니다. 미시간대학병원의재정지원정책수용에 동의한합작사업체들은본정책을따를것입니다.Applicability at UMHS joint ventures: Financial assistance policies for UMHS joint ventures through Michigan Health Corporation are established with the
venture partners. Joint ventures that have agreed to adopt the UMHS financial assistance policies will follow this policy. VI. 연락처 CONTACT INFORMATION 전화번호 Phone: (855) 853-3580 ( 무료전화 ) 이메일 Email: M-Support@med.umich.edu 웹사이트 Website: www.uofmhealth.org/financial-assistance 위의엠 - 써포트 (M-Support) 프로그램연락처로문의하시면사본을 보내드리며또한웹사이트를방문하시면정책정보를직접출력하실수 있습니다.A paper copy can be sent to the patient by contacting the M-Support Program using the contact information listed above or go to the website and print out the policy. VII. 전시물 EXHIBITS 없음 None VIII. 참고자료 REFERENCES 없음 None 저자 : Benjie Johnson, Chief Officer, Revenue Cycle ( 벤지존슨, 수익담당최고 책임자 ) Author: Benjie Johnson, Chief Officer, Revenue Cycle 초판발행 : 2004 년 9 월 Initially issued: September 2004 승인 : FGP Board 2004 년 9 월 23 일 ; HHCEB 2004 년 9 월 27 일 Approved: FGP Board 9/23/2004; HHCEB 9/27/2004
수정 : FGP Board 2008 년 5 월 8 일 ; HHCEB 2008 년 5 월 28 일 Revised: FGP Board 5/8/2008; HHCEB 5/28/2008 수정 : FGP Board 9 월 11 일 ; UMHCC CEO 12 월 11 일 Revised: FGP Board 9/11; UMHHC CEO 12/11 수정 : UMHS CFO ( 미시간대학병원최고재무책임자 ) 2015 년 10 월 8 일 ; Revised: UMHS CFO 10/8/2015; 미시간대학병원최고재무책임자및임상업무부총장승인,2015 년 10 월 Approved by UMHS CFO and Senior Associate Dean for Clinical Affairs, October, 2015