4A (Expenses $ 405105668 including grants of $ 144225) (Revenue $ 457749517)
IN MARCH OF 2020, MIDDLESEX HOSPITAL AS PART OF MIDDLESEX HEALTH'S COMMUNITY HEALTH AND WELL-BEING BASED WORK SHIFTED DRAMATICALLY TO ADDRESS THE COVID-19 PANDEMIC AND RESPOND TO COMMUNITY LEVEL NEEDS. MIDDLESEX HOSPITAL CONTINUES TO GO ABOVE AND BEYOND TO PROVIDE THE SAFEST POSSIBLE CARE TO ALL PATIENTS, WHETHER OR NOT THEIR ILLNESS IS RELATED TO THE CORONAVIRUS. MIDDLESEX HOSPITAL CONTINUES TO PROVIDE UPDATES AND ACCESS TO RESOURCES TO HELP MEMBERS OF THE COMMUNITY STAY SAFE AND HEALTHY DURING THESE CHALLENGING TIMES. ARMED WITH SKILLED STAFF, PROGRESSIVE DIAGNOSTIC TOOLS AND ADVANCED SURGICAL TECHNIQUES, THE HOSPITAL WAS WELL POSITIONED TO ENSURE A COMFORTABLE, SAFE ENVIRONMENT FOR EXCEPTIONAL MEDICAL TREATMENT AND RECOVERY. (CONTINUED ON SCHEDULE O)IN THE FISCAL YEAR ENDING 9/30/22, INPATIENT CARE REPRESENTED 11,902 DISCHARGES AND 54,020 PATIENT CARE DAYS. INPATIENT CARE FROM REGISTRATION THROUGH DISCHARGE IS CAREFULLY MANAGED TO EXCEED REGULATORY REQUIREMENTS AND ENSURE QUALITY, PATIENT SATISFACTION, AND BEST PRACTICE WITH EACH ASPECT OF THE INPATIENT EXPERIENCE, INCLUDING ALL ELEMENTS OF CARE FROM NURSING COMPETENCY AND COMPASSION, TO MEAL QUALITY, LAB AND DIAGNOSTIC TESTING, SAFE AND SECURE PHYSICAL SURROUNDINGS TO PATIENT EDUCATION. MIDDLESEX HOSPITAL, LICENSED FOR 275 BEDS AND 22 BASSINETS, PROVIDES ACUTE CARE FROM DEDICATED HEALTH CARE TEAMS WHICH INCLUDE SURGEONS, HOSPITALISTS, FAMILY PRACTITIONERS AND RESIDENTS, MEDICAL STAFF PHYSICIANS, MAGNET NURSES, PHYSICIAN ASSISTANTS, PATIENT CARE TECHNOLOGISTS, DIAGNOSTIC TECHNICIANS, PATHOLOGISTS, ADMINISTRATORS, ENVIRONMENTAL SERVICES, SECURITY, ENGINEERING AND A HOST OF OTHERS WORKING TOGETHER TO ENABLE THE ORGANIZATION'S SUCCESS.THE HOSPITAL UNITS INCLUDING INTENSIVE AND CRITICAL CARE, MEDICAL SURGICAL, ONCOLOGY, ORTHOPEDIC, PULMONOLOGY, VASCULAR AND CARDIOLOGY, GASTROINTESTINAL, MATERNITY, A 20-BED PSYCHIATRIC FLOOR, AND HOSPICE SERVICES SPECIALIZE IN THE SPECIFIC NEEDS OF THEIR PATIENTS AND ARE STAFFED TO ACCOMMODATE THE UNIQUE TREATMENT REQUIREMENTS OF EACH. ALL ANCILLARY SERVICES INCLUDING LABS, RADIOLOGY, FOOD SERVICES, PATHOLOGY, PHARMACY, MEDICAL TRANSCRIPTION AND INFORMATION SERVICES TOO ARE A PART OF THE HOSPITAL TEAM. PATIENT CARE IS DEVELOPED WITH FULL CONSIDERATION OF THE WHOLE INDIVIDUAL, AS THEY ARE ASSIGNED TO CONDITION SPECIFIC CARE PATHWAYS AND SERVICES TO SECURE BEST TREATMENT AND RECOVERY.

MIDDLESEX HOSPITAL
PART V, SECTION B, LINE 3J: IN ADDITION TO THE ELEMENTS SELECTED IN PART V, LINE 3, MIDDLESEX HOSPITAL'S MOST RECENTLY COMPLETED (2022) COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) EXAMINED HOW SOCIAL DETERMINANTS OF HEALTH AND HEALTH DISPARITIES IMPACT HEALTH OUTCOMES. THE REPORT CONTINUED TO RAISE AWARENESS ABOUT HEALTH-RELATED SOCIAL NEEDS, WELL-BEING AND QUALITY OF LIFE; HEALTH DISPARITIES; AND, VULNERABLE POPULATIONS. ACHIEVING HEALTH EQUITY THE ATTAINMENT OF THE HIGHEST LEVEL OF HEALTH FOR ALL PEOPLE STARTS WITH ASKING THE APPROPRIATE QUESTIONS RELATIVE TO DETERMINANTS OF HEALTH AND HOW THEY DISPROPORTIONATELY AFFECT CERTAIN GROUPS OF PEOPLE; NEXT STEPS INVOLVE ADDRESSING THE CONDITIONS THAT PREVENT THE REALIZATION OF GOOD HEALTH FOR THESE VULNERABLE OR MARGINALIZED GROUPS. THROUGH EXAMINATION OF THE INFLUENCE OF DETERMINANTS OF HEALTH, IT IS POSSIBLE TO DEVELOP STRATEGIES THAT ELIMINATE PERSISTENT AND PERVASIVE HEALTH DISPARITIES, PROMOTE HEALTH EQUITY, IMPROVE HEALTH OUTCOMES AND REDUCE FINANCIAL COST.

