4A (Expenses $ 75651361 including grants of $ 0) (Revenue $ 51020403)
Montefiore Mount Vernon Hospital is a 176 bed, community-based teaching hospital that has been serving the medical needs of the community since its inception. Montefiore Mount Vernon provides inpatient, critical care and ambulatory services to residents of lower Westchester County. The hospital is part of Montefiore Health System, the University hospital for the Albert Einstein College of Medicine. Montefiore MOUNT VERNON HOSPITAL BEGAN OPERATIONS ON NOVEMBER 6, 2013 as part of the Montefiore Health System. MONTEFIORE MOUNT VERNON'S MISSION IS TO HEAL, TO TEACH, TO DISCOVER AND TO ADVANCE THE HEALTH OF THE COMMUNITIES IT SERVES. To this mission, the health system brings a unique synergy of strengths and resources that has helped define healthcare delivery in the area and have earned Mount Vernon the distinction of being a designated New York stroke and HIV/aids Center. Mount Vernon hospital is also home to the Beale Chronic Wound treatment and hyperbaric center and the Montefiore School of Nursing. The hospital provides a range of diagnostic and therapeutic medical and surgical services in addition to specialty programs and services. It operates a family health and wellness center with more than 20 specialized ambulatory care clinics as well as an inpatient and outpatient behavioral health program offering psychiatric services. The hospital also operates a chronic wound treatment and hyperbaric medicine center that offers advance wound management as well as hyperbaric oxygen therapy helping to reduce the risk of amputation for individuals suffering from traumatic injuries. Montefiore Mount Vernon Hospital also operates a drug and alcohol addiction rehabilitation facility located in close proximity to their main campus committed to helping those addicted in getting the treatment that they need. The center offers personalized treatment program specifically designed for the patient including group counseling, 12-step programs, medically assisted detoxification, and individual counseling, among others, that can help to give our patients the confidence needed to successfully overcome their addiction to drugs or alcohol. During 2021, Montefiore Mount Vernon Hospital was again at the forefront of the fight against the resurgent waves of the COVID-19 virus that has continued relentlessly throughout 2021. Our Covid admissions grow as each new waves of the virus spread throughout the community causing immense suffering and volumes of deaths in its wake.

Schedule H, PART V, SECTION B, LINE 5
The process for preparing the 2019-2021 Community Health Needs Assessment was an inter-organizational and community collaborative process, initiated with the goal of developing an assessment that was reflective of the needs of the community including the clinical and social determinants of health. The 2019-2021 Community Health Needs Assessment involved a primary data collection strategy in conjunction with secondary data. Community input on health priorities in Westchester County was gathered through a community survey and an in-person summit with stakeholders. Multiple approaches to primary data collection were used to make use of existing and cost-efficient data collection activities and to employ multiple methods at gathering community input, so that no single group was over represented in the identification of community concerns. Montefiore Mount Vernon Hospital engaged with the Westchester County Department of Health's online Community Resident Survey in the winter and spring of 2019 to facilitate the implementation of the primary data collection process for the Community Health Needs Assessment for Westchester County and to assist in the facilitation of these community level connections thereby alleviating additional surveying overload. The community survey could be completed via a web-based tool (SurveyMonkey) or on paper. The paper surveys were available in English and Spanish and other languages by request. The primary distribution of the survey was conducted through the Westchester County Department of Health's Office of the Administrator and was made available through its website. The Montefiore Hudson Valley Collaborative also distributed the survey to its membership of over 900 hospitals, community based organizations, faith-based organizations and other social service providers. The survey was disseminated through multiple distribution points including other hospitals, health care providers, community-based organizations and others. A Community Health Survey of the Hudson Valley was created and administered by Siena College Research Institute on behalf of the CHA Collaborative. The survey was conducted in all seven counties in the region. Additionally, in March and April of 2019, Members of the Local Health Department Prevention Agenda collaborative conducted 10 focus groups with health and service providers to identify the most pressing barriers and issues facing the populations they serve. The Local Health Department Prevention Agenda collaborative designed the focus groups as a supplement to the Community Health Survey acknowledging that certain populations, mainly those who speak English as a second language, those experiencing homelessness, members of the LGBTQ community, and children may have been under represented in the original data collection process. In addition to collaborative input from the local Department of Health, Montefiore worked closely with it communities, organized partnership and collaborates, and other providers in lower Westchester as well as extensive work with representatives of the affected communities to help Montefiore to identify health care needs and determine the appropriate configuration of services. While the exact priorities identified through each of these approaches varied somewhat, there was a consistent placement of healthy eating and food security, and its related environmental factors of access to healthier food and the health consequences of chronic disease care and screening as the top community health priorities. Montefiore Mount Vernon meets regularly with the local Department of Health, and continues to participate in a MHVC DSRIP aligned Collaborative with membership from St. Joseph's Medical Center (including St. Vincent's Hospital - Westchester), St. John's Riverside Hospital, White Plains Hospital, and Burke Rehabilitation Hospital working to ensure that the Community Service Plan and DSRIP goals retain their alignment. As the CHNA process was conducted simultaneously with the New York State Community Service Plan (CSP) review, there is strong alignment between the areas of focus in this report and the areas presented in the CSP. Montefiore will continue to work with its partners on existing program initiatives in its mission of advancing healthcare to the communities that it serves. The Hospital has not received any written comments concerning it most recent conducted CHNA and implementation strategies.

