ubufasha bw’amahera ku barwayi - saintalphonsus.org · b. serivisi zitemerewe ubufasha...
TRANSCRIPT
Trinity Health West Region FAP (02/2018)
Ubufasha bw’Amahera ku Barwayi
Trinity Health – Intara y’Iburengerazuba
ITARIKI IZOKURIKIZWA: 01 Munyonyo 2016
INTEGO:
Trinity Health ni umuryango w’abantu bakorana mu rwego rw’Ivugabutumwa,
bafise akagongwe kandi bifuza ko hoba impinduka igaragara mu miryango yacu.
Dushingiye ku Ndangagaciro zacu z’ibanze, by’umwihariko indangagaciro yo
Kwiyemeza Gufasha Abakene, tuvuza abatishoboye kandi twita by’umwihariko ku
bantu batagira kivurira. Muri aba hakaba harimo abadashobora kwirihira kimwe
n’abafise ubushobozi buke cane, butuma badashobora kuriha amahera yo
kwivuza. Trinity Health yiyemeje kubafasha:
• Guha serivisi nziza cyane abo tuvura kandi tubafitiye akagongwe, tubaha
agaciro n’icubahiro cabo, by’umwihariko abakene n’abatagira kivurira mu
miryango y’iwacu;
• Gufata neza abantu bose, tutitaye ku bushobozi bwabo bwo kuriha izo
serivisi; no
• Gufasha abarwayi badashobora kuriha igice canke amahera yose yakwa iyo
bivuje.
Trinity Health yubaha ubuziranenge n’icubahiro ca buri muntu, yubahiriza
amategeko ya Leta Zunze ubumwe agenga uburenganzira bw’ikiremwa
muntu, kandi nta vangura ibagirira rishingiye ku byiciro bifise uburinzi,
harimo ariko ritagarukira gusa ku bwoko, irangi, igihugu c’amavuko,
ubukure, ubumuga, canke igitsina. Ubufasha bwa gusa na serivisi zihabwa
abamugaye ziraboneka kimwe na serivisi zo gusemura za gusa, ku bantu
bavuga ururimi rwakavukire rutari Icongereza. (Reba Umugereka A.)
INGENE:
Ingene Abarwayi baronka Ubufasha bw’Amahera vyarateganyijwe kugira
bakemure ikibazo c’ubufasha bw’amahera abarwayi boba bafise, mu gihe
bariko bararondera serivisi mu Ishirahamwe ry’Intara y’Amagara ya Trinity
Health. Ibi byubahirizwa kuri serivisi zose zemewe, nkuko biteganyijwe mu
itegeko rikoreshwa muri Leta imwe canke muri Leta Zunze Ubumwe. Mu
Trinity Health West Region FAP (02/2018)
gihe co kwemererwa ubufasha bw’amahera n’inkunga, hazorabwa ikibazo
ca buri muntu, hubahirijwe ingene bikorwa kandi isuzumwa rizokorwa
hitawe ku buvuzi bukenewe n’umurwayi canke n’umuryango wiwe, ku
bushobozi bw’amahera n’ibindi basabwa.
I. Ibigenderwaho Byemewe kugira uzoronke Ubufasha bw’Amahera
a. Serivisi zemerewe Ubufasha bw’Amahera:
I. Serivisi zose zikenewe mu gukumira, kugenzura, gusuzuma canke kuvura
uburwayi runaka, hatitawe gusa ku murwayi canke ku muganga.
Ubufasha bw’Amahera buhabwa Abarwayi mu Ntara y’Iburengerazuba ya Trinity Health (11/2016) Paji ya 1
II. Serivisi zakira indembe zo kwa muganga zizoshikirizwa abarwayi bose
bazogana igisata cakira indembe c’Ishirahamwe ry’Intara y’Amagara,
hatitawe ku bushobozi bwo kuriha bw’umurwayi.
b. Serivisi zitemerewe Ubufasha bw’Amahera:
I. Serivisi zerekeye ibintu byo kwisiga, kuvura ubugumba n’ubundi buryo
bukoreshwa na serivisi zidakenewe mu gusana amagara.
II. Serivisi zidatangwa kandi zitarihwa n’Ishirahamwe ry’Intara y’Amagara
(akarorero. Serivisi z’abaganga bikorera, harimo serivisi z’abaganga bita ku
ndembe, abaforomo bikorera, imodoka zitwara abarwayi, ubucuruzi
bw’ibikoresho byo kwa muganga, serivisi zo gukodesha abagore batwitira
abanda ku mahera, kuraba icishe umurwayi, aho bakorera ibizami
by’uburwayi, n’ibindi.).
III. Amavuriro asanzwe avura abarwayi (RHMs) ashobora kutemera kuvura
umurwayi ufise ubwishingizi bwo mu kindi gisara umuryango wa Trinity
Health RHMs utarimo, nyuma yo gushira imbaraga nyinshi mu guhugura
abarwayi ku mbibe z’aho ubwishingizi bugarukira, nimba ibisabwa
n’Itegeko rya Leta Zunze Ubumwe rigenga Ubuvuzi bw’Indembe
n’Umurimo vyemewe.
Trinity Health West Region FAP (02/2018)
IV. Medicaid, Medi-Cal canke izindi za gahunda za leta zigira uruhare mu
kwishyurira abarwayi amahera abarwayi bavuriwe zifatwa nk’igice kininiya
c’izo Gahunda za Leta. Ubufasha bw’Amahera ntibukoreshwa
m’wisaranganwa y’inyishu.
c. Kurondera Ubufasha bw’Amahera
• Amashirahamwe ashobora kurondera Ubufasha bw’Amahera bw’Abarwayi,
butangwa nk’igice cyo kwinkira no gusohoka mu bitaro, kimwe n’ibisata
bitanga serivisi zivura indembe, ibiro vyakira abarwayi, ibiro by’umuhanuzi
mu vy’amahera n’ibiro bakoreramo fagitire mu bigo bitandukanye.
Impapura nazo zizoboneka mu rurimi rw’ibanze rukoreshwa
n’abanyagihugu bo muri iyo Ntara barenga 5% y’abatuye muri iyo Ntara,
canke barenga abantu 1,000 bafashwa n’Ishirahamwe ry’Intara
y’Amagara(RHM).
• Inyandiko zirondera ubufasha mushobora kuzitora ku rubuga rwa interineti
rw’Ishirahamwe ry’Intara y’Amagara(RHM) canke mu iposita mubisavye
igisata kijejwe kwakira abakiriya c’Ishirahamwe ry’Intara y’Amagara, ni
mworaba ku rubuga rwa interineti.
• Abahanuzi mu vy’amahera bari muri buri Shirahamwe ry’Intara y’Amagara,
kimwe n’abaserukiye Serivisi ijejwe kwakira abakiriya bazobafasha kuzuza
Impapura nimwobavugisha kuri terefone. Ubufasha bwo gusemura indimi
burahari ku barwayi baburondera.
• Amashirahamwe y’Intara z’Amagara(RHM) azotanga urutonde rw’abaganga
bikorera, inteko z’abakora uwo mwuga canke izindi serivisi zifasha indembe
canke zitanga ubuvuzi bukenewe muri ico kigo, bakoresha izina ryaco mu
gukora amasezerano n’ibitaro canke gukora fagitire z’abarwayi zerekeye
gusana amagara baronse. Ku rundi ruhande, ibitaro bishobora kugaragaza
abasana amagara muri buri gisata canke hakurikijwe ubwoko bwa serivisi
nimba ibimaze kuvugwa bishobora kugaragaza neza serivisi n’abazitanga
bemererwa kuronka ubufasha bw’amahera mw’Ishirahamwe ry’Intara
y’Amagara. (Raba Umugereka B.)
• Amashirahamwe y’Intara z’Amagara(RHM) azofata ingamba zo
kumenyesha abanyagihugu baronka ubufasha bw’Ishirahamwe ry’Intara
y’Amagara, bwerekeye Ubufasha bw’Amahera ku Barwayi. Izo ngamba
zirimo, akarorero, gushikiriza Impapura zisobanurira mu magambo make
Ubufasha bw’Amahera ku Barwayi, amashirahamwe ya Leta
n’amashirahamwe adaharanira inyungu, akemura ibibazo vy’amagara
vy’abanyagihugu bari mu ciciro co hasi gihembwa amahera make cane.
• Amashirahamwe y’Intara z’Amagara azoshikiriza abarwayi itangazo
Trinity Health West Region FAP (02/2018)
ryanditse ribamenyesha ko hari ubufasha bw’amahera ku barwayi
batoranijwe, azoshira kandi ahagaragara, Ibikorwa Bidasanzwe vyo
Gukusanya ubufasha (ECA)
Ubufasha bw’Amahera buhabwa Abarwayi mu Ntara y’Iburengerazuba ya Trinity Health (11/2016) Paji 2
• Ishirahamwe ry’Intara y’Amagara (canke urundi ruhande rubifitiye
ububasha), rutekereza gutangura kugira hazoboneke inyishu yo gusana
amagara, kandi ruzogaragaza itariki ntarengwa, kugira nyuma yayo ECA
izobashe gutangura ariko bitari mbere y’iminsi 30, nyuma y’itariki izoba
yatangiweho itangazo ryanditse. Amashirahamwe y’Intara z’Amagara
(RHMs) azoshiramo incamake mu rurimi rukoreshwa na FAP n’itangazo
ryanditse kandi azogerageza no kumenyesha abarwayi mu majambo,
Ubufasha bw’Amahera ku Barwayi (FAP) bw’Ishirahamwe ry’Intara
y’Amagara (RHM) n’ingene umurwayi ashobora kuzoronka ubufasha
abisavye akoresheje Impapura za FAP.
