Palin's Federal Tax Returns

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        A                                   NEWSLETTER
                                                          November 2008
                                                       Seminar Highlights
        M                          On Friday, October 10, ARMDS hosted
                               an educational seminar for our clients and
                               friends at the Woodbridge Hilton Hotel in
                                                                                   most thought-provoking presentation of the
                                                                                   day. Afterwards, participants joined us for
                                                                                   lunch and an opportunity to continue the
                               Iselin, NJ. We had a lively group of                discussions started during the seminar.

        D                      speakers who discussed a variety of topics,
                               from Federally Qualified Health Centers to
                               point of service collections. Impending
                               legislation   on   universal    healthcare
                                                                                   We would like to thank everyone who
                                                                                   participated, and especially our guest
                                                                                   speakers who helped make this event a
                                                                                   great success.
                               coverage in New Jersey was perhaps the


       Federally Qualified                         Point of Service Collections
         Health Centers                                                                                  “ KEEP PATIENTS
                                                                                                       INFORMED OF THEIR
                                                 The cost of providing medical care is rising,
                                             fiscal pressure is mounting, and hospitals are                 RIGHTS AND
                                             seeking new ways to minimize bad debt and                RESPONSIBILITIES, AND
    As the uninsured population              improve cash flow.       One approach that is             GIVE THEM SEVERAL
continues to grow, health care industry      beginning to take hold in some New Jersey               OPPORTUNITIES TO MEET
leaders are exploring different options,     hospitals is point of service collections. John             THEIR FINANCIAL
including Federally Qualified Health         Bucci, Patient Accounts Manager at Cooper                     OBLIGATION. “
Centers (FQHCs) to provide much              University Hospital, shared his knowledge and
needed relief to overburdened hospital       experience of launching a point of service
emergency rooms and clinics. Chief           collections pilot program at one South Jersey
Financial Officer of the Henry J. Austin
Health Center in Trenton, Richard
                                                 Although asking patients for payment at the
                                                                                                     Universal Healthcare
Mushock, talked about the history and        time of service is no longer taboo, it does require             Coverage
development of FQHCs in the U.S.             a high level of sensitivity and customer service         ---------------------------
over the past 40 years.                      know-how.       Cooper Hospital administrators            One day, in the not too distant
                                             recognized this and set out to create a system        future,      affordable      health
   Federally Qualified Health Centers        that would allow them to not only collect cash        insurance will be available to all
are public or private non-profit             with minimal complaints, but also promote better      residents of New Jersey …or at
organizations that receive grant             patient relations.      Cooper’s program was          least that is the plan that Senator
funding,      and     other    economic      developed over the course of several months and       Joseph Vitale (D-Middlesex) and
incentives, for providing health care        in close coordination with ARMDS. Already             David Knowlton, President &
                                             managing Cooper’s self-pay financial counseling,      CEO of the New Jersey Health
services to Medically Underserved            point of service collections was a natural            Care Quality Institute (NJHCQI),
Areas/Populations (MUA and MUP).             extension of ARMDS’ services.                         are proposing. The pair, along
The       first     federally    funded                                                            with a team of experts from
neighborhood health centers were                Cooper’s initial goal has been to collect          around the State, has been
started in 1965, as part of the              deductibles, co-insurances, and co-payments           working      on legislation     for
government’s efforts to target poverty       from patients at bedside. Individuals who are         comprehensive        reform    that
across the nation. The idea was that         unable to pay are evaluated for financial             would make universal healthcare
low-income communities would see             assistance programs. This is in addition to           coverage in New Jersey a reality.
                                             increased efforts to collect payments from
many benefits, including decreased
                                             patients who are scheduled for elective                See page 4, Healthcare Coverage
poverty, if residents of those                                            Continued on page 3
                      Continued on page 3
         NJ FAM LY CAR E
              AM LY AR E                  babies born to mothers who are                    PRESIDENTIAL C ANDIDATES
           EXPAN SIIION                   already enrolled in Medicaid, the                            &
           EXPAN S ON
             XPAN S ON
                                                                                              HEALTH C ARE REFORM
                                          hospital must submit a PA-1C form to
                                          the local County Board of Social
    This year, there seems to be a        Services Office.                               As you head to the polls on
push to get uninsured children health                                                November 4 to cast your vote for the
care coverage in New Jersey.                                                         next U.S. President, we would like to
                                              It has become clear that the efforts   remind you to take into consideration the
Starting in January, NJ FamilyCare        to increase enrollment of children in      health care plans of both the Democratic
Advantage became available for            NJ FamilyCare and NJ FamilyCare            and     the       Republican  candidates.