Schedule H, Part V, Section B, Line 6A
Montefiore Mount Vernon Hospital's CHNA was conducted along with Montefiore New Rochelle Hospital. The reporting data between the two facilities are essentially the same, even though demographically distinct, due to the close proximity of each facility to the other, the high migration of patients between facilities and the sharing of employees. Both organizations are also members of the Montefiore Health System, the premier academic health system and the University Hospital for Albert Einstein College of Medicine, serving the 3.1 million people living in the New York City region and the Hudson Valley.

Schedule H, Part V, Section B, Line 7a
The CHNA report is available to the public on Montefiore's website: https://www.montefiore.org/documents/communityservices/MNR-MMV-Community-H ealth-Needs-Report-2019-2021.pdf

Schedule H, Part V, Section B, Line 10a
The hospital facility's most recently adopted implementation strategy is posted on the website: https://www.montefiore.org/documents/communityservices/MNR-MMV- Community-Health-Needs-Report-2019-2021.pdf

Schedule H, Part V, Section B, Line 11
In the Comprehensive Community Services plan developed for 2016-2018, the priority areas selected were Prevent Chronic Disease and Promote Healthy Women Infants and Children. Through the projects and activities initiated during that plan, Montefiore Mount Vernon was able to contribute to the overall trend improvements in those areas for New York State. However, although Westchester County has continued to be among the top five and has shown improvements along with the rest of New York State, the rates for conditions identified in the communities of Mount Vernon remains higher in most cases than the countywide and statewide averages. The Priority Areas that were selected in 2016 have been expanded upon to have greater alignment with the initiatives of the Delivery System Reform Incentive Payment Program (DSRIP). Montefiore Mount Vernon choose to continue its work on Maternal and Child Health with an emphasis on breastfeeding. Furthermore, Montefiore Mount Vernon will continue their participation with the Westchester County Department of Health's Community Service Plan Collaborative to coordinate their alignment with the County's other healthcare providers. Montefiore has elected to retain these two priority areas, Prevent Chronic Disease and Promote Healthy Women Infants and Children for the 2019-2021 plan. Montefiore Mount Vernon Hospital has also added a new priority area for this cycle: Prevent Communicable Disease with a focus on vaccine preventable disease, specifically HPV. The first Priority area selected was preventing chronic Disease with a specific focus on preventive Care and Management. This hospital is addressing this need by providing access to a range of preventive, maintenance and self-management programs for individuals across the pre-diabetes and diabetes spectrum with assistance from our partners in providing technical Assistance, opportunities for neighborhood based culture/linguistic specific classes and opportunities for data sharing and collaboration. Our goal is to increase early detection of cardiovascular disease, diabetes, pre-diabetes and obesity. The targeted community is mainly low-income individuals that includes a high proportion of Hispanic and non-Hispanic black. The second priory area selected was to promote healthy women, infants and children with a focus on perinatal and infant health. The hospital will address this need by engagement and referral into appropriate clinical or community programs to support mothers with breastfeeding. Our partners will also provide technical assistance and supportive community programming. Our goal is to increase the percentage of all infants who are exclusively breastfed in the hospital by 10% from 47.0% to 51.7%. The third and new priority area