MIDDLESEX HOSPITAL
PART V, SECTION B, LINE 5: IN COMPLETING ITS MOST RECENT (2022) COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), MIDDLESEX HOSPITAL TOOK INTO ACCOUNT INPUT FROM REPRESENTATIVES OF ITS COMMUNITY SERVED, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. A COMMUNITY HEALTH NEEDS ASSESSMENT ADVISORY COMMITTEE WAS FORMED TO PROVIDE INPUT AND GUIDANCE, INCLUDING REVIEW OF THE STUDY'S DATA COMPONENTS; REVIEW AND INPUT ON THE MIDDLESEX HEALTH CHNA COMMUNITY SURVEY; ASSISTANCE WITH SERVICE AREA-WIDE COMMUNITY SURVEY DISSEMINATION; AND REVIEW AND INPUT ON COMMUNITY RESOURCES AND ASSETS. THE ADVISORY COMMITTEE WAS COMPRISED OF STAKEHOLDERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY, INCLUDING LOCAL HEALTH DEPARTMENTS, HEALTH CARE ORGANIZATIONS (INCLUDING MEDICAL AND BEHAVIORAL), COMMUNITY-BASED ORGANIZATIONS, FAITH-BASED ORGANIZATIONS, ADVOCACY GROUPS, SUPPORT PROFESSIONALS EMBEDDED IN THE COMMUNITY (I.E., COMMUNITY HEALTH WORKERS, DOULAS, RECOVERY COACHES, ETC.) AND COMMUNITY MEMBERS TO ENSURE COMMUNITY VOICE WAS REPRESENTED. TO CAPTURE BROAD COMMUNITY INPUT ON HEALTH NEEDS, SOCIAL DETERMINANTS OF HEALTH AND HEALTH EQUITY, MIDDLESEX HOSPITAL ADMINISTERED A COMMUNITY SURVEY FOR ITS CHNA. SURVEY TOPIC AREAS INCLUDED KEY HEALTH ISSUES AND HEALTH BEHAVIORS, HEALTH CARE ACCESS, AND SOCIAL DETERMINANTS OF HEALTH. QUESTIONS RELATED TO COVID-19 WERE ADDED. ALL THE SURVEY RESPONSE OPTIONS WERE POSED IN QUANTITATIVE FORM THROUGH LIKERT SCALES. A QUALITATIVE OPEN-ENDED TEXT BOX WAS PROVIDED AT THE END OF THE SURVEY TO ALLOW FOR COMMENTS. THE EIGHT-QUESTION SURVEY (FIVE FOCUSED QUESTIONS, TWO DEMOGRAPHIC QUESTIONS AND AN OPTION TO ADD COMMENTS) WAS ADMINISTERED ELECTRONICALLY THROUGH THE ONLINE SURVEYMONKEY FORMAT. TO ENSURE RESPONSES FROM A WIDE RANGE OF REPRESENTATIVE COMMUNITY MEMBERS AND LEADERS WITH DIVERSE BACKGROUNDS, PERSPECTIVES AND FIRST-HAND KNOWLEDGE ABOUT THEIR COMMUNITIES, THE SURVEY WAS EXTENSIVELY DISSEMINATED TO AN ARRAY OF SECTOR CONTACTS; FORWARDED TO MULTIPLE COLLABORATIVE E-DISTRIBUTION LISTS; POSTED ON WEBSITES AND SOCIAL MEDIA PLATFORMS; AND INCLUDED IN E-NEWSLETTERS THROUGHOUT MIDDLETOWN, MIDDLESEX COUNTY AND THE PERIPHERY TOWNS OF MIDDLESEX HEALTH'S SERVICE AREA. SECTORS INCLUDED ADVOCACY GROUPS, ALLIANCES/COALITIONS, THE BUSINESS COMMUNITY, EDUCATIONAL INSTITUTIONS, COMMUNITY-BASED ORGANIZATIONS, COMMUNITY RESIDENTS, ELECTED OFFICIALS, MUNICIPAL STAFF, FAITH-BASED ORGANIZATIONS, FOUNDATIONS, HEALTH CARE ORGANIZATIONS (INCLUDING MEDICAL AND BEHAVIORAL), LOCAL HEALTH DEPARTMENTS, MENTAL HEALTH ORGANIZATIONS, SUBSTANCE TREATMENT FACILITIES, AND YOUTH AND FAMILY SERVICES. COMMUNITY HEALTH NEEDS ASSESSMENT ADVISORY COMMITTEE MEMBERS WERE ASKED TO BROADLY SHARE THE COMMUNITY SURVEY LINK, AND ALL SURVEY RECIPIENTS WERE INVITED TO SHARE THE LINK WITH COWORKERS, FRIENDS AND FAMILY OR ANYONE WHO LIVES OR WORKS IN MIDDLESEX COUNTY. A TOTAL OF 204 SURVEYS WERE COMPLETED AND RESPONSE RESULTS ARE INCLUDED IN THE MIDDLESEX HEALTH CHNA COMMUNITY SURVEY SECTION OF THE CHNA.