• Mu gihe basubitse canke banse gutanga ubufasha, canke bagusavye kuriha
ubuvuzi bukenewe, bitewe n’umuntu utarariha imwe canke fagitire nyinshi
kuberra ubuvuzi yakorewe mbere, bugomba kuzorihwa na RHM's FAP,
Ishirahamwe ry’Intara y’Amagara (RHM) rizomenyesha uwo muntu
ivyerekeye FAP yaryo mu minsi itari munsi ya 30 mbere yo gutanguza ECA.
Yamara, kugira ashobore kurihirwa, umuyoboke wa RHM agomba kuba
yujuje ibintu vyinshi bisabwa bikurikira:
Guha umurwayi urupapura rurondera Ubufasha bw’Amahera ku Barwayi (FAP)
(kugira bimenyekane ko umurwayi azoshobore kurondera ubwo bufasha ako
kanya, nimba ari ngombwa). Umurwayi agomba kumenyeshwa mu icete ko hari
ubufasha bw’amahera ku bantu batoranijwe kimwe n’itariki ntarengwa, bitagenze
gutyo, ibitaro ntibizokwakira no gusubiza icete rirondera ubufasha bwa FAP,
ryorungitswe n’umurwayi. ryerekeye ugusana amagara yaronse kuvugwa. Igihe
ntarengwa ntikigomba kuzoja munsi y’iminsi 30 nyuma y’itariki icete
ryorungitsweho, canke iminsi 240 nyuma y’itariki yaronkeyeho fagitire ya mbere,
yerekeye ugusana amagara yahawe, amaze gusezererwa mu bitaro. Kubera izo
mvo, nubwo uruhara rwa ECA mu gusubika canke kumwankira ubuvuzi bishobora
kuzomubaho ako kanya nyuma y’itangazo riri mw’icete (no mu majambo),
umurwayi agomba guhabwa byibuze iminsi 30 nyuma y’itangazo ryo kurungika
icete risaba Ubufasha bw’Amahera ku Barwayi, bwerekeye ugusana amagara
yaronse mbere.
Kumenyesha umurwayi ivyerekeye FAP mu ncamake iri mu rurimi rukoreshwa na
Trinity Health West Region FAP (02/2018)
FAP no kumenyesha mu majambo ivyerekeye inyubako z’ibitaro vya FAP n’ingene
umurwayi ashobora kuronka ubufasha arungitse icete ribusaba muri FAP.
Gusuzuma ningoga icete rirondera ubufasha, kugira bamenye neza ko ubuvuzi
bukenewe butozogira ikibukereza nta mvo mu gihe hari icete risaba ubufasha
ryarungitswe.
Imihati ishoboka yavuguruwe yavuzwe hejuru ntabwo ikenewe mu ngero
zikurikira:
• Iyo hashize iminsi 150 kuva aho fagitire ya mbere y’ubuvuzi buherutse
ikorewe, nyuma yo gusezererwa n’ibitaro na RHM ikaba yari
yaramenyesheje umurwayi ivyerekeye ECA.
• Iyo RHM yamaze kugena nimba umurwayi yari yemerewe ubufasha bwa
FAP, bwerekeye gusana amagara yoba yaronse mbere, bushingiye ku icete
risaba ubufasha bwa FAP canke yatekereje kugaragaza ko umurwayi yoba
yaratoranijwe kuronka ubufasha bwa FAP ku buvuzi waronse mbere.
Amacete yujujwe neza arondera ubufasha, n’inyandiko ziyaherekeza kugira
bagaragaze ingene umuryango ungana n’amahera umuryango uronka, bigomba
gusubizwa muri RHM canke kurungikwa mw’iposita kuri aderesi iri ku icete mu
gihe ntarengwa. Iyo icete risaba ubufasha riheze kuzuzwa rirakirwa, kurisuzuma
no kugena amahera aronderwa bishobora gutwara iminsi igera kuri 30.
d. Inyandiko Zerekana Amahera Yinjira
Ubufasha bw’Amahera buhabwa Abarwayi mu Ntara y’Iburengerazuba ya Trinity Health (11/2016) Paji3
i. Amakuru atangwa n’umurwayi muri RHM na/canke umuryango agomba
kugaragaza n’amahera yinjiye, harimo ibihembofatizo, umushahara
n’amahera yinjizwa n’umuntu wikorera; amahera adakomoka ku gihembo
harimo amahera yo gufasha uwo mwatandukanye, amahera y’ikiruhuko
cy’izabukuru, amahera akomoka ku migabane, inyungu n’amahera
akomoka ahandi hantu (akagero., impapura zihesha indya); imigabane ku
isoko ry’amahera, harimo konti zo kwizigamira na konti zidakorwaho mu
gihe runaka, hatabariwemo gahunda z’ikiruhuko cy’izabukuru canke
gahunda zo kurihwa nyuma, zemewe mu Itegeko rigenga Umusoro
w’imbere mu Gihugu, canke gahunda zitemewe zo kurihwa nyuma, zireba
abo utunze iwawe; igitigiri c’abantu utunze iwawe n’andi makuru
Trinity Health West Region FAP (02/2018)
aronderwa ku icete risaba ubufasha FAP. Ibihumbi $10,000 by’imigabane
ku isoko ry’amahera ntabarwa igihe cyo kugena abemerewe, na 50%
y’imigabane ku isoko ry’amahera arenga ku bihumbi $10,000 vya mbere
ntazobarwa mu kugena abazokwemerewa.
ii. Impapura nka lisiti baronkeraho igihembo, imenyekanisha ry’ikori,
imenyekanisha ry’inyungu n’igihombo n’Impapura za banki zizoronderwa
kugira zihinyuze amakuru yatanzwe kandi zizobikwa hamwe n’urupapura
rusaba ubufasha rwujujwe n’ico baruvuzeko. Amashirahamwe y’Intara
z’Amagara (RHMs) ntashobora kwanka ubufasha bw’amahera, kubera
kwibagira amakuru canke inyandiko zitosabwe mu buryo bweruye na FAP,
canke mu rupapura rwa FAP rwariko rurondera ubufasha.
iii. RHMs zizoha abarwayi, barungitse urupapura rwa FAP rusaba ubufasha
rutujujwe neza, itangazo ryanditse risigura andi makuru na /canke
inyandiko igomba kuzotangwa mu minsi 30 itangura kuva ku itariki
y’itangazo mu nyandiko, rimenyesha ko urupapura rwa FAP rugomba
kujuzwa. Iryo tangazo rizomenyekanisha amakuru ku muntu ujejwe ibibazo
biraba amakuru aburaho. RHMs zishobora gutanguza ECA nimba umurwayi
atotanze amakuru abura na/canke inyandiko zironderwa mu gihe c’iminsi
30, ikurikira itariki yo kongera kubirungika, kandi ugereranije iminsi mike ni
150 utanguriye ku itariki RHM yatangiyeho fagitire ya mbere nyuma yo
gusezererwa mu bitaro. RHMs zigomba gusuzuma urupapura rurondera
ubufasha rwa FAP nimba umurwayi yoba yaratanze amakuru
yaburaga/canke inyandiko zikenewe mu gihe co kurondera ubufasha
c’iminsi 240 (canke, bitinze, kongera kubirungika mu gihe c’iminsi 30).
e. Ubufasha bushoboka
RHMs ziremeza ko atari abarwayi bose bashobora gutanga amakuru yuzuye ku
mahera. Nuko, Trinity Health ishobora gukoresha amahera y’abaterankunga
kugira ifashe kumenya imyirondoro y’abarwayi badafise ubushobozi bwo kuriha
serivisi zo gusana amagara. Nimba ico cemezo gifashwe kizobikwa nk’ “Ubufasha
bushoboka”.
I. Icitegererezo co guteganya ibizoba ni bumwe mu buryo buciriritse
buzokoreshwa na RHMs kugira bamenye imyirondoro y’abarwayi
bazoshobora kwemererwa ubufasha bw’amahera, mbere yo gutanguza
ibikorwa vyo guhitamo, akagero., gufuta ideni umurwayi adashobora kuriha
no kurirungika mu kigo cishuza amadeni. Ici citegererezo co guteganya
Trinity Health West Region FAP (02/2018)
ibizoba gishoboza Trinity Health RHMs kumenya gushira muri gahunda
abarwayi bafise ibibazo bikomeye vy’amahera.
II. Raba ibigereranyo vy’ivyitegererezo vyo guteganya ibizoba:
o Abarwayi bapfuye badafise ubutunzi buzwi
o Abarwayi b’inzererezi
o Serivisi zo gusana amagara zikenewe zidafise ubwishingizi, zihabwa
abarwayi bemerewe kuronka ubufasha bwa gahunda za Leta
(akarorero., serivisi zitari iz’indembe zihabwa abarwayi bafise gusa
ubwishingizi bw’indembe)
o Abarwayi baronka magingo aya ubufasha bwa Leta (akarorero.,
impapura zibahesha indya ku buntu)
Ubufasha bw’Amahera buhabwa Abarwayi mu Ntara y’Iburengerazuba ya Trinity Health (11/2016) Paji 4
o Ibihombo vy’abarwayi
o Abagize imiryango y’amadini bakoze indahiro y’ubukene kandi
badafise ubutunzi bwite canke buri mw’idini ryabo.