added for the 2019-2021 plan is to prevent communicable disease focusing on vaccine preventable diseases. We plan to support outreach efforts through education and advocacy of the importance of HPV vaccination with parents of children and adolescents age 9-13 and provide vaccinations with the goal of increasing the percentage of NYS 13-year-old adolescents with a complete HPV vaccine series by 10% to 37.4%. The targeted community is mainly low-income individuals including a large Hispanic or non-Hispanic black population. Despite each of the different methods and approaches to primary data collection in gathering community input, there was a consistent focus on obesity and related behaviors and outcomes among the main community health concerns. Obesity and its related behaviors have significant impact in chronic disease, therefore, it is intended that the programs that are detailed specifically for the reduction of obesity will also affect the prevalence of Diabetes, hypertension, asthma, cancer and cardiovascular disease in Westchester County. Montefiore has a vast portfolio of programs and services that address a majority of the significant community health needs identifies in the community health needs assessment. The breadth and depth of the programs and service vary, but each address a need identifies in the community. In particular, there are programs underway in collaboration with Hudson River Healthcare and Westchester local government units to work with bodegas on healthy snack displays and creating walking paths in parks and communities. In addition to the multiple resources that have been developed at Montefiore independently and through partnership with other organizations, there continues to be a need for community-based programs and resources that can augment Montefiore's programs and services. Montefiore continues to engage in cross-sector partnerships with government, community organizations, hospitals, and businesses to address the health and social needs of our patient population. Since the previous version of this report in 2016, Montefiore has begun using the internet database platform www.nowpow.com, to connect patients to needed resources, which has been a challenge for the health care sector. This online tool is a much more comprehensive and practical alternative to the homegrown referral guides that many health care providers have had to use in the past, which were difficult to search and keep-up-to-date, a problem that is largely addressed by the online version. Many Montefiore sites have been introduced to this new online resource and work is underway to more seamlessly integrate this kind of solution into the various workflows across the ambulatory, ED and inpatient setting. The use of an internet database will allow Montefiore to connect patients to important community resources provided outside of the health system by many of our community partners to address community needs such as housing (quality and affordability), transportation, employment, and education. As Montefiore is an organization that works with complex health needs and whose community faces multi-factorial crisis that impact overall health, we at Montefiore recognizes the importance of addressing the social determinants of health in order to advance the health of the communities that we serve.

Schedule H, Part V, Section B, Line 13H
Family size is factored into the eligibility criteria for financial assistance. Schedule H, Part V, Section B, Lines 15D & 15E The Medical Center has internal resources available for assistance with the FAP application process. The organization's FAP provides addresses, locations and phone numbers for offices within Montefiore to assist with completing applications. The financial aid and Medicaid staff at these locations are also certified application counselors that assist with market place and Medicaid applications.