MIDDLESEX HOSPITAL
PART V, SECTION B, LINE 7D: MIDDLESEX HOSPITAL POSTED ITS MOST RECENTLY COMPLETED CHNA (2022) ON ITS WEB-SITE (HTTPS://MIDDLESEXHEALTH.ORG/MIDDLESEX-AND-THE-COMMUNITY/SERVING-OUR-COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT) AND ELECTRONICALLY DISTRIBUTED IT THROUGH THE FOLLOWING DISSEMINATION CHANNELS: THE CHNA ADVISORY COMMITTEE; COMMUNITY MEMBERS; AND EXISTING HOSPITAL-COMMUNITY BASED PARTNERSHIP DISTRIBUTION LISTS. RECIPIENTS WERE ENCOURAGED TO WIDELY SHARE THE ASSESSMENT. HARD COPIES OF THE CHNA WERE AND WILL CONTINUE TO BE PROVIDED UPON REQUEST.

MIDDLESEX HOSPITAL
PART V, SECTION B, LINE 11: MIDDLESEX HOSPITAL COMPLETED ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN 2022, AND ITS CHNA IMPLEMENTATION STRATEGY WAS APPROVED BY MIDDLESEX HEALTH'S GOVERNING BODY IN FEBRUARY 2023. A FACILITATED COMMUNITY CONVERSATION WAS HELD TO REVIEW, PRIORITIZE, AND DISCUSS STRATEGIES AND SOLUTIONS FOR THE SIGNIFICANT HEALTH AND HEALTH-RELATED NEEDS IDENTIFIED IN MIDDLESEX HEALTH'S 2022 COMMUNITY HEALTH NEEDS ASSESSMENT, THEREBY INFORMING MIDDLESEX HEALTH'S CHNA IMPLEMENTATION STRATEGY. A FLIER AND INVITATION TO THE EVENT WAS WIDELY DISSEMINATED TO AN ARRAY OF CONTACTS IN MIDDLETOWN, MIDDLESEX COUNTY AND THE PERIPHERY TOWNS OF MIDDLESEX HEALTH'S PRIMARY SERVICE AREA TO ENSURE PARTICIPATION BY COMMUNITY LEADERS, STAKEHOLDERS AND COMMUNITY MEMBERS WITH DIVERSE BACKGROUNDS, PERSPECTIVES AND FIRST-HAND KNOWLEDGE ABOUT THEIR COMMUNITIES. THE COMMUNITY CONVERSATION FORMAT WAS SELECTED AS IT PROVIDES A PRACTICAL, PURPOSEFUL AND INTERACTIVE APPROACH FOR 1) EXPLORING THE CAUSES AND UNDERLYING ISSUES BEHIND SPECIFIC HEALTH PROBLEMS; 2) ADDRESSING CONCERNS; 3) DISCUSSING DESIRED FUTURE STATE; 4) DESIGNING STRATEGIES BASED ON DATA AND INDIVIDUAL KNOWLEDGE, PERSPECTIVE AND EXPERIENCE; AND, 5) SERVING AS A FOUNDATION TO ENCOURAGE SUSTAINED ENGAGEMENT AND TO CREATE OPPORTUNITIES FOR COOPERATIVE ACTION. GIVEN COVID-19 CONCERNS, THE COMMUNITY CONVERSATION WAS HELD VIA A VIRTUAL FORMAT. A TOTAL OF 65 PEOPLE PARTICIPATED, REPRESENTING VARIOUS SECTORS INCLUDING ADVOCACY GROUPS, ALLIANCES / COALITIONS, EDUCATIONAL INSTITUTIONS, COMMUNITY BASED ORGANIZATIONS, COMMUNITY RESIDENTS, ELECTED OFFICIALS, FAITH-BASED ORGANIZATIONS, HEALTH CARE ORGANIZATIONS (INCLUDING MEDICAL AND BEHAVIORAL), LOCAL HEALTH DEPARTMENTS, MUNICIPAL AGENCIES, SCHOOLS, SOCIAL SERVICES, STATE AGENCIES AND YOUTH AND FAMILY SERVICES. PRIOR TO THE PRIORITIZATION AND STRATEGY EXERCISES, AN OVERVIEW OF MIDDLESEX HEALTH'S 2022 CHNA WAS GIVEN, INCLUDING BACKGROUND ON THE PROCESS; KEY DEMOGRAPHIC DATA; DATA LIMITATIONS; DEFINITIONS OF HEALTH EQUITY AND SOCIAL DETERMINANTS OF HEALTH; DATA ON AN ARRAY OF HEALTH INDICATORS; SOCIAL AND HEALTH DISPARITY DATA, WHEN AVAILABLE; AND AN OVERVIEW OF THE TOP HEALTH NEEDS IDENTIFIED IN MIDDLESEX HEALTH'S 2022 CHNA. FACILITATORS WITH EXPERTISE IN COMMUNITY CONVERSATIONS LED THE ATTENDEES IN A PRIORITIZATION EXERCISE AND A DISCUSSION OF POTENTIAL STRATEGIES AND SOLUTIONS. PARTICIPANTS WERE ASKED TO CONSIDER THE IMPACTS OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH DISPARITIES WHEN REVIEWING EACH HEALTH ISSUE. ONCE THE RANKING PROCESS WAS COMPLETED, THE RESULTS WERE TALLIED AND FIVE PRIORITY AREAS WERE DETERMINED. THE RESULTS OF THE COMMUNITY CONVERSATION SERVED AS A GUIDE FOR MIDDLESEX HEALTH'S SELECTION OF PRIORITY AREAS FOR ITS CHNA IMPLEMENTATION STRATEGY. THROUGH THIS PROCESS, THE FOLLOWING HEALTH TOPICS WERE SELECTED AS AREAS OF FOCUS FOR THE IMPLEMENTATION