III. Ku barwayi badafise ibisabwa na gahunda yo kurondera ubufasha muri FAP,
nimba hari aho andi makuru yova, azoshobora gukoreshwa kugira hakorwe
isuzuma ry’amahera buri murwayi arondera. Aya makuru azofasha RHM
gufata icemezo gisobanutse ku mahera aronderwa n’umurwayi batagira ico
bitaho.
IV. Kugira bafashe abarwayi bafise ibibazo vy’amahera, undi muntu wo hanze
ashobora gusabwa kugenzura amakuru y’umurwayi kugira amenye
amahera akenewe, mbere yo kuyarungika mu kigo cishyuza canke gufuta
mu gitabo c’abafise amadeni bananiwe kuriha. Iri suzuma rikoresha serivisi
zo gusana amagarazemewe, icitegererezo co guteganya gishingiye ku
makuru ari mu bubiko bwa Leta. Aya makuru ari mu bubiko bwa Leta
afasha RHM gusuzuma nimba umurwayi afise ibimenyetso by’abandi
barwayi, bemerewe kuva kera ubufasha bw’amahera, bari muri gahunda
isanzwe yo kurondera ubufasha. Mu gihe amakuru yatanzwe n’umurwayi
adaciye ku bandi bantu yabuze, na nyuma yo gukora aho bwabaga ngo
bemeze ko ashobora kuvuzwa bikananirana, icitegererezo co guteganya
gitanga uburyo buri kuri gahunda yo kwemerera abarwayi kuronka
by’agateganyo amahera bakeneye.
Trinity Health West Region FAP (02/2018)
V. Nimba umurwayi atujuje ibisabwa mu citegererezo co guteganya, ashobora
kurungika ibisobanuro mu gihe coteganyijwe akaba yokwemererwa muri
gahunda yo kurondera ubufasha bw’amahera isanzwe.
VI. Abarwayi bazomenyeshwa ko bemerewe ubufasha bariko barondera.
Abarwayi bazoronka amahera ari munsi y’ubufasha bw’urukundo
bazoshobora kujurira mu minsi 30 bakimara kubimenyeshwa. Kugena
umurwayi wemerewe amahera ari munsi y’ubufasha bw’urukundo,
bishingiye ku miterere y’ubufasha bushoboka canke ku buryo vyakozwe
mbere, kugira yemererwe Ubufasha bw’Amahera ku Barwayi (FAP). Naho
ubundi, RHMs zishobora gutangiza canke kongera gutangura Ibikorwa
Bidasanzwe vyo Gukusanya ubufasha (ECA), nimba umurwayi adashobora
kurondera ubufasha butandukanye bw’urukundo mu gihe c’iminsi 30
abimenyeshejwe, nibura hashize iminsi 150 uhereye ku itariki RHM
yatangiye fagitire ya mbere yo gusezererwa mu bitaro. Amashirahamwe
y’Intara z’Amagara (RHMs) zizasesengura urupapura rushasha rurondera
Ubufasha bw’Amahera ku Barwayi (FAP) rurungikwa n’umurwayi mu gihe
kitarenze iminsi 240 yo kurondera ubufasha canke, byoba bitinze,
ntibirenze iminsi 30 yagenewe kurondera ubundi bufasha bw’amahera
bw’urukundo.
f. Ingengabihe yo gutegura Kwemererwa Ubufasha bw’Amahera -Igihe co
Gusaba
I. Ni ngombwa gukora aho bwabaga kugira batangaze umurwayi wemerewe
ubufasha bw’amahera mbere canke igihe co kwakirwa canke co guhabwa
serivisi. Igihe co kurondera ubufasha gitangura ku munsi wo gutangura
kuvurwa kikarangira bitarenze iminsi 240, nyuma yo gukora fagitire ya
mbere yahawe umurwayi asezerewe mu bitaro canke mu buryo bukurikira:
• Guhera kw’igihe umurwayi yemerewe amahera ari munsi y’ubufasha
bw’urukundo buhari, hashingiwe kumiterere y’ubufasha bushoboka
canke mbere y’icemezo co kwemererwa Ubufasha bw’Amahera ku
Barwayi (FAP), kandi ni ngombwa ko uwo murwayi yoba yarasavye
ubundi bufasha bw’amahera bw’urukundo butandukanye; canke
• Nyuma y’igihe ntarengwa cotanzwe mu nyandiko Ibikorwa
Bidasanzwe vyo Gukusanya ubufasha (ECA) bishobora gutangura.
Trinity Health West Region FAP (02/2018)
Ubufasha bw’Amahera buhabwa Abarwayi mu Ntara y’Iburengerazuba ya Trinity Health (11/2016) Paji 5
Kurondera Ubufasha bw’Amahera buhabwa Abarwayi (FAP) buzokwakirwa
igihe cose cemewe. Kuronka ubufasha bw’amahera, bishingiye ku itangwa
ry’icete ryujujwe neza, bizotangura gukorwa ku makonti yotangajwe mu
gihe ntarengwa co kurondera Ubufasha bw’Amahera ku Barwayi (FAP), no
mu gihe c’amezi 6 akurikira itariki yo gushira ikori ku icete rirondera
Ubufasha bw’Amahera ku Barwayi (FAP). Kuronka ubufasha bw’amahera,
bishingiye ku miterere y’ubufasha bushoboka, bigarukira ku makonti
yagaragajwe igihe co kurondera ubufasha kandi ku matariki yo gukora
kw’amakonti yagenzuwe gusa, nimba nta cete ryoba ryarakiriwe. Ibitaro
birashobora gusaba icemezo cofashwe co kubagwa na /canke kongera
kugenzura ibisabwa igihe ico ari co cose. RHMs zishobora kwemera no
gusesengura icete rya buri muntu rirondera Ubufasha bw’Amahera ku
Barwayi (FAP) ryarungitswe mu gihe kitari ico gusaba ubufasha, rimwe
rimwe nkuko vyemewe n’ivyiciro vyashizweho na RHM. Amakonti
arashobora kurungikwa mu kigo cishuza ibirarane kugira babanze
gusesengurwa mbere y’uko igihe co kurondera ubufasha gihera.
II. RHMs (canke urundi ruhande rubifitiye ububasha) zishobora gusubiza
umurwayi amahera yarishe arenga kuyo yagomba kuriha ku gusana
amagara yaronse, yari yemejwe ko ari yo agomba kuriha nk’umurwayi
wemerewe Ubufasha bw’Amahera ku Barwayi (FAP), keretse nimba uwo
mubare urenga uri munsi y’amadolari 5 (canke munsi y’undi mubare
watangajwe canke wagaragajwe n’andi mabwiriza yasohotse mu
Gitangazamakuru co mu gisata kiraba Ikori ry’Imbere mu Gihugu).
Gusubizwa amahera yarishe bikorwa gusa ku buvuzi yarose, bwemerewe
gusaba Ubufasha bw’Amahera ku Barwayi (FAP).
III. Kugena ubufasha bw’amahera bizokorwa nyuma yo gukora ibishoboka
vyose kugira umurwayi ashobore kuzuza ibisabwa na Leta vyose ngo aronke
ubufasha bw’amahera canke izindi gahunda zoba zorageragejwe zose
biranka. Kubahiriza uburyo bugamije guhabwa ubufasha na gahunda ya
Leta bishobora gusabwa umurwayi kugira yemererwe kuronka ubufasha
bw’amahera. Nta murwayi uzokwangirwa ubufasha nakora ibishoboka
vyose kugira aronke ubwishingizi bw’amagara ku bikorera canke muri Leta.
IV. RHMs zizokora ibishoboka vyose kugira bagene ubufasha bw’amahera mu
gihe gikwiye. Nimba hari izindi nzira z’ubufasha zirimo zironderwa, RHM
izomenyesha umurwayi ivyerekeye ingene n’igihe giteganijwemo igenwa
Trinity Health West Region FAP (02/2018)
ry’ubufasha kandi ntizizogerageza gukusanya ubufasha iryo genwa
ritarashirwa mu bikorwa.
V. Iyo ibisabwa kwemererwa ubufasha vyagenwe, gusuzuma ko umurwayi
akomeje kwemererwa serivisi zikurikiraho, bizokorwa nyuma y’igihe
giciriritse nkuko biteganijwe na RHM.
g. Igipimo c’Ubufasha bw’Amahera
i. Buri RHM izakurikiza amabwiriza ku mahera yinjira ateganijwe hepfo kugira
hagenwe nimba umurwayi yemerewe ubufasha. Amabwiriza ku Ijanisha
ry’Igipimo c’Ubukene muri Leta Zunze Ubumwe (FPL), avugururwa buri
mwaka, akoreshwa mu igenwa ry’ivyo umurwayi asabwa kuba yujuje. (Raba
Umugereka C.) Ariko hari n’ibindi bintu byo kuzirikana, nk’imiterere y’imari
y’umurwayi na /canke ubushobozi bwo kuriha nkuko vyagenwe mu
isuzuma ry’inzira bikorwamo.
ii. Amahera yijira mu Muryango angana canke ari munsi ya 200% y’Igipimo
c’Ubukene c’Amabwiriza ya Leta Zunze Ubumwe:
Ubufasha bw’Amahera buhabwa Abarwayi mu Ntara y’Iburengerazuba ya Trinity Health (FAP) (11/2016) Paji 6
• Kugabanyirizwa 100% ku mahera yose umurwayi yari ashigaje
kwishyura, bizakorerwa abarwayi bari mu muryango winjiza amahera
angana canke ari munsi ya 200% y’ Igipimo giheruka c’Ubukene muri
Leta Zunze Ubumwe (FPL).
iii. Amahera yinjira mu muryango ari hagati ya 201% na 400% y’ Igipimo
c’Ubukene muri Leta Zunze Ubumwe:
• Kugabanyirizwa amahera ku kiguzi cose kingana n’ikiri mu
masezerano yo kwivuza ya RHM kuri Medicare (Amahera yose
akorerwa fagitire muri rusange “AGB”) bizokorerwa abarwayi bo mu
miryango yinjiza hagati ya 201% na 400% y’igipimo c’ubukene (FPL).