Schedule H, Part V, Section B, Lines 16a-16c
The direct website where the FAP is publicized: http://www.montefiorehealthsystem.org/body.cfm?id=70

1. REQUIRED DESCRIPTIONS:
PART I, LINE 7: THE COST-TO-CHARGE RATIO METHODOLOGY WAS UTILIZED TO CALCULATE THE AMOUNT included IN THE TABLE. THE CALCULATION OF THIS RATIO WAS DERIVED FROM RATIO OF PATIENT CARE COSTS-TO-CHARGES. In calculating the patient care cost for the ratio, the organization reduced its operating expenses for its non-patient care costs and cost of its community benefits and building activities not relying on the RCC factor for costing purposes. In 2021, the organization received additional funding from the Cares Act Provider Relief Fund and FEMA for direct reimbursement of COVID-19 expenses. The organization further adjusted its patient care cost to exclude these expenses not adjusted in the prior year's cost to charge ratio calculation.

PART III, SECTION A, LINE 2:
THE COST OF BAD DEBT EXPENSE WAS ESTIMATED BASED ON THE CHARGES, APPLIED TO THE RATIO OF TOTAL PATIENT CARE EXPENSES TO TOTAL CHARGES FOR ALL services rendered. ANY PAYMENTS OR DISCOUNTS ARE EXCLUDED FROM BAD DEBT EXPENSE. PART III, SECTION A, LINE 3: THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE (AT COST) ATTRIBUTED TO PATIENTS under THE ORGANIZATION'S CHARITY CARE POLICY WAS BASED ON RESULTS OF predictive ANALYSIS. BAD DEBT SHOULD BE INCLUDED AS A COMMUNITY BENEFIT BECAUSE THE ORGANIZATION PROVIDES MUCH NEEDED HEALTH CARE SERVICES INDISCRIMINATELY TO THE COMMUNITY-AT-LARGE WITHOUT REGARD TO WHETHER OR NOT THE PATIENT HAS INSURANCE AND IF THE BILL WILL EVER BE PAID.

PART III, SECTION A, LINE 4:
"AS REPORTED IN MONTEFIORE HEALTH SYSTEM'S AUDITED CONSOLIDATED FINANCIAL statements, BAD DEBT EXPENSE IS DESCRIBED AS FOLLOWS: ""Subsequent changes to the estimate of the transaction price (determined on a portfolio basis when applicable) are generally recorded as adjustments to patient service revenue in the period of the change. For the years ended December 31, 2021 and 2020, changes in the Health System's estimates of expected payments for performance obligations satisfied in prior years were not significant. Portfolio collection estimates are updated based on collection trends. Subsequent changes that are determined to be the result of an adverse change in the patient's ability to pay (determined on a portfolio basis when applicable) are recorded as bad debt expense. Bad debt expense for the years ended December 31, 2021 and 2020 was not significant""."

PART III, SECTON B, LINE 8:
The MEDICARE REVENUE AND ALLOWABLE COSTS REPORTED IN PART III, SECTION B, were based on the allowable costs and Medicare reimbursements that were reported in the organization's 2021 Medicare Cost Report reduced for the Medicare subsidized services already reported in Part I, line 7G of Schedule H and direct graduate medical education reported in Part 1, line 7H. The Medicare ALLOWABLE COSTS WERE DERIVED using THE Medicare COST REPORT COST-FINDING METHODOLOGY, WHICH APPORTIONS ROUTINE costs TO MEDICARE USING DAYS and ANCILLARY COSTS TO MEDICARE USING departmental RATIOS OF COSTS TO charges. The following table represents a reconciliation of Medicare revenue and costs included on Lines 5, 6 and 7 in part III to the total actual Medicare revenue and costs of the hospital. REVENUE Allowable SURPLUS COSTS (SHORTFALL) Part 111, LINES 5-7: $5,856,164 $7,583,848 ($1,727,684) ADD: COSTS NOT INCLUDED IN MEDICARE COST REPORT: - 1,735,511 (1,735,511) ADD: MEDICARE DME: 117,472 535,768 (418,296) ADD: MED SUBSID HLTH SERV: 390,095 1,275,130 (885,035) MEDICARE Shortfall: $6,363,731 $11,130,257 (4,766,526) The Medicare Shortfall from Part III, Line 7 should be included as a community benefit, since the organization is rendering much needed health care services mainly to a frail elderly population living on a fixed income with great health needs.