STRATEGY: 1) MENTAL HEALTH ALL AGES; 2) SUBSTANCE USE ISSUES; 3) HEALTHY AGING; 4) MATERNAL CHILD HEALTH; AND 5) CHRONIC DISEASES, WITH SOCIAL DETERMINANTS OF HEALTH, HEALTH EQUITY AND THE IMPACTS OF COVID-19 AS ESSENTIAL COMPONENTS FOR EACH HEALTH AREA. WHILE MIDDLESEX HEALTH'S CHNA WAS COMPLETED IN 2022, ITS CHNA IMPLEMENTATION STRATEGY WAS COMPLETED AND APPROVED BY ITS GOVERNING BODY IN FEBRUARY 2023; THEREFORE, IN FISCAL YEAR 2022, MIDDLESEX HEALTH CONTINUED TO FOCUS ON THE HEALTH AND WELL-BIENG NEEDS IDENTIFIED IN ITS PREVIOUS CHNA. WITH REGARD TO NEEDS THAT ARE NOT BEING ADDRESSED, MIDDLESEX HOSPITAL RECOGNIZES THAT IT CANNOT FOCUS ON EVERY HEALTH AND SOCIAL NEED IDENTIFIED IN ITS PREVIOUSLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT AND IS THEREFORE COMMITTED TO ALLOCATING RESOURCES AND IN-KIND TIME TO THE HIGHEST AREAS OF IDENTIFIED NEED AND/OR AREAS WITH GREATEST POTENTIAL FOR IMPACT AND FEASIBILITY (THE SELECTED PRIORITY AREAS). RESOURCE CONSTRAINTS PREVENT THE HOSPITAL FROM ADDRESSING EVERY NEED, AND IN MANY CASES, OTHER LOCAL COMMUNITY BASED ORGANIZATIONS MAY BE BETTER SUITED TO TAKE A LEADERSHIP ROLE IN IMPROVING CERTAIN HEALTH OUTCOMES. AS WITH OUR PREVIOUS COMMUNITY HEALTH NEEDS ASSESSMENTS, THE HOSPITAL WILL CONTINUE TO BE A WILLING PARTNER, WHEN ABLE, FOR INITIATIVES NOT RELATED TO ITS SELECTED CHNA IMPLEMENTATION STRATEGY PRIORITY AREAS.TO ALIGN WITH ITS COMMUNITY HEALTH NEEDS ASSESSMENT FOCUS ON ADVANCING HEALTH EQUITY BY ADDRESSING THE ROOT CAUSES OF HEALTH DISPARITIES, MIDDLESEX HOSPITAL HAS ADOPTED A COLLABORATIVE PHILOSOPHY FOR ITS COMMUNITY HEALTH AND WELL-BEING VISION. IN FY22 MIDDLESEX HOSPITAL SECURED $1,521,120 IN GRANT FUNDING AND CONTINUATION FUNDING FOR COMMUNITY-LED PROGRAMS DEVELOPED TO SUPPORT STRATEGIC, PLACE-BASED PARTNERSHIPS. MIDDLESEX HEALTH WROTE THE GRANTS THAT SECURED FUNDING FROM MULTIPLE ORGANIZATIONS AND PROVIDED ASSISTANCE WITH BUDGET PREPARATION; THIS SUPPORT WAS PROVIDED IN-KIND AND 100% OF THE FUNDS WENT TO COMMUNITY-BASED ORGANIZATIONS AND CREATED JOBS. HEALTH SYSTEMS ARE ANCHOR INSTITUTIONS IN THEIR SERVICE AREAS. BY SUPPORTING ONGOING COMMUNITY INITIATIVES, MIDDLESEX HOSPITAL IS ENSURING THAT ITS COMMUNITY BENEFIT PROGRAMS MEET COMMUNITY NEEDS, AS DEFINED BY COMMUNITY INPUT AND VOICE. BY INFUSING 100% OF THIS GRANT MONEY INTO THE COMMUNITY AND CREATING COMMUNITY-BASED JOBS, MIDDLESEX HOSPITAL IS HELPING TO ADVANCE EQUITABLE AND INCLUSIVE ECONOMIC DEVELOPMENT STRATEGIES IN MEANINGFUL WAYS; THIS IS IMPORTANT BECAUSE SOCIOECONOMIC STATUS AND RELATED FACTORS, SUCH AS EMPLOYMENT, ARE DRIVERS OF HEALTH. THESE GRANTS, WRITTEN BY MIDDLESEX HOSPITAL AND SECURED IN PARTNERSHIP, HAVE UNDERWRITTEN MULTIPLE COMMUNITY-BASED PROGRAMS THAT FOCUS ON ADDRESSING SYSTEMIC BARRIERS THAT BLACK, INDIGENOUS, LATINO/A INDIVIDUALS EXPERIENCE WITH ACCESS TO QUALITY HEALTH CARE SERVICES. EACH PROGRAM HAS BEEN DESIGNED, IMPLEMENTED AND LED BY COMMUNITY LEADERS OR COLOR AND COMMUNITY MEMBERS OF COLOR WHO KNOW THE NEEDS OF AND SOLUTIONS FOR THEIR COMMUNITIES BEST. IN ADDITION TO PROVIDING SUPPORT FOR GRANT WRITING, BUDGET PREPARATION, PROGRAM DESIGN, PROGRAM IMPLEMENTATION, PROGRAM EVALUATION AND GRANT REPORTING, MIDDLESEX HEALTH IS AN ACTIVE PARTNER WITH THE ORGANIZATIONS OVERSEEING THE PROGRAMS.

MIDDLESEX HOSPITAL
PART V, SECTION B, LINE 13H: MIDDLESEX HOSPITAL'S SLIDING SCALE OUTLINES THE FACTORS THAT IT USES TO DETERMINE FINANCIAL ASSISTANCE DETERMINATIONS: THE FEDERAL POVERTY INCOME GUIDELINES AND NUMBER OF PERSONS IN HOUSEHOLD.