(Raba Umgereka C.)
• Ku barwayi baturuka muri California, abaganga bavura indembe
bagabanyiriza ikiguzi abarwayi badafise ubwiteganye canke abarwayi
bagomba kuriha amahera yo kwivuza menshi cane rwose binjiza
amahera Atari hejuru ya 350% y’igipimo c’ubukene (FPL).
• Abarwayi binjiza amahera ari munsi ya 350% y’igipimo c’ubukene
Trinity Health West Region FAP (02/2018)
(FPL) kandi basohora mu mwaka amahera ari hejuru ya 10% y’ayo
binjiza mu mwaka, bazoronka ubufasha bw’inyongera buzagenwa
hakurikije ibiteganijwe mu nyandiko za RHM na /canke umurwayi
yerekanye amahera yose yarishe yivuza mu gihe c’amezi 12.
• Imibare y’amahera yaringanijwe ku gipimo co hagati c’amasezerano
ya RHM n’ayo Medicare ikorera fagitire (AGB), azoharurwa
hakoreshejwe uburyo bwo kuraba inyuma ingene boharuye
igiteranyo c’amahera yasabwaga kurihwa, ugabanyije ayo bakoreye
fagitire yose kurihwa na System Office canke RHM buri mwaka,
hifashishijwe amezi 12 yarishywe mu gihe c’iminsi 30 y’ubukererwe,
uhereye ku itariki ya raporo kugeza ku itariki ya vuba cane yo
gusezererwa mu bitaro. (Raba Umgereka C.)
• Ku barwayi baturuka muri California, nimba igice ca konti ari
Ubufasha bw’urukundo ikindi gice akaba ari inguzanyo, iyo nguzanyo
ntizakwaho inyungu. Ku barwayi baturuka muri California, bujuje
ivyangombwa bisabwa, muri urwo rwego amasezerano yo kuriha
akaba adashobora kugerwaho igihe c’imishikirano, hazemezwa
gahunda yo kuriha buri kwezi amahera atari hejuru ya 10% y’ayo
umuryango w’umurwayi winjiza buri kwezi, havanywemo "amahera
akenewe kugura ibibatunga buri munsi". Amahera yo kugura
ibibatunga buri munsi ni ubukode canke arihwa ku nzu (harimo
ay’imirimo yo gusana inzu), gusuma indya n’ibindi bikenewe mu
rugo, amashanyarazi, amazi, gazi na terefone, impuzu, ubufasha
bw’umwana n’uwo bashakanye, amahera y’ingendo n’akoreshwa ku
muduga (harimo ubwiteganye, ibitoro no gusanasana), kuriha mu
byiciro, kumesura n’isuku, n’andi mahera arihwa bindi bikorwa
bidasanzwe.
iv. Ubufasha bwo kuvuza abatishoboye / Ibiza: Ubufasha bw’Amahera nabwo
buraboneka ku barwayi batishoboye bakeneye kuvurwa. Kutagira
ubushobozi bwo kwivuza bigaragara iyo umuntu adafise ubushobozi bwo
kuriha imwe canke fagitire zose zo kwa muganga kubera amahera
aronderwako yo gusana amagaraari hejuru y’igipimo c’ijanisha c’amahera
yinjizwa n’umuryango wabo canke ingo zabo (akarorero, bitewe n’ibiguzi
bikomoka ku vyago canke ku mvo zavyo), baba bafise canke badafise
ubutunzi bwinjira bushobora ndetse kuba buri hejuru y’ibisabwa
kwemererwa ubufasha bw’amahera ya gusa canke kugabanyirizwa ikiguzi
Trinity Health West Region FAP (02/2018)
c’ugusana amagara ku bufasha bw’Amahera ku Barwayi (FAP) bwa RHM.
Ibiguzi bikomoka ku vyago canke ku mvo zavyo bigaragazwa nuko habaye
gusezererwa ku kazi, urupfu rw’umuntu winjizaga amahera, amahera
arenze ubushobozi yo kwivuza canke iyo habaye ibindi vyago. Kuvura
abatishoboye /imvo z’ivyago bizokwigwa barora ikibazo ca buri muntu
harimo no gusuzuma igihembo c’umurwayi n’amahera akoresha.
Ubufasha bw’Amahera buhabwa Abarwayi mu Ntara y’Iburengerazuba ya Trinity Health (FAP) (11/2016) Paji 7
and expenses. Iyo umurwayi udafise ubwiteganye agaragaje ivyago yagize
kandi agakaba arondera ubufasha bw’amahera, ikiguzi c’ugusana amagara
mu bihe bitameze neza vyo kwivuza kiri hejuru ya 20% z’amahera yinjira
kizotuma amahera ntarengwa arihwa n’ubwiteganye bw’umurwayi,
adatangwaho ikori, n’andi arihwa n’ubufatanye bw’ibisata bitanga
ubwiteganye bizofasha umurwayi kwemererwa kuvurwa ku buntu
nk’umuntu wagize ivyago. Kugabanyiriza amahera yo kwivuza abarwayi
batishoboye badafise ubwiteganye ntashobora kuja munsi y’igitigiri kiri
hagati na hagati coteganyijwe mu masezerano ya RHM n’ayo Medicare
ikorera fagitire (AGB) kuri serivisi zotanzwe canke munsi y’igitigiri
kigabanya amahera umurwayi ariha yagize ivyago bituma yivuza kugeza ku
kigero ca 20% c’amahera yinjiza. (Raba Umgereka C.)
v. Nubwo ubufasha bw’amahera bugomba gutangwa, hubahirijwe ibisabwa
na RHM vyashyizweho mu nyandiko, biremewe ko rimwe na rimwe
hazakenerwa gutanga ubufasha bw’inyongera ku barwayi, hashingiwe ku
cubahiro ca buri muntu. Ico cubahiro kizoja cemezwa n’Umuyobozi Mukuru
w’Ubufasha (CFO) muri RHM kandi bimenyeshwe Umuyobozi Mukuru
w’Ibiro vy’ico Gisata.
II. Guha Ubufasha Abarwayi Bashobora Kwemererwa Ubwiteganye
a. Za RHM zigomba kugira ubwitange bwo gufasha abarwayi kurondera za
gahunda za Leta n’iz’abikorera zemera ko bujuje ibisabwa no kubafasha
kuronka no kuriha serivisi zo gusana amagara. Ubufasha bwo kuriha
amahera y’ubwiteganye bushobora kandi gutangwa mu ibanga nkuko
bikorwa iyo bariha "amahera ya QHP n’Amadeni y’Abarwayi" muri Trinity
Health. Abarwayi bo muri California bazorungikwa mu bigo vyaho bifasha
abarondera ugusana amagara, bikorera muri za biro vya ba avoka kugira
bibafashe kuzuza impapura zirondera ubufasha.
Trinity Health West Region FAP (02/2018)
b. Za RHM zizoteganya uburyo bworoshe kandi mu nyandiko bwo gufasha
abarwayi kumenya nimba bemerewe gahunda z’ubufasha bwa Leta canke
Ubufasha bw’Amahera ku Barwayi (FAP) bwa RHM.
III. Gushira mu bikorwa Politike Nyakuri kandi zidahindagurika
a. Abaserukira Serivisi zitanga ubufasha bw’Amahera ku Barwayi za RHM
n’ibisata bihura n’abarwayi bazokwigisha abakozi bakorana n’abarwayi buri
munsi (harimo abandika abarwayi n’ababaha ibitaro, ibiro bitanga ubufasha
bw’amahera, ibiro vyakira abarwayi, ibiro bikora fagitire bikanishuza
ibirarane, ibiro vya muganga) ivyerekeye gukora fagitire, ubufasha
bw’amahera, politike zo kugaruza ibirarane n’uko bikorwa, kuvurana
impuhwe abarwayi bose, agaciro n’icubahiro, ntakuraba ubwiteganye
n’ubushobozi bwabo bwo kuriha ugusana amagara bahabwa.
b. Za RHM zizokubahiriza amasezerano y’ubufasha bw’amahera yemejwe mu
mabwiriza aheruka. Nyuma y’uko kwemererwa ubufasha, umurwayi
ashobora kongera kugenzurwa kugira aronke ubufasha bw’amahera
hakoreshejwe amabwiriza yoshizeko muri iyi gahunda.
IV. Ubundi Bwasisi
a. Ubwasisi ku gihembo c’umurwayi wikorera: za RHM zizotanga ubwasisi
busanzwe butari itegeko ku mahera azwi abarwayi bikoresha bihemba
kandi batujuje ibisabwa kugira baronke ubufasha bw’amahera (akarorero,
hejuru ya 400% ya FPL) bushingiye ku gipimo co hejuru gitangwa mu
bucuruzi. (Raba Umgereka C.)
b. Ubwasisi bw’Inyongera: Kuzamura ibipimo vy’ijanisha vy’ubwasisi
buvugwa muri iyi gahunda bishobora gukorwa kuri dosiye hashingiwe ku
isesengura ry’imyaka n’uburyo bwo kugaruza amahera kuri konti kandi
bikemezwa n’inzego zifata ivyemezo za RHM.
