HCAI Syfphr

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Policy Effective Date (Date Posted):

Download: Policy File

Download: Application File

General Information

Hospital:

OJAI VALLEY COMMUNITY HOSPITAL

1306 MARICOPA HIGHWAY
OJAI, CA 93023
http://www.cmhhospital.org

License:

General Acute Care Hospital
Total Beds: 25
Emergency Room: Yes
more... Link to Atlas

Contact:

Terry Ellis
(805) 652-5036

OSHPD ID:

106560501

Fair Pricing Policy Information Show FPL Chart

Policy Effective Date:

6/28/2022

Download:

Federal Poverty Level for Free Care:

200%

Discount Payment Effective Date:

6/28/2022

Discount Payments

FPL Range: 201%-300%
Payment Basis:
Other: lesser of 25% of charges or Medicare IP DRG

FPL Range: 301%-500%
Payment Basis:
Other: lesser of 40% of charges or Medicare IP DRG

FPL Range: 0%-0%
Payment Basis:

Other Discount Payment Information:

Application Form Information

Application Form Eff Date:

6/29/2022

Download:

Income Type Used:

Salary Received
Interest Received
Pension Received
Other: Property Income, Alimony, Unemployment

Language Information

Available Languages:

English
Spanish

Additional Information

Family Size	100%	150%	200%	250%	300%	350%	400%