PART V, SECTION B, LINE 7A:
HTTPS://MIDDLESEXHEALTH.ORG/MIDDLESEX-AND-THE-COMMUNITY/SERVING-OUR-COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT

PART V, SECTION B, LINE 10A:
HTTPS://MIDDLESEXHEALTH.ORG/MIDDLESEX-AND-THE-COMMUNITY/SERVING-OUR-COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT

PART V, SECTION B, LINE 16A, FAP WEBSITE:
HTTPS://MIDDLESEXHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE-SERVICES

PART V, SECTION B, LINE 16B, FAP APPLICATION WEBSITE:
HTTPS://MIDDLESEXHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE-SERVICES

PART V, SECTION B, LINE 16C, FAP PLAIN LANGUANCE SUMMARY WEBSITE:
HTTPS://MIDDLESEXHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE-SERVICES

PART VI, QUESTION 4 - COMMUNITY INFORMATION (CONTINUED):
WHILE THE MAJORITY OF TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA EXPERIENCE A LOWER HOUSING COST-BURDEN RATE (HOUSEHOLDS THAT SPEND AT LEAST 30% OF THEIR ANNUAL HOUSEHOLD INCOME ON HOUSING COSTS) WHEN COMPARED TO CONNECTICUT (39.6%), FOR THIS COHORT, THE PERCENTAGE OF HOUSEHOLDS IN THE TOWNS THAT ARE COST-BURDENED IS HIGH, RANGING FROM 22% - 37.8%. THE TOWNS OF CLINTON, LYME, AND MIDDLETOWN COMPARE TO CONNECTICUT, WHILE CHESTER, OLD SAYBROOK, AND WESTBROOK EXCEED THE STATE AVERAGE WITH A RANGE OF 41.2% - 43.6% EXPERIENCING HOUSING COST-BURDEN (CONNECTICUT DATA COLLABORATIVE, 2015-2019).FOR HEALTH INSURANCE STATUS, UNDER AGE 18, ALL TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA HAVE A LOWER UNINSURED RATE WHEN COMPARED TO CONNECTICUT (3.0%), EXCEPT CLINTON (3.4%), ESSEX (4.9%) AND OLD LYME (4.7%) [CONNECTICUT DATA COLLABORATIVE, FROM THE AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES 2015-2019]. FOR HEALTH INSURANCE STATUS, AGES 18-64, ALL TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA HAVE A LOWER UNINSURED RATE WHEN COMPARED TO CONNECTICUT (7.5%), EXCEPT DEEP RIVER (12.8%) [CONNECTICUT DATA COLLABORATIVE, FROM THE AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES 2015-2019]. FOR HEALTH INSURANCE STATUS, AGES 65+, ALL TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA HAVE A LOWER UNINSURED RATE WHEN COMPARED TO CONNECTICUT (0.6%), EXCEPT DEEP RIVER (1.0%) AND KILLINGWORTH (2.9%) [CONNECTICUT DATA COLLABORATIVE, FROM THE AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES 2015-2019]. IN 2022, THE PERCENT OF HOSPITAL DISCHARGES FOR MEDICAID/SAGA/UNINSURED COMBINED WERE: 21% INPATIENT; 15% OUTPATIENT; 29% EMERGENCY DEPARTMENT NON-ADMISSION; AND, FOR THE FOLLOWING SERVICES: 37% NEWBORN; 50% INPATIENT PSYCHIATRY; 14% OUTPATIENT SURGERY AND 15% OTHER OUTPATIENT SERVICES. MIDDLESEX COUNTY HAS BEEN DESIGNATED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) TO BE A MEDICALLY UNDERSERVED AREA EXPERIENCING A SHORTAGE OF SELECT HEALTH SERVICES WHICH INCLUDE A LACK OF ACCESS TO PRIMARY CARE SERVICES.

PART V, SECTION B, LINE 20A:
WRITTEN NOTICE ABOUT UPCOMING ECAS WAS NOT REQUIRED BECAUSE THE ORGANIZATION DID NOT PURSUE ANY EXTRAORDINARY COLLECTION ACTION'S DURING THE YEAR. IF AN ECA WAS PURSUED IN THE FUTURE, PROPER NOTICE WOULD BE GIVEN.

PART I, LINE 3C:
"IN GENERAL, MIDDLESEX HOSPITAL (""THE HOSPITAL"") USES FPG TO DETERMINE ELIGIBILITY. THERE ARE, HOWEVER, SPECIAL CIRCUMSTANCES (SUCH AS A CATASTROPHIC EVENT) WHICH MAY AFFECT A PATIENT'S ABILITY TO PAY. IN THIS CASE, THE HOSPITAL EVALUATES THE APPLICATION WITH CONSIDERATION GIVEN TO THE PATIENT'S CURRENT SITUATION. WITH SPECIAL CIRCUMSTANCES, IN ORDER TO MAXIMIZE THE AMOUNT OF FINANCIAL ASSISTANCE DISCOUNT, THE FPG THRESHOLD MAY BE IGNORED AND THE HOSPITAL MAY USE THE PATIENT'S ASSETS AND/OR TAX RETURN ITEMIZED DEDUCTIONS TO DETERMINE THE AMOUNT OF FINANCIAL ASSISTANCE."