Ubufasha bw’Amahera buhabwa Abarwayi mu Ntara y’Iburengerazuba ya Trinity Health (FAP) (11/2016) Paji 8
IMBIBI/AHO BIZUBAHIRIZWA
Iyi gahunda izokubahirizwa muri za RHM zose za Trinity Health zikorera mu bitaro
vvyemewe bidatanga ikori. Amashirahamwe ya Trinity Health adakorera mu
bitaro vyemewe bidatanga ikori, ashobora gushiraho uburyo bwayo bwo gutanga
ubufasha bw’amahera mu zindi serivisi zo gusana amagarabatanga kandi
Trinity Health West Region FAP (02/2018)
boshishikarizwa kubahiriza amabwiriza yashizweho muri gahunda y’ubu Bufasha
bw’Amahera ku Barwayi (FAP) nk’inama.
Nimba imwe mu ngingo z’ubu Bufasha bw’Amahera ku Barwayi (FAP) inyuranya
n’ibisabwa n’itegeko rya Leta RHM ya Trinity Health ikoreramo, itegeko ry’iyo Leta
risosimbura ingingo ifise ikibazo kandi RHM izokubahiriza itegeko rikurikizwa muri
iyo Leta.
INSOBANURO:
Igihe ntarengwa co kurondera ubufasha – Ico gihe gitangura ku munsi yaronseko
ubuvuzi kandi ntikirenza iminsi 240 nyuma y’uko umurwayi azoba yakorewe kandi
agahabwa fagitire ya mbere, akimara gusezererwa mu bitaro canke kimwe muri
ibi bikurikira:
i. Mu mpera z’igihe c’iminsi 30 kigenerwa abarwayi bemerewe kuronka
ubufasha bw’urukundo buri munsi y’ubuhari, hashingiwe ku miterere
y’ubufasha bushoboka canke mbere yo kwemerwa Ubufasha bw’Amahera
ku Barwayi (FAP) kugira bashobore kurondera ubufasha bw’urukundo
burushijeko.
ii. Itariki ntarengwa izotangazwa mu nyandiko hanyuma hazotangura Ibikorwa
Bidasanzwe vyo Gukusanya ubufasha (ECA)
Amahera akorerwa fagitire muri rusange ("AGB") - Amahera yose akorerwa
fagitire muri rusange “AGB”, yerekeye gutabara indembe canke ubundi buvuzi
bwa ngombwa buhabwa abarwayi bafise ubwiteganye bwo kuzoriha ubwo
buvuzi. Amahera yose ya muganga kandi afise ishingiro akorerwa fagitire muri
rusange “AGB” muri RHM, azoharurwa hakoreshejwe uburyo bwo kuraba ku
vyakozwe mbere, kugira haharurwe igiteranyo c’amahera Medicare yasavye
kurihwa, ugabanyije igiteranyo canke amahera "adakurwaho ikori" asabwa na
System Office canke RHM buri mwaka habarwa amahera yarishwe mu mezi 12
y’igihe c’iminsi 30 utanguriye ku itariki raporo yatanzweho kugeza ku itariki ya
vuba cane gose yo gusezerera umurwayi mu bitaro. Ibi bizoja bihinduka buri
mwaka.
Ubwasisi bwo Gusana Amagara – Kugabanyirizwa igice c’amahera ku giteranyo
cirihwa n’abarwayi bemerewe ubufasha bw’Amahera muri gahunda ya FAP.
Umurwayi wujuje Ibisabwa – Umurwayi wujuje ibisabwa kugira yemererwe
ubufasha bivugwa muri izi ngamba, yoba adafise (1) ubwiteganye; (2) yoba
aronka ubwiteganye muri gahunda za Leta (akarorero., Medicare, Medicaid,
Trinity Health West Region FAP (02/2018)
canke inkunga y’ubwiteganye bwo gusana amagara igurwa binyuze mu kugurana
amakuru ku magara), canke (3) umurwayi udafise ubwiteganye buriha amahera
ntarengwa, adatangwaho ikori, n’andi arihwa n’ubufatanye bw’ibisata bitanga
ubwiteganye.
Indembe – Serivisi z’ubuvuzi ni izikenewe mu gihe ubuzima bugeraniwe canke
gukomereka bikomeye cane kandi bisaba kuvurwa vyihuse. Iyi mimerere
y’uburwayi igengwa muri rusange n’Itegeko riraba Ubuvuzi bw’Indembe no
Kuramukwa (EMTALA).
Ibikorwa Bidasanzwe vyo Gukusanya ubufasha ("ECA") - Ibikorwa vyo
Gukusanya ubufasha vyotangujwe na RHM (canke ikigo kibafasha kugaruza
ibirarane) harimo n’ibi bikorwa:
• Gukereza canke guhakana, canke kuriha mbere yo gutanga ubuvuzi
bukenewe kubera umurwayi atorishe imwe canke za fagitire z’ubuvuzi
yohawe, burihwa n’ Ubufasha bw’Amahera ku Barwayi (FAP) bw’ibitaro.
Nimba RHM isaba umurwayi kuriha mbere yo kuvurwa fagitire imwe canke
nyinshi, uko gusabwa kuriha kuzofatwa nk’imvo y’umurwayi yo kutariha
fagitire y’ibirarane, Ubufasha bw’Amahera buhabwa Abarwayi mu Ntara y’Iburengerazuba ya Trinity Health (FAP) (11/2016) Paji 9
• Keretse RHM ishoboye kugaragaza ko umurwayi yasabwe kuriha bitewe
n’imvo zitandukanye, kandi hatitawe, kuri fagitire ze za kera atorishe.
• Kumenyekanisha amadeni mu kigo kijejwe inguzanyo.
• Gutanga ikirego muri sentare kugira haronke intahe (akagero. Gufatira
ibihembo, kugenzura ufise ideni).
• Kugwatiriza imitungo y’abantu.
Umuryango (nkuko usobanurwa n’ibiro vy’ibarura vya Leta Zunze Ubumwe za
Amerika) – ni itsinda ry’abantu babiri canke benshi babana kandi bafise isano
y’amaraso, ubukwe, canke kurerwa. Nimba umuryayi yemeza ko hari umuntu
atunze iwe mw’imenyekanisha ry’ikori ku gihembo, hubahirijwe amategeko
agenga Ikori ryo mu Gihugu Imbere, ashobora gufatwa nk’uwo ashinzwe
gutunga, kugira bashobore kugena nimba yemerewe Ubufasha bw’Amahera
ku Barwayi (FAP) bwa RHM.
Amahera yinjira mu muryango – Amahera yinjizwa n’umuryango w’umuntu,
harimo n’ayinjizwa n’abagize umuryangon bose bakuru (abafise isano
y’amaraso, ubukwe, canke kurerwa). Ku barwayi bafise munsi y’imyaka 18
y’ubukure, amahera yinjira mu muryango agizwe n’ay’abavyeyi na /canke
abavyeyi b’umufasha we, canke amahera yinjizwa buri mwaka n’abagize
umuryango w’umukozi wo mu rugo mbere y’igihe c’amezi 12 canke umwaka
Trinity Health West Region FAP (02/2018)
umwe ubanziriza uw’ikori, nkuko bigaragazwa n’impapura za vuba z’ibihembo
canke imenyekanisha ry’ikori n’andi makuru. Gihamya y’ubutunzi bwinjiye
ishobora kugaragazwa no kuringaniza amahera umuryango winjije mu mwaka
kugeza ubu, bifashishije igipimo ca vuba c’amahera yinjiye canke
hagakoreshwa imenyekanisha ry’ikori ry’umwaka ushize. Amabwiriza ku
Amabwiriza ya Leta Zunze Ubumwe ku byerekeye Ubukene (“FPG”) -
Amabwiriza ashiraho inzego z’amahera yinjizwa buri mwaka n’abakene nkuko
yagenwe n’Igisata c’Amagara n’Imibereho ca Leta Zunze Ubumwe z’Amerika.
Aya mabwiriza avugururwa buri mwaka mu gitabo ca Leta Zunz Ubumwe.
Ubufasha bw’Amahera – Inkunga (urukundo, ubwasisi, n’ibindi.) bihabwa
abarwayi badashobora kuriha ikiguzi cose c’ubuvuzi bukenewe, butangwa na
Trinity Health kandi bujuje ibisabwa kugira baronke ubwo bufasha
bw’amahera, kandi boba barahetuye serivisi zose zo kubarihira zoba iza Leta
canke z’abikorera.
Ingamba z’Ubufasha bw’Amahera ("ubufasha bw’Amahera ku Barwayi
(FAP)") – Ingamba n’Uburyo biri mu Nyandiko byujuje ibisabwa, bivugwa muri
§1.501(r)-4(b). Ingamba z’Ubufasha bw’Amahera ("ubufasha bw’Amahera ku
Barwayi (FAP) Urupapura rurondera ubufasha – Urupapura n’inyandiko
iruherekeje umurwayi arungika arondera ubufasha bw’amahera muri gahunda
RHM y’ubufasha bw’Amahera ku Barwayi (FAP). Za RHM zishobora kuronka
amakuru y’umurwayi mu nyandiko canke mu magambo (canke muri izo nzira
zombi).
