WSHA has developed a standard financial assistance application form and standard plan for communicating about financial assistance. The WSHA Board of Trustees unanimously voted to urge every hospital in Washington State that is subject to the state’s charity care law to adopt the standard application form and communication plan. Adopting the application and communication plan are the right thing to do for our patients, our communities, and our hospitals. Read more about this work here.
- Download standard financial assistance/charity care application and Instruction sheet (Word Document)
- In Chinese (simplified) (Word Document / PDF)
- In Chinese (traditional) (Word Document / PDF)
- In Khmer (Word Document / PDF)
- In Korean (Word Document / PDF)
- In Laotian (Word Document / PDF)
- In Russian (Word Document)
- In Spanish (Word Document)
- In Vietnamese (Word Document)
- Download guidance on adoption of standard application form and Instruction sheet (PDF)
- Download standard communication plan for financial assistance/charity care (PDF)
- Download model plain language summary (Word Document)
Hospitals should review financial assistance policies and procedures and, if necessary, update them to ensure the new form and communication plan fit within the hospital’s financial assistance/charity care structure. These policies should include the voluntary pledge made by hospital CEOs in 2007 to provide care at a sliding scale up to 300% of the Federal Poverty Guidelines. Hospitals must submit any change to financial assistance policies to the Department of Health for approval.
Click here to see the list of hospitals that have adopted WSHA’s standard financial assistance application form and standard plan for communicating about financial assistance
Materials for Complying with Billing Notification Law (RCW 70.41.400)
State law requires hospitals to give each inpatient on or before discharge a written statement providing a list of professional partners that commonly provide care for patients at the hospital and from whom the patient may receive a bill. WSHA has produced the following materials for hospitals to use to help in informing patients.
- Understanding Your Hospital Bill Sample Insert (PDF/Word template)
- Click here for a template of a 3.375” by 8.5” single-panel card insert (MS Word)
- Click here for a full page sheet insert (MS Word)
- Order “Understanding Your Hospital Bill” brochure
Materials for Complying with Notice Requirements (WAC 246-453)
State law requires hospitals to post or prominently display information on charity care within public areas of the hospital. WSHA has produced a model sign about financial assistance, including information in English and eight other commonly spoken languages.
Order free financial assistance signs from the WSHA Bookstore
- April 2014: WSHA bulletin on changes to the charity care law
- 2007 WSHA voluntary pledge for hospitals on billing to the uninsured.
- RCW Chapter 70, Section 170
- Washington Administrative Code at Chapter 246, Section 453
- DOH’s Annual Charity Care Report
- Current Federal Poverty Guidelines (U.S. Health and Human Services)
DOH can be contacted at 360-236-4210