PART III, SECTION C, LINE 9B:
FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE, ALL collection activity IS HALTED AND THE PATIENT IS REFERRED FOR FINANCIAL AID. IF AN account IS IN COLLECTION AND THE PATIENT REQUESTS FINANCIAL AID OR IF THE AGENCY DETERMINES THAT THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE, THE ACCOUNT IS REFERRED BACK TO THE HOSPITAL WHERE THE PATIENT IS PROVIDED ASSISTANCE WITH COMPLETING AN APPLICATION FOR ASSISTANCE. The organization also uses predictive analysis to assist in charity care determinations in the absence of completed financial aid applications. Financial screening/Presumption Charity uses financial information that is contained in a patient's credit report and other patient specific attributes to estimate a patient's income level and where they are in relation to the Federal Poverty Level to qualify under the Hospital's Charity Care Policy. Presumptive eligibility may also be based on prior FAP eligibility or enrollment in certain specified means-tested public programs to presumptively determine if an individual is FAP eligible. Full Financial aid is also granted to patients with outstanding self-pay bills and current Medicaid coverage and patients who are homeless. Ambulance reports can be a source of reference if it is documented in the report that the patient is undomiciled.

6. AFFILIATED HEALTH CARE SYSTEM:
MONTEFIORE MOUNT VERNON HOSPITAL IS AN AFFILIATE OF MONTEFIORE HEALTH System, Inc. The Health System is a leader in community and population health and has a long history of developing innovative approaches to care and tailoring programs to best serve the changing needs of its community. These include, but are not limited to the following: Community Service Plan, Community Service Strategy, Accountable Care Organization, Patient-centered medical home, disease management programs and community outreach. The integration of these innovative approaches supports Montefiore well in its provision of service to the community.

7. STATE FILING OF COMMUNITY BENEFIT REPORT:
MONTEFIORE MOUNT VERNON HOSPITAL FILES A COMMUNITY SERVICE PLAN WITH THE State of NEW YORK.

2. NEEDS ASSESSMENT:
In addition to collaborative input from the local Department of Health and clinical partners, Montefiore works closely with its communities including the Mount Vernon Community Advisory Board (MVCAB). Working with a variety of organized partnerships and collaboratives and other providers in lower Westchester as well as extensive work with representatives of the affected communities has helped Montefiore to identify health care needs and determine the appropriate configuration of services. Beyond the formal structures that Montefiore established to gain input from the communities it serves, Montefiore's Office of Community and Population Health participates in a variety of informal organized partnerships and collaboratives, working with other providers in Westchester, the Westchester County Department of Health, community-based organizations and others, using a community level approach that involves relevant community based organizations interested in planning and developing initiatives aimed at improving the health of the residents of Westchester County.

3. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:
ALL INTAKE, REGISTRATION, AND COLLECTION AGENCY STAFF IS TRAINED ON THE HOSPITAL'S FINANCIAL AID POLICY AND HOW TO PROVIDE PATIENTS WITH ASSISTANCE. MONTEFIORE MOUNT VERNON HOSPITAL HAS A POLICY THAT ESTABLISHES GUIDELINES FOR THE BILLING OFFICE TO FOLLOW WHEN WORKING WITH INDIVIDUALS WHO ARE HAVING DIFFICULTY PAYING THEIR MEDICAL BILLS. A REFERRAL IS MADE TO THE HOSPITAL'S FINANCIAL AID OFFICE AND A FINANCIAL COUNSELOR WILL HELP THE PATIENT APPLY FOR FREE OR LOW-COST INSURANCE. IF THE FINANCIAL COUNSELOR DETERMINES THAT THE PATIENT DOES NOT QUALIFY FOR LOW-COST INSURANCE, THE COUNSELOR WILL HELP THE PATIENT APPLY FOR A FINANCIAL AID DISCOUNT BASED ON INCOME LEVEL. THE HOSPITAL MAKES ITS FINANCIAL AID POLICY KNOWN TO THE PUBLIC BY PROVIDING WRITTEN INFORMATION AVAILABLE IN ENGLISH, SPANISH, Arabic, Haitian-CREOLE, ITALIAN AND PORTUGUESE INCLUDING BROCHURES AT ALL PATIENT SERVICE AREAS, INFORMATION POSTED ON THE INTRANET AND INTERNET, AND INFORMATION SENT OUT ON PATIENTS' BILLS. THERE ARE ALSO SIGNS POSTED AT ENTRANCEWAYS, IN THE emergency DEPARMENT, ADMITTING OFFICE, BILLING AND MEDCAID OFFICES AND OTHER REGISTRATION AND WAITING AREAS ADVISING PATIENTS OF THE AVAILABILITY OF FINANCIAL AID.