Ubuhanuzi mu vy’Amahera – Uburyo bukoreshwa gufasha abarwayi kugira
bashakishe ubufasha bw’amahera butandukanye n’ubwiteganye bw’amagara
n’amahitamo y’ubwiteganye bw’amagara aboneka kugira harihwe serivisi
zitangwa na RHM ya Trinity Health. Mu barwayi bashobora kurondera
ubuhanuzi mu vy’amahera harimo, ariko batagarukiye gusa, kubadafise
ubwiteganye, abafise ubudahagije, n’abagaragaje ko nta bushobozi bafise bwo
kuriha ideni ryose ry’umurwayi.
Umuntu utahira inzu yo kubamo – Bisbanuye imiterere y’umuntu uba ahantu
hamwe canke ufise ikibazo co kuba ahantu havugwa hepfo:
• Ahantu hatagenewe gutura abantu, nko mu miduga, mu busitani bwa Leta,
mu miferege; canke
• Mu bwugamo bw’ubutabazi; canke
Trinity Health West Region FAP (02/2018)
Ubufasha bw’Amahera buhabwa Abarwayi mu Ntara y’Iburengerazuba ya Trinity Health (FAP) (11/2016) Paji 10
• Mu macumbi y’agateganyo canke yo gufasha abantu b’inzererezi bakuwe
mu mihanda canke mu bwugamo bw’ubutabazi; canke
• Hamwe muri aho havuzwe hejuru, ariko akahaba igihe gito (kugera ku minsi
30 ikurikiranye), mu bitaro canke mu kindi kigo.
Ubutunzi bwinjira - Ibihembo, imishahara, igihembo n’amahera yinjizwa
n’umuntu wikorera, inshumbushanyo y’ubushomeri, inshumbushanyo
y’umukozi, amahera y’ubwizigame, inkumga ya Leta, inshumbushanyo
y’abavuye mu ntwaramiheto, inkunga yo gusuma indya ku bavananye,
inshumbushanyo y’abacikacumu, ubwizigame, amahera y’izabukuru,
ubwiteganye busanzwe n’inyungu zabwo, amahera ava mu mitungo
yazunguwe no ku migabane mu masosiyete, ubukode bw’amazu, inyungu/ku
migabane, n’andi mahera akomoka ahandi hantu hatandukanye.
Ubuvuzi Bukenewe – Kuvurwa, ingene bikorwa na serivisi nkuko vyasobanuwe
kandi vyanditse muri buri Gitabo c’Umuntu utanga Serivisi za Medicaid yo muri
Leta RHM ikoreramo.
Ingamba – Amabwiriza ku cerekezo co mu rwego rwo hejuru, yerekeye ibibazo
vy’ingenzi ku ngamba za Trinity Health canke amabwiriza asobanura kurushako
inyandiko zigenga Trinity Health. Ingamba z’imikorere zishobora kuba zikukiye
canke ari icirore ca cashizweko n’ikigo gitanga impusha.
Incamake mu rurimi rwumvikana y’Ubufasha bw’Amahera ku Barwayi (FAP)-
Itangazo ryanditse rizomenyesha umurwayi ko ibitaro bitanga ubufasha
bw’amahera biciye muri gahunda yitwa Ubufasha bw’Amahera ku Barwayi
(FAP) kandi ritange n’amakuru y’inyongera mu rurimi rwumvikana,
rusobanutse, kandi rworoshye kumva:
• Incamake ku vyo asabwa kuzuza kugira atoranywe kandi aronke ubufasha
butangwa muri gahunda yitwa Ubufasha bw’Amahera ku Barwayi (FAP).
• Incamake ku ngene barondera ubufasha muri gahunda yitwa Ubufasha
bw’Amahera ku Barwayi (FAP).
• Aderesi y’urubuga rwacu rwa interineti (canke URL) n’aho umurwayi
ashobora kuza kurondera kopi n’impapura zirondera Ubufasha
bw’Amahera ku Barwayi (FAP) n’ Ubufasha bw’Amahera ku Barwayi (FAP).
• Amabwiriza ku ngene umurwayi ashobora kubona kopi ya gusa Ubufasha
bw’Amahera ku Barwayi (FAP) n’impapura zo kurondera Ubufasha
bw’Amahera ku Barwayi (FAP) akoresheje iposita.
• Amakuru kuri aderesi yacu, harimo nimero ya terefone n’aho tubarizwa, ku
biro by’ibitaro canke igisata gishobora kubaha amakuru yerekeye Ubufasha
Trinity Health West Region FAP (02/2018)
bw’Amahera ku Barwayi (FAP) kandi no kubafasha ingene buzuza impapura
zirondera Ubufasha bw’Amahera ku Barwayi (FAP).
• Itangazo rimenyesha ko hari ubusemuzi k’ Ubufasha bw’Amahera ku
Barwayi (FAP), bw’impapura zirondera Ubufasha bw’Amahera ku Barwayi
(FAP), n’incamake y’Ubufasha bw’Amahera ku Barwayi (FAP) mu zindi
ndimi, bibaye ngombwa.
• Itangazo rimenyesha ko umurwayi wujuje ibisabwa kugira aronke Ubufasha
bw’Amahera ku Barwayi (FAP), ntashobora kuriha amahera asumvye
Amahera yose Akorerwa Fagitire muri Rusange (“AGB”) ku ndembe canke
ku bundi buvuzi bukenewe.
Imikorere -inyandiko yateguwe kugira bashire mu bikorwa ingamba canke
incamake y’ibikorwa vyihariye bisabwa canke ingene bikorwa.
Ishirahamwe ry’Intara y’Amagara (RHM) – Ishami ryo mu rwego rwa mbere,
ishami canke igisata kijejwe ibikorwa vya Trinity Health, gifise umutwe ugenzura
buri munsi imicungire y’ibikorwa vy’igice bashinzwe ca Trinity Health System. Za
RHM zishobora kugira icyicaro mu gace karimo isoko canke kwitangira urutonde
rwa serivisi canke rw’ibikorwa vy’ubucuruzi.
Akarere gatangirwamo Serivisi – Urutonde rw’imibare iranga uturere harimo na
RHMs zikikije aho isoko ribarizwa, rigizwe n’ "umuryango w’ibikenewe" mu
gutanga serivisi z’ibanze z’amagara.
Ishami – Umuryango wemewe n’amategeko ugizwe na Trinity Health RHM
yonyine nk’umunyamuryango canke nk’umunyamigabane umwe wenyine.
Ubufasha bw’Amahera buhabwa Abarwayi mu Ntara y’Iburengerazuba ya Trinity Health (FAP) (11/2016) Paji 11
Ubwiteganye budahagije – Umurwayi, nubwo afise ubwishingire bwo gusana
amagara, akaba agomba kuriha amahera y’ubwiteganye, gusangira kuriha ikiguzi,
gusangira ubwiteganye, n’amahera adatangwaho ikori ni umuzigo w’amahera
utoroshe utuma akererwa canke atabona serivisi y’ubuvuzi ikenewe, kubera
kubura amahera yo kuriha ikiguzi.
Umurwayi dafise Ubwiteganye - Umurwayi udafise Ubwiteganye budahagije,
ntagire ubwiteganye bw’undi mudandaza w’ubwiteganye, nka gahunda
y’ubwiteganye ya ERISA, gahunda za Leta Zunze Ubumwe zo Gusana Amagara
(harimo ariko zitagarukiye gusa kuri Medicare, Medicaid, SCHIP, na CHAMPUS),
Worker’s Compensation, canke ubufasha bw’abandi baterankunga, bwo kuriha
Trinity Health West Region FAP (02/2018)
igice canke ikiguzi cose c’ubuvuzi, harimo gutera amahane n’abandi bantu bafise
ubwiteganye Trinity Health idafisemo uruhara, ariko gusa iyo kuriha biriko
birakorwa na sosiyete y’ubwiteganye.
Abatagira kivurira – ni abantu bafise amagara n’imibereho bifatwa nk’aho
byugarijwe n’akaga kurusha abanda banyagihugu muri rusange, bitewe
n’imiterere y’ibi bazo vyerekeye umuryango n’ubukungu, ingwara, ubwoko,
imyaka y’ubukure, canke ibindi bintu biteza ingaruka mbi.