uninsured children whose parents          Advantage go hand in hand with a           Senators Barack Obama (D-Illinois) and
earn too much to qualify for regular      proposal     for   healthcare    reform    John McCain (R-Arizona) have very
NJ FamilyCare, but not enough to          introduced by Senator Joseph Vitale        different ideas about how to address
pay for private health insurance.         (D-Middlesex) in March. A bill passed      important healthcare issues, from
Offered through Horizon NJ Health,        by the Legislature over the summer         access      to     coverage   and     cost
the program is a low-cost insurance                                                  containment, to financing Medicare and
                                          and supported by Governor Corzine,
plan for families with income over                                                   caring for veterans. Any reforms to
                                          which mandates insurance for all           health care on a National level are likely
350% of the Federal Poverty Level         children and expands the NJ                to have an impact on New Jersey
(FPL). There are no upper income          FamilyCare Program for parents, is         residents and, in particular, on those of
limits, however, children must be         the first phase of a comprehensive         us who work in this field. Following is a
without insurance for at least six        reform plan that is expected to lead to    list of resources where you can find
months before they are eligible to        universal health care coverage in New      information about both candidates’
apply. (Children who lost Medicaid        Jersey.                                    health care reform proposals.
or NJ FamilyCare coverage are
exempt from this requirement). The                                                       The Kaiser Family Foundation, a
                                               The “Kids First” mandate requires
application form, monthly premium                                                    private, non-profit organization focused
                                          that all children under 19 years of age    on major health care issues, has set up
rates, and benefits information can       have health insurance by July 2009.        a website with information and
be        found       online       at     This coverage may be through a             resources about health policy issues in under NJ          private or employer-sponsored plan, a      the 2008 presidential campaign. The
FamilyCare Advantage.                     government assistance program, or          site features a side-by-side comparison
                                          the NJ FamilyCare Advantage buy-in         tool of both candidates’ health care
    This past April, in an effort to      program.         Rather than impose        reform proposals, as well as links to
ensure the integrity of the Charity       penalties for non-compliance, the DHS      other websites.
Care Program as payer of last resort,     will attempt to increase public
the New Jersey Department of                                                             Details about Barack Obama and Joe
                                          awareness and boost enrollments. In        Biden’s “Plan for a Healthy America” can
Health and Senior Services (DHSS)         coordination with the Commissioner of      be found on the presidential candidate’s
issued a bulletin regarding NJ            Education,       ongoing     enrollment    website                                at
FamilyCare/Medicaid       Presumptive     initiatives will be established in
Eligibility for newborns.     Effective   elementary and secondary schools,          althcare/.
June 1, 2008, all claims for newborns     day care centers, and other child care
submitted to the Charity Care             centers      throughout    the   State.       Facts about John McCain and Sarah
Program would be denied.          This    Beginning with the 2008 tax year, the      Palin’s Health Care Plan for the U.S. can
announcement came three months                                                       be        found         online          at
                                          Department of the Treasury will
before legislation that has expanded                                       
                                          require residents to indicate health
the ban on Charity Care claims for        insurance coverage for themselves              As you exercise your right to vote this
newborns to include uninsured             and dependents on income tax               election, we encourage you to make an
children under age nineteen.              returns.     Uninsured taxpayers with      informed decision.
                                          income below 350% FPL will be
   Hospitals are mandated to screen       mailed an application for Medicaid or
patients for third party payers and       NJ FamilyCare. Hospitals, clinics and
medical assistance programs before        other health care centers will also
determining Charity Care eligibility.     continue to        provide   enrollment
Children with a family income up to       opportunities.
350%       FPL       are      deemed
presumptively eligible for Medicaid or       In order to take full advantage of
NJ FamilyCare and must be referred        federal funding available through the         For more information on these
to these programs.          The NJ        State Children’s Health Insurance                   topics and others,
Department of Human Services              Program (SCHIP), and make health                  Read ARMDS’ article
(DHS),     which      oversees     the    insurance more accessible,                     “The Future of Charity Care”
Presumptive Eligibility program, now                                                           published in the
requires hospitals to complete and                                                      September/October issue of NJ
submit an online application for          Continued on page 3                              HFMA Focus Magazine.
newborns within 24 hours.          For
                                                        Federally Qualified cont.                        range of primary and ancillary
procedures. The cash collecting is done in such         ---------------------------------------------    services     including      general
a way as to keep patients informed of their rights      communities were healthy. Thus,                  medicine; pediatrics; women’s
and responsibilities, and give them                                                                      health; geriatrics; podiatry; vision
several opportunities to meet their
                                                        the government began an initiative
                                                        to enhance access to affordable                  care; dental care; behavioral
financial obligation. Cooper and ARMDS are
                                                        primary and preventative health                  health, and many subspecialty
pleased with the results so far and continue to
improve and expand the program.                         care services in underserved                     services.     All are welcome,
                                                        areas.                                           regardless of ability to pay, and
   If you would like to start a point of service            Over the years the Federally                 many centers have county
collections program at your hospital, or enhance        Qualified Health Center Program,                 outstation workers to assist
an existing program, below are some tips and            as it is now known, has grown in                 patients in applying for Medicaid.
ideas to consider:                                      size and scope. Today there are                  Self-pay patients are charged
                                                        approximately 4,500 centers in the               relatively low fees based on a
Patients scheduled for elective services:                                                                sliding scale up to 250% of the
                                                        U.S., providing health care to more
                                                        than 16 million patients annually.               Federal Poverty Level.
