The Missouri Hospital Association Board of Trustees has adopted the following principles to guide the development of hospital charity care policies by which all Missouri's hospitals have been asked to comply.

• Missouri's hospitals will offer financial assistance and counseling for uninsured people of limited means, without regard to race, ethnicity, gender, religion or national origin.

• Financial assistance provided by Missouri's hospitals to uninsured people of limited means should in no way substitute for state efforts to provide or expand coverage to the uninsured.

• Missouri hospitals should have policies to provide essential health care services at no charge to uninsured patients below an established income level that is appropriate to the hospital's geographic location. Essential health care services are defined by each hospital to meet the needs of its patients.

• Missouri hospitals will provide financial assistance to all other low-income, uninsured patients who do not fall into the above category. For these patients, hospitals may choose to charge on a sliding scale.

• The provision of financial assistance by Missouri's hospitals is contingent upon the cooperation of a patient in providing the information necessary for a hospital to qualify that patient for its programs of assistance or for public or other coverage or assistance that may be available. Patients receiving financial assistance from hospitals shall have a responsibility to pay according to the terms of that policy.

• Cosmetic surgery and other nonmedically necessary services are exempt.

• Missouri's hospitals will make information about a hospital's financial assistance policy easily available to the public.

• Missouri hospitals that use outside debt collection organizations will obtain written assurances that the organization complies with the Fair Debt Collection Practices Act and the Association of Credit and Collection Professional's Code of Ethics and Professional Responsibility.

• Missouri hospitals will have written policies as to when and under whose authority a patient account is advanced for collection. If a patient has completed a hospital's application for financial assistance, that account should not be advanced for collection pending determination of eligibility.

Missouri hospitals will have written policies as to when and under whose authority a lien can be placed on a patient's primary residence.