ISHAKIRO: ronderwa
• Itegeko Rirengera Umurwayi n’Ubuvuzi Buhendutse: Icyiciro Gikurikizwa
501(r), Itegeko Rusange
• Ikigo gitoza Ikori imbere mu Gihugu, Amabwiriza ku Umugerka H (Ifishi 990)
• Ubushikiranganji bw’Imari, Ikigo gitoza Ikori imbere mu Gihugu,
Ibironderwa ku Mugereka w’Ibitaro vy’Abagiraneza; Itegeko rya Nyuma:
Umuzingo 79, No. 250, Umutwe II, 26 CFR, Umutwe 1
• Leta ya California AB774 (Igice 755, Amategeko yo muri 2006; na none
yitwa Hospital Fair Pricing Policies Law)
• Igitabo ca Leta Zunze Ubumwe kibitse amakuru n’Amabwiriza ku Ubukene
ya buri mwaka ya Leta Zunze Ubumwe
• Igitabo c’Amategeko IRS, 26 CFR Umutwe 1 na 53 na 1545-BL58
Ibironderwa ku Mugereka w’Ibitaro vy’Abagiraneza
• Ishirahamwe Gatolika ry’Amagara ryo muri Leta Zunze Ubumwe –
Amabwiriza ku Igenamigambi no Gutanga amakuru
Akamaro ku Muryango
KWEMERERWA Kwemererwa kwa Mbere: Ndamukiza 1, 2014
Vyavuguruwe: 8/6/2014 Vyavuguruwe 8/14/2014 Vyavuguruwe 3/13/2015
Vyavuguruwe 7/1/2016 Vyavuguruwe 11/1/2016
Ubufasha bw’Amahera buhabwa Abarwayi mu Ntara y’Iburengerazuba ya Trinity Health (FAP) (11/2016) Paji 12
Trinity Health West Region FAP (02/2018)
— Amakuru y’Ingenzi —
Saint Alphonsus Health System, Inc. yubaha ubuziranenge n’icubahiro ca buri
muntu, yubahiriza amategeko ya Leta Zunze ubumwe agenga uburenganzira
bw’ikiremwamuntu, kandi nta vangura igira rishingiye ku byiciro bifise uburinzi,
harimo ariko bitagarukira gusa ku bwoko, irangi, igihugu c’amamuko, ubukure,
ubumuga, canke igitsina
Saint Alphonsus Health System, Inc.:
• Itanga ubufasha na serivisi za gusa ku bantu ubumuga bwo kuyaga natwe neza,
akarorero:
▪ Abahinga mu gusemura ururimi rw’amarenga
▪ Amakuru yanditswe mu yindi miterere nk’inyuguti niniya
cane, amakuru yo kumviriza, amakuru y’ikoranabuhanga yoroshye
kugerwaho n’afise indi miterere
• Itanga serivisi z’ubusemuzi za gusa ku bantu bavuga ururimi rwakavukire rutari
icongereza, akagero: ▪ Abahinga mu gusemura indimi▪ Amakuru yanditse
mu zindi ndimi. Nimba ukeneye izi za serivisi, geregeza kuyaga n’Umuhuza
wa Serivisi z’Ishirahamwe ryacu kuri iyi terefone 1-866-727-6248.
Nimba utekereza ko Saint Alphonsus Health System, Inc. yirengagije ku guha izi
serivisi canke ikaba yaragukoreye ivangura mu bundi buryo rishingiye ku bwoko,
irangi, igihugu c’amamuko, ubukure, ubumuga, canke igitsina, ushobora gutanga
ikirego ubwawe, mu iposita, kuri fax canke ukoresheje imeli aha hantu:
• Umuhuza wa Serivisi zakira Abarwayi,1055 N Curtis Road, Boise, Idaho 83706
• Terefone: 208-367-6226 I Fagisi: 208-367-8181• Imeli: BO-
Trinity Health West Region FAP (02/2018)
Nimba ukeneye ubufasha bwo gutanga ikirego, Umuhuza wa Serivisi zakira
Abarwayi yiteguye kuguha ubufasha.
Urashobora kandi gutanga ikirego cerekeye uburenganzira bw’ikiremwa muntu
mu Bushikiranganji Bujejwe Amagara na Serivisi zihabwa Abantu bwa Leta Zunze
Ubumwe za Amerika, mu Biro bijejwe Uburenganzira bwa muntu, ukoresheje
imeli ku rubuga rwa interineti, iposita canke terefone kuri iyi aderesi:
• Ubushikiranganji Bujejwe Amagara na Serivisi zihabwa Abantu bwa Leta Zunze
Ubumwe za Amerika, 200 Independence Avenue, SW, Room 509F, HHH Building,
Washington, DC 20201
Trinity Health West Region FAP (02/2018)
EXHIBIT B-UMUGEREKA B
Urutonde rw’abatanga serivisi
Abaganga, abatanga serivisi n’andi matsinda
y’abanyamwuga badakorera Saint Alphonsus bazokora
fagitire zitandukanye kandi ntibarabwa na Gahunda
y’Ubufasha bw’Amahera butangwa n’ibitaro.
Abatanga Serivisi z’Imiduga Iheka Abarwayi
Abatabazi ba Canyon County
Abatabazi ba Ada County
Abatabara bakoresheje Indege
Abatabazi ba Treasure Valley
Abahinga mu gutera ikinya bakorera muri Idaho (Abahinga mu gutera ikinya)
Allen, Andrew Morgan, Paul States, Shawn
Black, Randall Page, Dennis Trainer, Kerri
Busch, Ned Rigby, Curtis Ragsdale, Lee
Crawford, Russell Stacy, Mark
Blue Mountain Pathology (Abahinga mu Gutohoza uburwayi)
Adams, Larry
Boise Anesthesia(Ikinya)
Scarbough, John Turner, Nicole
Anesthesiologists Cohen, Ross Packer, Stephen
Fowler, Matthew Poulson, Nate
Fox, Donald Reid, Steven
Grange, Daniel Stratton, Mike
Jacks, Shelley Anesthetist-Abatera ikinya Allen, Brian Gundersen, Grant Shippers, Jim
Anderson, Hannah Haymore, David Sibbett, Brady
Armayor, Marilyn Hoffman, Sarah Skidmore, Aaron
Bevan, Gary Ilgenfritz, Chris Skidmore, Tammy
Trinity Health West Region FAP (02/2018)
Bevan, Jared Lee, Darin Smith, Ben
Black, Terry Leuenhagen, Bryan Steenblik, Nate
Bootsma, Lisa Lowery, Janel Stevenson, Mark
Borders, Jeff Mansfield, Paul Stover, Joe
Burke, Lara Noe, Laurie Streeper, Amber
Coburn, Tyler Owens, Dennis Suida, Mike
Cohen, Clara Powell, Gus Varga, Jeff
Trinity Health West Region FAP (02/2018)
Curley, Brett Reid, Jessica Voorhies, Mike
Foss, Brad Romero, Joseph Weber, Gary
Gardner, Cody Sargeant, Robert Westerlund, Scott
Garrett, Michael Schnell, Cassie Wheeler, Bryce
Gibbons, Patricia Schrank, Michael White, Ryan
Goeddertz, John
Cancer Care of Idaho-Ubuvuzi bwa Kanseri bwo muri Idaho
CEP America (Emergency Department Physicians)
Physicians Angleton, Peter
Harris, Tyler
Quinn , Jason
Austin, Colby Huang, Po Reynolds, Brian
Binnion, D. Lee Judd, Matthew Reynolds, Charles
Boesiger, Brian Kim, David Riss, David
Burriesci, Mark Kitamura, Brian Saak, Kristen
Calder, Jonathan Korinek, Justin Southard, Andrew
Campbell, Matthew Kraska, Eric Stillwagon, Nathan
Conklin, Matthew Lee, Darin Thomas, Mark
Cornett, Benjamin Marshall , Shane Tobe, Christopher
Davis , Robert Miller, Jonathan Wasielewski, Jessica
Elliott, Eric Morris, C. Luke Wilding, Brandon
Epperson, John Nelson, Andrew Wyatt, Christopher
Gibson, John Olsen, Molly Hammerstedt, Heather Peterson , Kari
Assistants Heaton, Rhoda
Maus, Eric
Orloff, Michael
Jimenez, Elisha Nelson, David Sherwood, Charles
Lesso, Jennifer O'Connor, Jared Tate, Nancy
Diagnostic Pathology Services (Pathology)
Davis, Brian Kronz, Joseph Cowley, David
Grant, Nicholas
ER McKesson (Emergency Department Physicians)- Abaganga bo mu Gisata c’Indembe
Family Medicine Residency of Idaho
Third Year Resident Physician
Abul-Husn, Nina
Beal, Matthew
Doyle, Catherine
Henkle, Sarah
Twomey, Michael
Wauters, Michael
Carlson, Chelsea Ingersoll, Jenna Webster, Laurisa
Cooperrider, Jaclyn Mertz-Hack, Tara Welle, Julia
Davies, Danielle Orme, Lindsay Wertzler, Kelsey
Trinity Health West Region FAP (02/2018)
Defrees, Dean
Second Year Resident Physician
Pinsky, Maia
Atnip, Elizabeth Herron, Kacy McCormick, Molly
Colsen, Loren Holland, Benjamin Morelli, Margaret-Mary
Crouch, Robert Knudsen, Emily Redden, Kaleb
Dauten, Amanda Krahn, Janae Schweitzer, Andrew
Galligar, Billy
First Year Resident Physician
Bartels, Josef
Mather, Luke
Hofstetter, Annamarie
Smith, Jacob
Waterman, Sarah
Bartoletti, Louis Luftig, Daniel Weiss, Zachary
Brandenburg, William Roop, Melissa Wilson, Zechariah
Cook, Marion Sandmann, Megan Yordon, Minnie
Henderson, Jared
Hippe, Scott
Shippen, Justin
Stockton, Benjamin
Gem State Radiology (Radiologists)
Cegnar, Janet M
Christianson, Kimball L
Goodman, Cyle S
Hom, Benjamin K
Peck, Dallas
Salber, Jason
Chugg, Jaren A Jackson, John Scales, Lisa M
Coffman, Carolyn Kaufman, Christopher R Schaff, Howard B
Coulam, Curtis Knochel, John Seabourn, Jeffrey
Davey, Ian C Mcgonegle, Shane J Smith, Loreli
Davey, Neil Modica, Michael J Sobota, Caroline
Garabedian, Vicken Moore, Matt T Stemmler, Bertram J
Giauque, Anthony Morgan, Laurel Taylor, William
Gobel, R Joseph Papenfuss, Mark R Wegner, Daniel J
Hanger, Inc. (Durable Medical Equipment)-
Intermountain Imaging (MRIs)
Cegnar, Janet M