PART I, LINE 7:
FOR PART 1, LINE 7 SECTIONS (A) FINANCIAL ASSISTANCE AT COST, (B) MEDICAID, (C) COSTS OF OTHER MEANS-TESTED GOVERNMENT PROGRAMS, PORTIONS OF (F) HEALTH PROFESSIONS EDUCATION, AND (G) SUBSIDIZED HEALTH SERVICES, THE COSTING METHODOLOGY USED IS A HYBRID COST ACCOUNTING/MEDICARE COST-TO-CHARGE RATIO CALCULATION. THE PERCENTAGES ARE DERIVED FROM THE MOST CURRENT MEDICARE COST REPORT AND APPLIED BY CHARGE LINE APPROPRIATELY. INDIRECT COSTS WERE APPLIED TO SUBSIDIZED HEALTH SERVICES. THE MEDICARE COST REPORT DOES NOT ADDRESS ALL AREAS OF THE HOSPITAL IN THE SAME DETAIL, BUT DOES ACCURATELY ADDRESS INPATIENT AND OUTPATIENT, HOMECARE AND TO AN EXTENT PHYSICIAN SERVICES. SECTIONS (E) COMMUNITY HEALTH IMPROVEMENT; PORTIONS OF (F) HEALTH PROFESSIONS EDUCATION, (H) RESEARCH, AND (I) CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS ARE COMPRISED (EXCEPT FOR CASH DONATIONS AND IN-KIND MATERIAL DONATIONS) OF 1) SUPPLY EXPENSES; 2) PURCHASED SERVICES; AND 3) THE DIRECT SALARY COSTS FOR HOSPITAL STAFF WHOSE TIME WAS COMPENSATED BY THE HOSPITAL FOR TIME SPENT PARTICIPATING IN ACTIVITIES THAT QUALIFY AS COMMUNITY BENEFITS PLUS THE CURRENT FISCAL YEAR FRINGE BENEFIT RATE. IN ADDITION TO SUBSIDIZED SERVICES, INDIRECT COSTS WERE APPLIED TO A SMALL SELECTION OF SALARIES AND SERVICES UNDER COMMUNITY HEALTH IMPROVEMENT, RESEARCH, AND COMMUNITY BENEFIT OPERATIONS, BUT NOT BROADLY ACROSS ALL COMMUNITY BENEFIT ACTIVITY ENTRIES.

PART I, LINE 7G:
MIDDLESEX HOSPITAL INCLUDES ITS FAMILY MEDICINE GROUP AS A SUBSIDIZED SERVICE. FOR FY22, 7,778 UNIQUE INDIVIDUALS WERE SERVED WITH A TOTAL HOSPITAL SUBSIDY OF $509,742. MIDDLESEX COUNTY HAS BEEN DESIGNATED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) TO BE A MEDICALLY UNDERSERVED AREA EXPERIENCING A SHORTAGE OF SELECT HEALTH SERVICES WHICH INCLUDE TOO FEW PRIMARY CARE PROVIDERS. IN ADDITION, HRSA REPORTS HEALTH PROFESSIONAL SHORTAGE AREAS (HPSAS) FOR PRIMARY CARE (MIDDLETOWN SERVICE AREA; LOW INCOME POPULATION), MENTAL HEALTH (MIDDLESEX COUNTY; HIGH NEED GEOGRAPHIC) AND DENTAL HEALTH (CENTRAL MIDDLETOWN; LOW INCOME POPULATION). MIDDLESEX HOSPITAL'S FAMILY MEDICINE GROUP FILLS A VITAL COMMUNITY HEALTH NEED BY PROVIDING ACCESS TO PRIMARY CARE SERVICES.

PART III, LINE 2:
DUE TO THE ADOPTION OF ASC NO 2014-09 CONTRACTS WITH CUSTOMERS (TOPIC 606) BAD DEBT EXPENSE IS NO LONGER REPORTED ON THE AUDITED FINANCIAL STATEMENT. RATHER IT IS TREATED AS A PRICE CONCESSION. THE BAD DEBT EXPENSE FOR FY2022 WAS $20,768,625.

PART III, LINE 3:
THE HOSPITAL ESTIMATES THAT 10% OF ITS BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. THE HOSPITAL HAS A WELL-ESTABLISHED PROCESS WITH ITS THIRD PARTY AGENCIES TO CAPTURE AS MANY PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE AS POSSIBLE AND AWARDS FINANCIAL ASSISTANCE TO THOSE PATIENTS IN COLLECTIONS WHO ARE KNOWN TO QUALIFY. ONCE IN COLLECTIONS, THERE ARE TWO METHODS WHICH ENABLE PATIENTS TO RECEIVE FINANCIAL ASSISTANCE AWARDS: 1) PATIENTS EITHER COMPLETE A FINANCIAL ASSISTANCE APPLICATION, MEET ELIGIBILITY CRITERIA AND ARE APPROVED; OR 2) THE THIRD PARTY ORGANIZATIONS THAT WORK ON BEHALF OF THE HOSPITAL TO COLLECT BALANCES SCREEN FOR FINANCIAL ASSISTANCE ELIGIBILITY. IN ORDER TO ENSURE THAT ALL PATIENTS IN COLLECTIONS ARE AWARE OF FINANCIAL ASSISTANCE AVAILABILITY, THE HOSPITAL REQUIRES THIRD PARTY ORGANIZATIONS TO FOLLOW THE HOSPITAL'S POLICIES REGARDING PATIENT NOTIFICATION ABOUT THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. WITHIN THE POLICY THERE IS A PROVISION WHEREBY COLLECTION AGENCIES, USING GUIDELINES SET FORTH BY THE HOSPITAL, ASSIST THE HOSPITAL IN IDENTIFYING PATIENTS WHO DO NOT HAVE A MEANS TO PAY FOR SERVICES AND THEREFORE QUALIFY FOR THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM WHILE THESE PATIENTS HAVE NOT GONE THROUGH THE FORMAL APPLICATION PROCESS, THEY MEET THE ELIGIBILITY GUIDELINES FOR FINANCIAL ASSISTANCE AS DEFINED BY THE HOSPITAL. THESE PATIENTS ARE THEN TRANSFERRED AND INCLUDED UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE UMBRELLA. WHILE THIS PROCESS CAPTURES THE MAJORITY OF THOSE WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE, THE HOSPITAL RECOGNIZES IT WILL STILL HAVE A POPULATION OF PATIENTS WHO COULD POTENTIALLY QUALIFY FOR FINANCIAL ASSISTANCE AND DO NOT RECEIVE AWARDS THOSE WHO ARE UNCOOPERATIVE, UNRESPONSIVE OR HAVE MOVED AWAY. BAD DEBT DOLLARS ARE NOT INCLUDED IN ANY OF THE HOSPITAL'S PROGRAMMATIC COMMUNITY BENEFIT VALUES AND, WHILE NOTED, ARE NOT INCLUDED IN THE HOSPITAL'S COMMUNITY BENEFIT TOTALS IN ANY HOSPITAL COMMUNITY BENEFIT PUBLICATION.