   When scheduling an elective procedure,
    verify insurance information and determine          In New Jersey, Centers for Primary
    the patient’s co-payment or deductible.             Health Care (CPHC), have served                     As the number of uninsured
                                                        the State’s low-income and                       Americans grows, FQHCs will
   During appointment confirmations, remind                                                             continue to be an integral part of
                                                        uninsured populations since the
    patients of their financial responsibility and                                                       our nation’s and our State’s
    accepted methods of payment.                        1960s. New Jersey now has 20
                                                        main centers, as well as 49                      health care delivery system.
Patients who have been admitted:                        satellite locations and mobile units.            Information about New Jersey
                                                        Most are located in high-density                 CPHCs as well as a complete list
   Visit patients at bedside to discuss co-
    payments and deductibles before discharge.          urban        areas        and       typically    by County can be found online at
    (This is also a good time to reconfirm              underserved rural areas.               
    demographic and insurance information.)                CPHCs offer patients a wide                   ndex.shtml.
   Always get permission from the nursing
    station before entering a patient’s room.
   Be sensitive to the patient’s circumstances
    and/or medical condition.
   Offer the patient a welcome packet that
    includes information about the hospital and                                   ARMDS
    its services.
   Inform patients of their financial responsibility
                                                                          Client Holiday Luncheon
    verbally and in writing, such as a letter.
   Attempt to collect the patient’s portion due
    before discharge.
   Offer the patient several different payment
    options, including cash, check, and credit
   Give patients who are unable to pay before
    discharge a self-addressed stamped                                                                      In addition to these changes,
    envelope for them to mail their payment from        NJ FamilyCare cont.
                                                        ----------------------------------------------   the new law requires a number of
                                                        the health care reform act                       health insurance market reforms,
   For patients who are unable to pay in full,         expands          eligibility      for     NJ     with the overall goal of stabilizing
    request a minimal deposit and offer a               FamilyCare to low-income parents                 costs and making benefits more
    payment plan. Have the patient sign a                                                                affordable to individuals and small
    detailed payment plan agreement.
                                                        earning up to 200% of the Federal
                                                        Poverty Level. That is currently                 businesses. Details about these
   Follow up with patients who have been               $42,400 for a family of four.                    market reforms and additional
    discharged but have not fulfilled their             Previously only parents earning up               information about Senator Vitale’s
    financial obligation.                               to 133% FPL were eligible. The                   health care reform plan can be
   Track payments collected as well as                 DHS estimates that more than                     found     online.         Go       to
    outstanding patient balances.                       200,000 residents (over 150,000         and
                                                        children and almost 50,000                       type “Health Care Reform Act”
Remember – collecting payment from the patient                                                           under Keyword to search. Click
at point of service is generally more cost-effective
                                                        parents) will enroll in NJ
                                                        FamilyCare.           Although adding            on “Vitale Unveils Plan For Health
and has a higher success rate than attempting to
                                                        more parents and children will be                Care Coverage For All New
collect after the patient has left the hospital. 
                                                        a cost to the State, New Jersey                  Jersey” and scroll to the bottom of
                                                        will receive additional federal                  the page to access the Bill
                                                        funds and Charity Care claims will               Statement, Facts & Figures, and a
                                                        likely decrease as a result.                     White Paper 
   Healthcare Coverage cont.                                                               regardless of ability to pay, and this will
                                               system of delivering health care            not change with this series of reforms.
-----------------------------------------                                                  What will change is the way health
                                               services to those who remain
                                               uninsured. Senator Vitale will likely       care services are delivered to the
   Nowadays, most of us are quite                                                          uninsured. With the creation of a
familiar with the term “universal              introduce the second phase of the plan
                                               this fall.                                  collaborative care system, hospitals
healthcare”, although our ideas of what it
                                                                                           will be encouraged to refer patients to
means may vary. One thing we know for
                                                   Garden State All-Care will be a         clinics or, depending on the level of
sure is that our State’s health care                                                       care needed, to hospitals designated
system is under enormous strain, from          comprehensive health insurance plan,
                                               sponsored and controlled by the State.      by the State to treat uninsured
escalating costs for individuals and
                                               The plan will be offered as both an         patients. The plan would effectively
providers, to a growing uninsured
                                               HMO and a PPO, and will include,            end the Charity Care Program as it is
population that is relying more and more                                                   today, and divert funds to Garden
on government assistance programs              among other services, hospitalization,
                                               prescription drugs, and preventative        State All-Care and the collaborative
such as Medicaid and Charity Care.
