Ubufasha bw’Amahera ku Barwayi - saintalphonsus.org · b. Serivisi zitemerewe Ubufasha bw’Amahera: I. Serivisi zerekeye ibintu byo kwisiga, ... RHMs zizoha abarwayi, barungitse

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


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.


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


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


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


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


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)


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.


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.



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


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


(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


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.


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.


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.


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


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,


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


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



• 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


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.


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


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



— 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-

[email protected]


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


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


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


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


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


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


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


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%


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)


Documents

Ubufasha bw’Amahera ku Barwayi - saintalphonsus.org · b. Serivisi zitemerewe Ubufasha bw’Amahera: I. Serivisi zerekeye ibintu byo kwisiga, ... RHMs zizoha abarwayi, barungitse