WHEREAS, in San Francisco, an estimated 135,000 people, or 17 percent of the City’s population, are uninsured; and,

WHEREAS, many of the uninsured rely on charity care services provided by hospitals to access needed primary and acute care services; and,

WHEREAS, in order to enable the City and County of San Francisco to evaluate the need for charity care in the community and to plan for the continued fulfillment of the City’s responsibility to provide care to indigents, the Board of Supervisors passed Ordinance Number 163-01, the Charity Care Policy Reporting and Notice Requirement; and,

WHEREAS, Ordinance Number 163-01 (the Charity Care Ordinance) requires hospitals to report to the Department of Public Health specific information related to the amount of charity care they provide and to notify patients of the hospital’s charity care policies; and,

WHEREAS, California Pacific Medical Center, Chinese Hospital, Saint Francis Memorial Hospital, St. Luke’s Hospital, and St. Mary’s Medical Center are subject to the terms of the Charity Care Ordinance; and,

WHEREAS, San Francisco General Hospital and Kaiser Permanente Medical Center have voluntarily complied with the Charity Care Ordinance; and,

WHEREAS, the University of California, San Francisco, has indicated that it intends to voluntarily comply with the Charity Care Ordinance beginning with the fiscal year 2003 report; and,

WHEREAS, the San Francisco Health Commission appreciates San Francisco hospitals’ efforts to comply with the Charity Care Ordinance; and,

WHEREAS, the charity care information provided by hospitals helps the San Francisco Health Commission evaluate the utilization of charity care services and provides an indication of the health care needs of our City’s low-income, uninsured and underinsured populations; and,

WHEREAS, while the hospitals reporting pursuant to the Charity Care Ordinance have complied with most of the provisions of the Charity Care Ordinance, there are some areas where information continues to be lacking; and,

WHEREAS, among other requirements, the Charity Care Ordinance requires hospitals to submit copies of charity care notices that must be posted in English, Spanish and Chinese in each hospital’s emergency room, waiting rooms, and billing offices; and,

WHEREAS, no reporting hospital, except San Francisco General Hospital, has submitted copies of their charity care notices in English, Spanish and Chinese along with the locations where these notices are posted; and,

WHEREAS, correspondence was sent to the hospitals on October 31, 2003 requesting that by the date of this resolution hospitals submit copies of their charity care notices in English, Spanish and Chinese and the locations of their posting; and,

WHEREAS, under the Charity Care Ordinance, hospitals are required to report the residence zip codes of individuals who applied for charity care and were accepted and individuals who applied for charity care and were denied; and,

WHEREAS, no reporting hospital has been able to report information on the zip codes of patients who applied for but were denied charity care; and,

WHEREAS, hospitals are also required to submit copies of their charity care policies, though the Charity Care Ordinance does not set forth any requirements as to the contents of these policies; and,

WHEREAS, the hospitals’ charity care policies vary widely in terms of eligibility and process; and,

WHEREAS, not all hospitals’ charity care policies include an appeals process; and,

WHEREAS, the Charity Care Ordinance is local law; now, therefore, be it,

RESOLVED, that the San Francisco Health Commission directs each hospital to fully comply with its provisions; and, be it,

FURTHER RESOLVED, that, in particular, the San Francisco Health Commission requests that hospitals report accurate information on the number of denied applications for charity care, including the zip codes of patients whose charity care applications were denied; and, be it,

FURTHER RESOLVED, that the San Francisco Health Commission urges hospitals to include as part of their charity care policies an appeals process that specifies the steps that are taken both by the patient and internally within the hospital when a charity care applicant disputes a determination of ineligibility for charity care.

I hereby certify that the San Francisco Health Commission at its meeting of November 18, 2003 adopted the foregoing resolution.

Michele M. Olson, Executive Secretary to the Health Commission