Effective October 1: Changes to State Charity Care Law

September 6, 2018

To:                   CEOs, CFOs, Legal Counsel, and Government Affairs Staff

From:              Zosia Stanley, JD, MHA, Associate General Counsel

Staff Contact: Zosia Stanley, ZosiaS@wsha.org or (206) 216-2511

Subject:           Effective October 1: Changes to State Charity Care Law


The purpose of this bulletin is to remind hospitals of changes to the state charity care law, RCW 70.170. The new law, Senate Bill (SB) 6273, takes effect October 1, 2018 and all hospitals must comply as of this date.

This bulletin contains a checklist and resources to help hospitals comply with the new law.


Washington State’s charity care law applies to acute care hospitals licensed under RCW 70.41 and psychiatric hospitals licensed under RCW 71.12. The changes to the charity care law apply to all acute care and psychiatric hospitals.


SB 6273 standardizes the way hospitals notify patients of the availability of charity care, clarifies definitions in state law, and requires hospitals to train appropriate staff on charity care policies and use of interpreter services. The new law aligns with the federal 501(r) requirements applicable to federal 501(c)(3) nonprofit hospitals

Leading up to the 2018 legislative session there was considerable interest from legislators, advocates, and hospitals in addressing concerns about the state charity care law. During the 2018 legislative session, WSHA successfully negotiated changes to the state charity care law that are beneficial for both patients and hospitals. The changes in the charity care law address some areas of concern for hospitals. WSHA advocated to establish a timeline/deadline for charity care applications, but we were unable to gain traction on that issue. However, the bill does provide more clarity on the time period hospitals use when assessing a patient’s income.

The Department of Health (DOH) has yet to conduct rulemaking on this new law. This rulemaking will be a top priority for WSHA. The majority of the detail of the state charity care law is contained in the administrative code, WAC 246-453. DOH will create new rules to implement the changes in SB 6273 and is likely to start rulemaking in the fall of 2018. DOH’s goals in rulemaking are to eliminate any conflicts between the new law and the current regulations and clarify ambiguous provisions.

Recommendations and Next Steps

In order to comply with the changes in the state charity care law every hospital must:

Know the law: Review the changes in the charity care law.

Update the hospital’s charity care policy and submit policy to DOH: Review and update the hospital’s charity care policy and procedures as needed.

  • WSHA has prepared sample policy language to add to existing polices.
  • Submit the hospital’s updated charity care policy to the DOH at least 30 days before the policy is effective.
  • Policies must be submitted via email to CharityCare@doh.wa.gov

Establish training programs: Establish training programs for appropriate staff regarding the hospital’s charity care policy and use of interpreter services.

  • WSHA has prepared guidance on staff training requirements for both charity care and interpreter services.
  • Hospitals are not required to conduct staff training by October 1, but hospitals must develop a standardized training program and establish a procedure or plan to provide regular training to appropriate staff. Appropriate staff include those who perform functions relating to registration, admission, or billing.

Post charity care signs in the hospital: Ensure that notice about charity care is posted and proximately displayed in the hospital.

  • Signs about the availability of charity care must be displayed in areas where patients are admitted or registered, in emergency departments, and in financial services or billing areas (if these are accessible to patients).
  • Signs must be posted in languages spoken by 10% of the population of the hospital’s service area.
  • WSHA provides charity care signs with information in English and eight other languages on our website.

Include a statement in English and Spanish about charity care in billing and collections communications: A statement about charity care availability must be included on all billing and collections communications sent by the hospital.

  • The statement must be the following or substantially similar:
    • You may qualify for free care or a discount on your hospital bill, whether or not you have insurance. Please contact our financial assistance office at [web site] and [phone number].
  • The statement must be prominently displayed on the first page of the communication and be in both English and the second most common language spoke in the hospital’s service area. The second most commonly spoken language in Washington State is currently Spanish. Here is the above statement translated into Spanish:
    • Usted puede calificar para recibir atención gratuita o un descuento en su factura del hospital, sin importar si tiene o no seguro. Para comunicarse con nuestra oficina de ayuda financiera, visite [web site] o llame al [phone number].

Post charity care information on hospital’s website: Hospitals must post the current charity care policy, a plain language summary of the policy, and the hospital’s charity care application form on the hospital’s website.

  • The plain language summary and application form must be available in all languages spoken by more than ten percent of the population of the hospital’s service area.
  • WSHA’s standard charity care application form is available in English and many other languages. A model plain language summary is also available.


Under state law, Washington hospitals are required to provide free or reduced care for all qualifying applicants. Free care for hospital services must be provided to patients (insured and uninsured) with incomes under 100 percent of the federal poverty level. Hospitals must provide discounted care for any patient with income under 200 percent of the poverty level. In 2007, to supplement existing law and to avoid additional legislation, the WSHA Board asked all hospitals to pledge to provide discounts to uninsured patients with incomes up to 300 percent of the poverty level and to ensure that the discounts were meaningful. All Washington hospitals signed the pledge.

In 2015 WSHA worked with member hospitals to develop a standard charity care application form and instruction sheet, a standard communication plan, and a model plain language summary. Over 90% of Washington State hospitals have adopted these documents.



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