PART III, LINE 4:
THE HOSPITAL ESTIMATES A RESERVE FOR UNCOLLECTIBLE ACCOUNTS AGAINST ITS PATIENT ACCOUNTS RECEIVABLES. WHEN BAD DEBTS ARE IDENTIFIED, THEY ARE ACCOUNTED FOR AS A COMPONENT OF THE NET PATIENT REVENUE PROVISION FOR BAD DEBTS NET OF RECOVERIES. PAGE 15 OF THE MIDDLESEX HEALTH SYSTEM'S CONSOLIDATED FY22 AUDITED FINANCIAL STATEMENT STATES: THE SYSTEM DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON ITS HISTORICAL COLLECTION EXPERIENCE FROM THAT CATEGORY OF PAYOR.

PART VI, LINE 4:
MIDDLESEX HOSPITAL IS THE SOLE HOSPITAL PROVIDER IN ITS SERVICE AREA, WHICH INCLUDES THE LARGE GEOGRAPHIC AREA OF MIDDLESEX COUNTY AND SURROUNDING TOWNS. IT ENCOMPASSES 24 MUNICIPALITIES, INCLUDING THE 15 TOWNS OF MIDDLESEX COUNTY. MIDDLESEX HOSPITAL HEALTH'S SERVICE AREA. THERE ARE NINETEEN TOWNS IN ITS PRIMARY SERVICE AREA: CHESTER, CLINTON, CROMWELL, DEEP RIVER, DURHAM, EAST HADDAM, EAST HAMPTON, ESSEX, HADDAM, KILLINGWORTH, MIDDLEFIELD, MIDDLETOWN, OLD SAYBROOK, PORTLAND, AND WESTBROOK (THE FIFTEEN TOWNS OF MIDDLESEX COUNTY) AND COLCHESTER, LYME, MARLBOROUGH AND OLD LYME; AND, FIVE TOWNS IN ITS SECONDARY SERVICE AREA: GUILFORD, HEBRON, MADISON, MERIDEN, AND ROCKY HILL. BY LAND AREA, MIDDLESEX COUNTY (369.3 SQUARE MILES) IS THE SMALLEST COUNTY OF THE EIGHT COUNTIES IN CONNECTICUT AND IS THE SIXTH IN POPULATION SIZE (U.S. CENSUS, 2020). MUNICIPALITY SIZES BY LAND MASS VARY THROUGHOUT THE COUNTY, FROM 10.40 SQUARE MILES (ESSEX) TO 54.25 SQUARE MILES (EAST HADDAM) WITH MIDDLETOWN HAVING 41.02 SQUARE MILES OF LAND AREA. THE CITY OF MIDDLETOWN (ZIP CODE 06457) IS CENTRALLY LOCATED 16 MILES SOUTH OF HARTFORD. THE POPULATION IN MIDDLETOWN IS ECONOMICALLY AND RACIALLY / ETHNICALLY MORE DIVERSE WHEN COMPARED TO OTHER MUNICIPALITIES IN MIDDLESEX COUNTY AND IS ONE OF THE FEW COMMUNITIES IN CONNECTICUT TO INCLUDE URBAN, SUBURBAN, AND RURAL CHARACTERISTICS. THE DATA THAT FOLLOWS IS PER MIDDLESEX HEALTH'S MOST RECENTLY COMPLETED COMMUNITY HEALTH NEEDS ASSESSMENT (2022).OF THE TOTAL STATE OF CONNECTICUT POPULATION (3,605,597), 4.6% (164,759) RESIDE IN MIDDLESEX COUNTY (U.S. CENSUS, 2021). WITH A POPULATION OF 47,108 (U.S. CENSUS, 2021), MIDDLETOWN IS THE LARGEST MUNICIPALITY IN MIDDLESEX COUNTY. THE REMAINING TOWNS IN MIDDLESEX HEALTH'S PRIMARY SERVICE AREA FALL INTO THREE POPULATION RANGES. COLCHESTER, CROMWELL, CLINTON, EAST HAMPTON AND OLD SAYBROOK HAVE POPULATIONS BETWEEN 10,000 AND 15,600. PORTLAND, EAST HADDAM, HADDAM, OLD LYME, DURHAM, WESTBROOK, ESSEX, KILLINGWORTH AND MARLBOROUGH HAVE POPULATIONS BETWEEN 5,000 AND 9,999. DEEP RIVER, MIDDLEFIELD, CHESTER AND LYME HAVE POPULATIONS LESS THAN 5,000. THE CONNECTICUT OFFICE OF RURAL HEALTH (CT-ORH) DEFINES RURAL AS ALL TOWNS WITH A POPULATION CENSUS OF 10,000 OR LESS AND A POPULATION DENSITY OF 500 OR LESS PEOPLE PER SQUARE MILE. BASED ON THIS METRIC, THE TOWNS OF CHESTER, DEEP RIVER, DURHAM, EAST HADDAM, HADDAM, KILLINGWORTH, LYME, MARLBOROUGH, MIDDLEFIELD, OLD LYME AND WESTBROOK ARE CONSIDERED RURAL. FOR THE AGE