Christianson, Kimball L
Goodman, Cyle S
Hom, Benjamin K
Peck, Dallas
Salber, Jason
Chugg, Jaren A Jackson, John Scales, Lisa M
Coffman, Carolyn Kaufman, Christopher R Schaff, Howard B
Coulam, Curtis Knochel, John Seabourn, Jeffrey
Davey, Ian C Mcgonegle, Shane J Smith, Loreli
Davey, Neil Modica, Michael J Sobota, Caroline
Garabedian, Vicken Moore, Matt T Stemmler, Bertram J
Giauque, Anthony Morgan, Laurel Taylor, William
Gobel, R Joseph Papenfuss, Mark R Wegner, Daniel J
Trinity Health West Region FAP (02/2018)
Practice Management, Inc. (Pathologists)
Saint Alphonsus Pathology (Pathologists)
Chaffin, Jack Johnson, Cary Kois, Nancy
Hager, Christopher Kim, Edward Moore, Mark
Sound Inpatient Physicians (Hospitalist Services)
Treasure Valley Anesthesia (Anesthesiologists)
Treasure Valley Surgeons
Bruce, Pamela Spokas, Frank
Providers/Provider Groups with Hospital Privileges-Abaganga bakorana n’ibitaro
A To Z Family Care Gem Family Practice Portneuf Primary Care
Ada Pediatrics Genesis Medical Center Primary Health Eagle
Adams County Health Center Gillette, Austin C Primary Health Meridian
Advanced Family Medical Glenns Ferry Health C Savage, Cheri K
Advanced Women's Speciality Care Gombert, Sheryl Seasons Medical
Affinity Primary Care Haynes, Joan Shanks, Lorna Jean
All Seasons Healthcare With Heart St. Luke's Clinics Anderson, Robert H Healthwest, Fam Med Cl St. Luke's Family Medicine Aspen Dental Care Inc Hill, Douglas St. Luke's Internal Medicine
Associates In Family Practice Indian Creek Family Med St. Luke's TV Pediatrics Behavioral Health Integrated, Hcprimaryhealth St Luke's Physician Group
Black Canyon Family Intermountain Pediatriac Snyder, Tracie Denice
Blackfoot Medical Clinic Intermountain Medical Clinic Sonshine Family Health
Boise Heart Clinic Internal Medicine Specialists Southwick, Boyd K
Boise Surgical Group Iron Eagle Family Medicine Spine Institute Of Idaho
Brizzee Family Medicine Jenkins, Janeen Spring Creek Women's Health
Buhl Medical Center Jerome Family Clinic Spritzer, David M
Burke, Louis Andrew Keystone Healthcare PCP St Benedicts Family Clinic
Caldwell Immediate Care Khanal, Yogesh Raj St Marys Craigmont, Clinic
Capital City Family Medicine Kolb, Peter Southwest District Health
Cascade Medical Clinic Kuna Family Medical Clinic Sweeten, Harley Neil
Cascade, Family Practice Levenson, Darcie L Talford, David B
Cherry Ln Family Clinic Mack, Charisse Lee Terry Reilly Health Services
Clearwater Valley Clinic Malheur Memorial Clinic The Clinic at Eagle
Clemens, Alison McCall Medical Clinic The Clinic at Parma
Cottonwood Family Medical Mckie, Robert The Clinic at Wilder
Couer d'Alene Pediatrics Meridian Family Medicine Health The Clinic at Middleton
Council Mountain Medical Clinic Meridian Family Medical The Neighborhood Clinic
Crosspointe Primary Care Meridian Saltzer Medical The Pediatric Center
Trinity Health West Region FAP (02/2018)
Crossroads Primary Health Meridian Saltzer Peds The Smith Clinic
Davis Family Medicine Micron Health Clinic The Women's Clinic
Deaver, Joseph Daniel Miller, Nancy N Treasure Valley Women's Clinic
Desert Sage, Health Ctr Mores Creek Family Medicine Treasure Valley Family Practice
Digestive Health Clinic Moscow Family Medicine Treasure Valley Pediatrics
Duffy, Kathleen Mountain Home AFB Trinity Mtn Clinic
Eagle Creek Family Medicine Mountain States Medical Group Trinity Family Med Primary Care
Eagle Family Medicine Mountain View Family Medicine Two Rivers Med Clinic
Eagle Pediatrics Mountain View Medical Group Unity Health Center
Elgin Family Health Clinic Nelson, Sarah Dee Valley Family Healthcare
Elks Internal Medicine New Plymouth Clinic, Wvmg Valley Family Health
Emmett Medical Center North End Children's Health Clinic Valley Medical Center
Express Lab Northview Medical Clinic Veterans Affairs
Family Medicine OB-Gyn Associates Welliness Ctr Fam Med
Family Health Services OB Hospitalist Group West Boise Family Med
Family Medical Center OB/Gyn Associates West Valley Medical Group
Family Medical Health Center Orthopedics Associate West Valley Medical Center
Family Medicine Health Center Overland Family Medicine West Valley Clinic
Family Medical Healthcare Owyhee Medical Ctr West, Brandon
Fifth Ave Surgery Clinic Park Center Family Medicine Willes, Jeremy
Fmh Family Medicine Health Pediatrics and Adolescent Medicine Williams, Michelle
Fortuin, Brian W Physicians Primary Care Willis, Park Weed
Friendship Clinic Pioneer Family Medicine Women's Health Associates
Garden City Comm Clinic Pocatello Child Clinic Woods, Jodie Beth
Garden Valley Family Med Pocatello Clinic of Internal Medicine
Trinity Health West Region FAP (02/2018)
EXHIBIT C-UMUGEREKA C
Trinity Health West Region
Federal Poverty Level (FPL) & Charity Adjustment Guidelines- Igipimo c’Ubukene ca
Leta Zunze Ubumwe n’Amabwiriza Yo Kuringaniza Imiryango y’Abagiraneza
100% 200% 201% 400%
Persons in Family/Household
Income Income to: Income to: Income to:
1 $12,140 $24,280 $24,401 $48,560
2 $16,460 $32,920 $33,085 $65,840
3 $20,780 $41,560 $41,768 $83,120
4 $25,100 $50,200 $50,451 $100,400
5 $29,420 $58,840 $59,134 $117,680
6 $33,740 $67,480 $67,817 $134,960
7 $38,060 $76,120 $76,501 $152,240
8 $42,380 $84,760 $85,184 $169,520
For families/households with more than 8 persons, add $4,320 for
each additional person
Charity Adjustment Uninsured Discount
Saint Alphonsus - BAKER CITY
100%
100% 49% 49% 10%
Saint Alphonsus - BOISE
100%
100% 72% 72% 10%
Saint Alphonsus - NAMPA
100%
100% 73% 73% 10%
Saint Alphonsus - ONTARIO
100%
100% 68% 68% 10%
Saint Agnes - FRESNO
100%
100% 78% 78% 20%
*Source: Federal Register and the Annual Federal Poverty Level (FPL) Guidelines
Average Medicare Contractual Adjustment Amounts (Amounts Generally Billed or AGB)
Inpatient Outpatient Total Facility
RHM FY17 FY16 FY17 FY16 FY17 FY16
Baker City 24.6% 30.7% 24.6% 30.7% 48.9% 48.9%% Boise 71.9% 70.2% 71.3% 69.7% 71.7% 70.0%
Nampa 70.5% 68.9% 76.2% 76.4% 73.0% 72.1%
Ontario 62.0% 61.4% 74.0% 74.1% 68.1% 68.6%
Fresno 76.5% 76.4% 83.1% 82.7% 78.4% 78.3%
Trinity Health West Region FAP (02/2018)
Ibyitonderwa : Ibisobanuro by’ibyanditse haruguru
Hanger, Inc. (Durable Medical Equipment)= Ibikoresho vyo kwa Muganga bigumye
Pathologists=Serivisi zo Gutohoza Uburwayi (Gutohoza Uburwayi)
Anesthesiologists=Abahanga mu gutera Ikinya
Physicians=Umuganga.
Assistant=Umufasha
Emergency Department Physicians=Abaganga bo mu Gisata c’Indembe
Radiologists=Abahinga bacisha abarwayi mu cuma
Second Year Resident Physician=muganga w’ikigo
ugilozimo imyaka ibiri
Surgeons=Abaganga babaga
Imaging(MRIs)= Gukoresha Sikaneri MRI, n’ibindi byuma
bifata amafoto mu Gutohoza uburwayiPersons in
Family/Household- Abantu bagize
Umuryango/Nyir’urugo
Income=Ubutunzi bwinjira
Income to:=Ubutunzi bwinjira kugera ku.
For families/households with more than 8 persons, add $4,160 for each additional person= Ku miryango/ba nyir’urugo batunze abantu barenga 8, ongeraho $4,160 kuri buri muntu urengaho
Charity Adjustment- Kugerereranya ubufasha.
Uninsured Discount= Ubwasisi Budafise Ubwiteganye
*Source: Federal Register and the Annual Federal Poverty Level (FPL) Guidelines= Inkomoko: Igitabo ca Leta Zunze Ubumwe n’Amabwiriza ya Buri Mwaka ya Leta Zunze Ubumwe ku Bukene.
Average Medicare Contractual Adjustment Amounts (Amounts Generally Billed or AGB)=Ikigereranyo kiri hagati
na hagati co Kuringaniza Imibare iri mu Masezerano y’Ubwiteganye bw’Amagara (Amahera yose Akorerwa
Fagitire muri Rusange canke AGB)
Trinity Health West Region FAP (02/2018)