4. COMMUNITY INFORMATION:
Mount Vernon is the third most populous city in Westchester County. The city is 4.4 square miles and is the 2nd most densely populated city in New York State, trailing only New York City. According to the 2017 American Community Survey, Mount Vernon has 68,671 residents and has experienced 0.4% population growth from 2000 to 2017. The city has the highest proportion of non-Hispanic black residents in Westchester County at 64% (compared to 13.5% countywide). One-third of all residents are Foreign born. Additionally, it is the seat of Westchester County's homeless services and senior services programs, housing a disproportionate number of lower-income residents. Mount Vernon is located just north of the Bronx and bordered by Pelham, Bronxville, Eastchester, and Yonkers. Mount Vernon is among the most ethnically diverse communities in Westchester County. Its population is 64.3% non-Hispanic black, 16.1% non-Hispanic white, 15.4% Hispanic, 2.0% non-Hispanic Asian and 1.9% non-Hispanic other. One-third (33%) of its residents are foreign-born. Among the foreign-born population, more people (55%) speak only English at home than Spanish (19%) and other languages (26%). The city has the second highest percentages of residents living below poverty in Westchester County. About 15% (14.8%) of the population lives below the poverty level (9.4% countywide) and the median household income is $54,573 (compared to $89,968 countywide). Twenty-percent of Mount Vernon children live below poverty; nearly twice the countywide proportion (11.7%). While Westchester County remains among the healthiest counties in New York State, several of its individual municipalities continue to have significant health gaps. Portions of lower Westchester, specifically Mount Vernon, Yonkers, New Rochelle and White Plains are hot spots for various health outcomes, such as asthma and preterm births in the County. Additionally, certain groups, such as some racial/ethnic minorities or those with less education, experience poorer health outcomes. The City of Mount Vernon has been deemed to have a geography that meets the criteria as a medically underserved area, with respect to its access to primary care services. This categorization is based on an index value that includes the infant mortality rate, the poverty rate, the percentage of elderly population and the primary care physician to population ratio.

5. PROMOTION OF COMMUNITY HEALTH:
MONTEFIORE HEALTH SYSTEM, INC. IS A LEADER IN COMMUNITY HEALTH AND HAS A LONG HISTORY OF DEVELOPING INNOVATIVE APPROACHES TO CARE AND CREATING programs TO BEST SERVE THE CHANGING NEEDS OF ITS COMMUNITY. MONTEFIORE's Office of Community & Population Health has a dedicated community educator who spearheads initiatives in the city of Mt Vernon. These events are focused on a variety of issues, ranging from chronic disease management and prevention, cancer screenings and promotion of healthy food consumption. Events range from farmers market walks, workshops in the community, walkathons, health fair and community-based health screens. The Mount Vernon Facility has focused its engagement across multiple health indicators; diabetes, breast, cervical and colorectal cancers while addressing cardiovascular disease in the older adult population. To increase screening rates for cardiovascular disease the team coordinates screening services and educational workshops to older adults at frequently occurring points of congregation, including senior centers and naturally occurring retirement communities. These workshops provide a gateway to engage the community in health programming that ensures that our work is targeted towards high needs/high impact activities.