Uncompensated Care (UCC) is care provided for which no compensation is received (typically a combination of charity care and bad debt). Maryland recognizes the financial burden hospital take on when providing quality care to patients who cannot readily pay for them. Unlike other states, Maryland’s rate setting system factors the cost of UCC into the State’s hospital rate setting structure. This provision increases access to hospital services in the state for those patients who cannot readily pay for them while hospitals get credited for the care provided.
Bad Debt:
Which is for “Commission regulated services rendered for which payment is anticipated and credit is extended to the patient” but the payment is not made. Unpaid cost share for patients that do not meet the free thresholds can be charged as bad debt after the hospital makes a reasonable attempt to collect those charges. However, there are several reasons that a hospital may not include bad debts into uncompensated care, most notably denials.
Charity Care:
Charity care services are “those Commission regulated services rendered for which payment is not anticipated.” Charity care if provided to patients who lack health care coverage or whose health care coverage does not pay the full cost of the hospital bill.
The HSCRC’s current policy provides for uncompensated care statewide at the level of the most recent year’s actual statewide experience. Hospital-specific uncompensated care provisions are determined by a blend of a hospital’s most recent year’s actual experience and its predicted performance determined by way of a regression analysis.
Pooling:
The UCC Fund is used to redistribute funds from hospitals with lower rates of UCC to hospitals with higher rates of UCC.
Determining hospital contribution/withdrawals: The 50/50 blend for each hospital is subtracted from the amount of state-wide actual UCC funding provided in rates and multiplied by the hospital’s global budget revenue (GBR) to determine how much each hospital will either withdraw from or pay into the statewide UCC Fund. The Fund is the mechanism through which HSCRC ensures the burden of uncompensated care is shared by all hospitals. Specifically, if a hospital’s 50/50 blend is less than the statewide average UCC rate, the hospital will pay into the UCC Fund. Conversely, if a hospital's 50/50 blend is greater than the statewide average UCC rate, the hospital will withdraw from the Fund.
UCC Write-Off Public Use Data:
The UCC Write-off Public Use dataset contains unique patient-level information obtained from the Uncompensated Care Write-off data, as well as, from the inpatient and outpatient confidential datasets submitted to the Commission for the current fiscal year. The data is intended to be used strictly for modeling and evaluation of alternative methos of estimating Maryland hospitals’ uncompensated care amounts to be built prospectively into rates for the current fiscal year.
Each requester of the data must sign the DUA and complete the Certificate of Destruction. Submission of analysis results and the completed Certificate of Destruction to HSCRC is required.
Certificate of Destruction
UCC Non-confidential White Paper Data Dictionary
UCC Policy (link)