                                               care. Consumers will have a statewide       care system.
Although the concept of government-
managed healthcare is highly contested,        network of providers who will be
                                               reimbursed at commercial rates.                With a nationwide economic crisis
supporters of universal healthcare
                                               Garden State All-Care will be available     and increasing fiscal pressure on the
believe that intervention at the State level
                                               to all New Jersey residents, regardless     State, the cost of the plan is a major
is essential to the well being of all New
                                               of family size or income. Non-citizens      area of concern. Although existing
Jersey residents.                                                                          Charity Care funds would be
                                               will not be eligible to enroll. Subsidies
                                               will be available to low-income families    redistributed, the current subsidy of
   We were honored to have David
                                               in order to ensure affordability.           $605 million is not enough to finance
Knowlton present his and Senator
Vitale’s proposal for transformational
health care reform at ARMDS’ seminar.
The foundation of this universal
healthcare coverage plan is the creation
of affordable and portable health
                                                     “ Every New Jersey Resident Will Be
insurance for all residents of the State.
Their approach to achieving this goal is
                                                     Required to Have Health Insurance”
multifaceted and involves maximizing
federal funds available through the
Federal      State    Children’s    Health
Insurance Program (SCHIP); reallocating
tax dollars that currently fund the Charity
                                                  Once the State-sponsored plan is in      these reforms. Health       care costs
Care Program; and implementing                                                             must also be
reforms to contain the rising cost of          place, every New Jersey resident will
                                               be required to have health insurance.       contained, which lawmakers hope to
health insurance in the private market.
                                               Although there will be no employer          achieve in part through prevention and
                                               mandate, the plan assumes that              treatment     of    chronic    diseases.
   The reform is divided into two phases,                                                  Legislators will have to take into
with the first phase addressing uninsured      companies will continue to provide
                                               health insurance as a benefit to their      account the increased pressure on
children and their parents. A large group
                                               employees. Employers that do not offer      primary care physicians that will likely
of senators made headway this past
                                               health insurance will be required to        result from all residents being insured.
June when the legislation they sponsored                                                   Furthermore they will need to consider
passed unanimously in the Senate and           establish Section 125 flexible spending
                                               accounts so that their employees may        how reducing aid to acute care
by a vote of 59 to18, with two absentions,
                                               purchase health insurance with pre-tax      hospitals will affect the State’s health
in the Assembly.       Two weeks later,
                                               income. Increased efforts will also be      care system overall. Senator Vitale,
Governor Corzine signed the bill into law,                                                 David Knowlton, and a number of
establishing a health insurance mandate        made to enroll adults and children who
                                               are eligible into Medicaid or NJ            experts continue to work out these and
for residents 18 years of age and
                                               FamilyCare. The individual mandate          other issues as they prepare to
younger, and expanding the NJ
                                               will be phased in over the course of four   introduce the second phase of their
FamilyCare program to include parents                                                      plan in the coming months.           For
with higher incomes. The new law also          years. Residents will have to show
                                               proof of health insurance on State          additional details or to voice your
calls for health insurance market reforms
                                               income tax returns. Those who do not        opinion about Senator Vitale and David
to make benefits more affordable to
                                               have insurance will be automatically        Knowlton’s proposed reforms please
individuals and small businesses.
Please read about the legislation and          enrolled in the State plan                  visit
resulting changes under “New Jersey            and billed the appropriate premium.
FamilyCare Expansion” on page 2 of this                                                       Thanks to the Special Projects Committee
newsletter.                                        A natural question for many who
                                               work in the field, and especially those              for composing this Newsletter.

    The second, more ambitious phase           who work in hospitals, is about patients                 Cindy Cole, Manager
of the reform is aimed at getting all adults   who remain uninsured, such as non-                    Diana Fonque, Sr. Manager
in the State covered. It involves creating     citizens and the homeless. Although it                Jamie Marchese, Manager
a State-managed insurance plan;                is estimated that more than 500,000
                                                                                                      Kristi Beringer, Manager,
mandating that all individuals have health     residents will enroll in the State-
                                               managed health plan, there will of                    Linda Bryson, Asst Manager
insurance, whether through an employer,
a government entitlement program, or           course continue to be an uninsured                     Maria Facciponti, Director

the State-sponsored plan; and creating a       population.    Hospitals must provide                 Rita Romeu, Vice President
more cost-effective                            emergency care to all patients
                                                                                               Special thanks to Mike Conca for his help

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