RE: annual income determination

[Guest guest]

Not sure if the BPHC would come out with a policy such as you are requesting

given that these are issues that are addressed both in the 330 statutes and

health center program expectations. The following are excerpts from both and

should help in a PCER.

This is defined in the 1996 Health Center Consolidation act in the health center

requirements:

``(i) has prepared a schedule of fees or

payments for the provision of its services

consistent with locally prevailing rates or

charges and designed to cover its reasonable costs

of operation and has prepared a corresponding

schedule of discounts to be applied to the payment

of such fees or payments, which discounts are

adjusted on the basis of the patient's ability to

pay;

Furthermore the Program expectations (PIN 98-23) states in the finance section:

Billing of clients without insurance, collection of co-payments and minimum

fees, and screening for financial status, must be done in a culturally

appropriate manner to assure that these important administrative steps do not,

themselves, present a barrier to care. This aspect is particularly important

for organizations working with special populations facing particular

socio-economic barriers. The steps outlined should not conflict with the

mission and mandate of health center programs, but rather assure that the

federal grant resources available to the organization are used to address true

financial access barriers to the maximum degree possible.

and ,

Health centers must have written, board approved, billing, credit, and

collections policies and procedures which, at a minimum, include: a fee schedule

for all billable services covering reimbursable costs and comparable to

prevailing local rates; a method of discounting or adjusting fees based upon the

patient's income and family size from current Federal Poverty Guidelines; and, a

system of billing patients and third-party payers within a reasonable period of

time after services are provided, typically within 30 days. Health centers

should establish a target for days in receivables for collections on billable

services by payer, monitor collection rates on outstanding balances and

follow-up or write-off such balances as appropriate. Where possible, health

centers are encouraged to utilize electronic systems for billing and insurance

verification.

As you can see, it appears to me that health center boards are given some lead

to develop billing and collection policies as long as it does not jeopardize the

financial position of the health center. This is nothing more than prudent

fiscal management.

Ruiz

Assistant Director Systems Development and Policy Administration

Migrant Health Coordinator

National Association of Community Health Centers, Inc.

7200 Wisconsin Avenue Suite 210

Bethesda, MD 20814

(301) 347-0442

(301) 347-0459 FAX

(202) 365-0154 Cell Phone

jruiz@...

www.nachc.com

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Sent: Thursday, June 12, 2003 11:49 AM

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There are 3 messages in this issue.

Topics in this digest:

1. Farmworker Mental Health Video

From: " Britney Lanham " <blanham@...>

2. Q about baby feeding

From: V Bletzer <keith.bletzer@...>

3. Re: annual income determination - CHC sliding fee scale

From: Deborah Norton <Deborah.Norton@...>

________________________________________________________________________

________________________________________________________________________

Message: 1

Date: Wed, 11 Jun 2003 11:22:36 -0600

From: " Britney Lanham " <blanham@...>

Subject: Farmworker Mental Health Video

Video Available for Farmworker Mental Health Outreach and Education-

Los Cuentos del Campo-

Las historias que nos enseñan que a pesar de la sombra hay esperanza

Stories from the fields-

Stories that show us that in spite of the darkness...there is hope

This ten minute Spanish language video slide show, created by the bilingual

mental health outreach team of Terry Reilly Health Services, presents how

farmworkers facing life problems can benefit from counseling services. These

mental health issues include:

- Child behavior problems and the benefits of play therapy

- Female depression and adjusting to life in the United States

- Grief and sadness after losing a loved one

- Recognizing panic attack symptoms

- Recognizing male depression symptoms

This video has been shown in mental health outreach presentations at the 2003

Western Migrant Stream Conference and the 2003 Northwest Spring Primary Care

Conference and is used by Terry Reilly Health Services to help create awareness

in the farmworker community of mental health issues and the benefits of

counseling. This video has been shown in the following settings:

- Community presentations(labor camps,churches,community centers, etc.)

- School parent meetings

- Health fairs

- Health clinic waiting rooms

" The cost of the video which includes a Spanish/English written presentation

guide for facilitating group discussions is $17.00, plus $3.00 for shipping and

handling, per video. Purchasers from Idaho, add 6% ($1.02/video) state sales

tax. "

Terry Reilly Health Services

Attn: Britney Lanham

211 16th Ave. N., P.O. Box 9

Nampa, ID 83653-0009

Questions? Please contact:

Britney Lanham

Terry Reilly Health Services

Bilingual Mental Health Educator

blanham@...

(208) 941-4121

[This message contained attachments]

________________________________________________________________________

________________________________________________________________________

Message: 2

Date: Wed, 11 Jun 2003 17:24:03 -0700

From: V Bletzer <keith.bletzer@...>

Subject: Q about baby feeding

Esther. This one's really interesting.

As you " approach with " the excellent information provided by and

, " approach as " a sharing encounter. Ask a couple of questions, before

mixing other questions with the advice you wish to communicate. You may

find the responses enlightening; certainly they should be helpful for the

immediate concern, but they might also provide bits and pieces of

information that'll be helpful in service delivery for other problems, if

not suggesting possible questions to ask when working with other problems.

Two additional points. One, it would be helpful to know in what settings

the infants " cry, " is it at the clinic, or home visits, or " everywhere. "

Two, these mothers are doing what a " good mother " does, hence their actions

make them " good mothers " in the eyes of others.

How can culture not be some part of all this? I suspect you'll find that

" weight " is linked to images of health. For infants, for children, and for

adults and seniors.

V Bletzer

________________________________________________________________________

________________________________________________________________________

Message: 3

Date: Thu, 12 Jun 2003 09:24:37 -0400

From: Deborah Norton <Deborah.Norton@...>

Subject: Re: annual income determination - CHC sliding fee scale

I would very much like to see a BPHC policy or guidance document on this

issue. Many centers fear repercussions during their PCER if they adopt

" MSFW equitable " policies, and ask for something in writing from the Bureau.

Deb Norton

Ruiz wrote:

>Good points.

>

>The issue is one that has been brought up before and concerns the use of

historical as opposed to prospective data to determine annual income. In the

case where a prospective annual income is derived on current income, the result

can often be a high annual income because it assumes full employment during the

year at the current rate of income. A more accurate reflection may be the

historical annual income.

>

>To some extent the determination of the MSFW annual income for sliding fee

scale purposes is up to the respective CHC policy set for determining income.

This policy is set by the C/MHC board and they have the discretion of how they

will determine the annual income. (note: this is not the case when it comes to

annual income determination for Medicaid and SCHIP purposes, that is set by the

respective State Medicaid agency.) Indeed, I have spoken to some migrant health

centers that are keen to the issue and have adopted a more MSFW patient

equitable policy.

>

>On the second issue, that of relatives outside of the US. I would venture to

say that again this is a policy that would be determined by the individual

health center and borders on the documentation and verification of the patient

assertions. I would be interested in hearing on how other migrant health centers

handle this issue.

>

>Both of these issue illustrate the importance of having migrant and seasonal

representatives on the governance board as well as having staff that is

sensitive to MSFW issues especially when it comes to access for health care

services.

>

>

> Ruiz

>Assistant Director Systems Development and Policy Administration

>Migrant Health Coordinator

>National Association of Community Health Centers, Inc.

>7200 Wisconsin Avenue Suite 210

>Bethesda, MD 20814

>(301) 347-0442

>(301) 347-0459 FAX

>(202) 365-0154 Cell Phone

>jruiz@...

>www.nachc.com

>

>

>

>

>

>

>

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