Administrative Instruction
Section IV
No. 9
Financial Hardship Policy
Effective Date: February 1, 2024
______________________________________________________________________________ Purpose
The City of South San Francisco finds that, although there may be incidental benefits to private individuals, the public purpose of relieving those most in need of financial relief of the typically unexpected financial hardship of ambulance transport and copayment charges serves a compelling public interest in ensuring that individuals are able to receive necessary medical treatment, among other public benefits.
This Administrative Instruction establishes a policy in order to maintain consistency in assisting uninsured and indigent patients who request a reduction or waiver of certain ambulance charges and/or copayment amounts.
This policy outlines the City’s policies and procedures in relation to the application and approval process for uninsured and indigent patients. The City will take into account the overall financial circumstances of the applicant and apply this policy consistently.
The City may elect to reduce or waive certain amounts which are due from patients who can successfully demonstrate that paying ambulance charges and/or copayment amounts would cause significant financial hardship.
This policy has been updated to reflect the amendments made to California law under Assembly Bill 716 (2023), and legally allowable collection activities. Though the City does not presently have a formal collection process beyond third-party insurance identification, these practices will be followed, consistent with the law, should the City engage a debt collection agency. Accordingly, the City has a 12-month abeyance on the collection of any medical debt, as required by law.
Policy
The City of South San Francisco will take into account a range of factors when deciding whether the full payment of the ambulance charges will cause the applicant significant financial hardship. In making the decision whether to waive the charges, the City will compare the household income, living expenses, assets and debts. Written verification, when available, may be required to substantiate and verify information contained in the financial hardship waiver application.
Any amount not paid by a patient’s insurance provider (if any) shall be adjusted to the prevailing Medicare or Medi-Cal fee for service rate, whichever is greater, prior to formal collections proceedings. Currently, the City does not recognize “network” rates for any providers other than those required by law. The City’s ambulance fee schedule is set by the South San Francisco City Council, guided by cost and fee studies, and is published on the City’s website.
The City uses the most recent County of San Mateo Department of Housing Income Limits by Family size to help in determining if an applicant qualifies for a financial hardship waiver.
In applying these guidelines, the City will also consider and take into account any other household income and expenses. Income and employment status verification are required; including tax returns; check stubs, etc. Other considerations include:
Whether payment of the ambulance or copayment charges will affect the applicant’s ability to pay for the following living expenses:
food and clothes;
rent or mortgage payments;
any other basic needs; or
any special needs (for a serious illness or disability) Whether the applicant owns any assets, such as a car and/or house. Assets also include:
investments;
money in the bank;
cash on hand for short term expenses; and
money designated for special needs.
Whether the applicant has any debts.
Procedures
An application for a financial hardship waiver of ambulance or copayment charges and fees must be made in accordance with City of South San Francisco’s, (hereinafter referred to as City), policy entitled “Financial Hardship”.
Applicants can request and complete a Financial Hardship Waiver Application Form. The form can be obtained by calling (650) 829-3950 or by visiting the South San Francisco Fire Department Administration office at 480 North Canal Street, South San Francisco, CA 94080, during normal business hours. Forms can also be requested, through submission of a written request, to the above listed address for the Fire Department Administration Offices and are downloadable online at HYPERLINK "http://www.ssf.net/432/EMS---ALS" http://www.ssf.net/432/EMS---ALS.
If applying in person, please be prepared to offer written verification of the necessary information about your financial circumstances. If you have difficulty performing any of these tasks, please contact the Fire Department at (650) 829-3950. Applicants are required to return the completed forms and submit all required documentation to the South San Francisco Fire Department located at 480 North Canal Street, South San Francisco, CA 94080. An application may also be submitted electronically by requesting a username from the City’s secured site. Please submit your request to HYPERLINK "mailto:[email protected]" [email protected] for access to the site. In order to protect your personal information, please do not e-mail your financial hardship waiver application to this address until you have received access to our secured site.
Required Information:
The City requires independent information to support claims of financial hardship, including verification of expenses and income. The information submitted will be treated confidentially and will only be reviewed by City administrative staff involved in processing requests for a waiver of ambulance and copayment charges.
Time Frame:
After an application and verification information is received, the City will consider the overall financial situation of the applicant and then render a decision. The City has designated the authority to grant or reject requests for financial hardship waivers to the City’s Director of Finance. All decisions will be made within 20 business days from the time that the City receives all required information.
Applicants will receive a notification letter stating whether the application has been approved or rejected. If your request for waiver of the charges is rejected, the City will provide the applicant with a written summary and explanation of its decision.
The Fire Department administrative staff will maintain all documentation related to the financial hardship waiver process. This documentation will include all supporting documentation, including the waiver request and all documents provided in support of the request.
Verification of ongoing qualification for a financial hardship waiver will be conducted at any time the applicant requests a waiver of ambulance charges or other applicable copayment amounts.
Income shall be annualized from the date of request based on documentation provided, and upon verbal information provided by the patient or their designee. The annualization process will also take into consideration seasonal employment and temporary increases and/or decreases to income.
Any denial of a financial hardship waiver request will be written and will include instructions for possible reconsideration. If additional documentation of financial need is received, the request will be reviewed and considered per the above guidelines.
Sharon Ranals
City Manager
Dated:
Administrative Instruction – Financial Hardship Policy
Section IV
No. 9 (Page PAGE 3)
08/01/2016
FILENAME \p S:\Administrative Instructions\IV No 9 Financial Hardship Policy.doc This is repetitive of the first paragraph on page 2. Delete? To what is this referring? Will the applicants know this term?