DISTRIBUTIONS, MIDDLESEX COUNTY IS LOWER THAN THE STATE AVERAGE IN THE 0-19 AND 20-44 AGE GROUPS AND EXCEEDS THE STATE AVERAGE IN THE 45-64 AND 65+ AGE GROUPS. MIDDLETOWN IS LOWER THAN THE STATE AVERAGE IN THE 0-19 AGE GROUP, IS SIGNIFICANTLY HIGHER THAN THE STATE AVERAGE IN THE 20-44 AGE GROUP AND LOWER THAN THE STATE AVERAGE IN THE 45-64 AND 65+ AGE GROUPS. WHEN EXTRACTING AGE 65+, MIDDLESEX COUNTY (19.0%) EXCEEDS CONNECTICUT (17.2%), AND THE MAJORITY OF THE TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA CONTINUE TO HAVE A GREATER CONCENTRATION OF OLDER ADULTS WHEN COMPARED TO CONNECTICUT. THE TOWNS OF COLCHESTER, MARLBOROUGH AND MIDDLETOWN FALL BELOW THE STATE AVERAGE OF 17.2%. PORTLAND IS ON PAR WITH THE STATE AVERAGE, WHILE CHESTER, CLINTON, CROMWELL, DEEP RIVER, DURHAM, EAST HADDAM, EAST HAMPTON, HADDAM, KILLINGWORTH, AND MIDDLEFIELD EXCEED THE STATE AVERAGE WITH AN AGE 65+ RANGE OF 19.1%-24.8%, AND ESSEX, LYME, OLD LYME, OLD SAYBROOK, AND WESTBROOK CONSIDERABLY EXCEED THE STATE AVERAGE WITH AN AGE 65+ RANGE OF 26.2%-30.9% (CT DATA COLLABORATIVE, 2016-2020).MIDDLETOWN HAS A MORE DIVERSE RACIAL / ETHNIC DEMOGRAPHIC RELATIVE TO THE OTHER TOWNS IN MIDDLESEX COUNTY AND RESEMBLES CONNECTICUT EXCEPT IN THE HISPANIC OR LATINO CATEGORY, WHERE MIDDLETOWN HAS A SMALLER POPULATION. MIDDLESEX COUNTY'S RACE AND HISPANIC OR LATINO ORIGIN COMPOSITION IS 82.4% WHITE, NON-HISPANIC OF LATINO; 6% BLACK OR AFRICAN AMERICAN, NON-HISPANIC; 7.1% HISPANIC OR LATINO; 3.3% ASIAN, NON-HISPANIC; 2.2% TWO OR MORE RACES, NON-HISPANIC (U.S. CENSUS QUICK FACTS 2021). MIDDLETOWN'S RACE AND HISPANIC OR LATINO ORIGIN COMPOSITION IS 66.8% WHITE, NON-HISPANIC OR LATINO; 15.8% BLACK OR AFRICAN AMERICAN, NON-HISPANIC; 10.3% HISPANIC OR LATINO; 6% ASIAN, NON-HISPANIC; 4.2% TWO OR MORE RACES, NON-HISPANIC (U.S. CENSUS QUICK FACTS 2021).THE MEDIAN HOUSEHOLD INCOME PER TOWN IN MIDDLESEX HEALTH'S SERVICE AREA RANGES FROM $62,022 (MIDDLETOWN) TO $130,635 (DURHAM) AND ALL TOWNS EXCEPT MIDDLETOWN, MIDDLEFIELD AND WESTBROOK EXCEED CONNECTICUT'S MEDIAN INCOME OF $79,855 (CONNECTICUT DATA COLLABORATIVE, 2016-2020). THERE ARE SIGNIFICANT MEDIAN HOUSEHOLD INCOME DISPARITIES WHEN DATA POINTS ARE DISAGGREGATED BY RACE AND ETHNICITY AND COMPARED TO WHITE ALONE NOT HISPANIC OR LATINO. IN MIDDLETOWN, WHITE HOUSEHOLDS EARN 1.6 TIMES MORE THAN BLACK HOUSEHOLDS AND 1.8 TIMES MORE THAN HISPANIC OR LATINO HOUSEHOLDS. IN MIDDLESEX COUNTY, WHITE HOUSEHOLDS EARN 1.8 TIMES MORE THAN BLACK HOUSEHOLDS AND 1.6 TIMES MORE THAN HISPANIC OR LATINO HOUSEHOLDS. WHILE THE GAP IS NARROWER, WHITE HOUSEHOLDS EARN 1.1 TIMES MORE (MIDDLETOWN) AND 1.4 TIMES MORE (MIDDLESEX COUNTY) THAN ASIAN HOUSEHOLDS. FOR POVERTY STATUS, THE TOTAL POVERTY RATE FOR MIDDLETOWN AT 12.3% EXCEEDS THE STATE OF CONNECTICUT AT 9.8%. THE TOTAL POVERTY RATES FOR MIDDLEFIELD (8.5%) AND MARLBOROUGH (8.4%) EXCEED THE MIDDLESEX COUNTY TOTAL POVERTY RATE OF 7.1%. THE UNDER 18 POVERTY RATE FOR MIDDLETOWN AT 16.1% EXCEEDS THE STATE OF CONNECTICUT AT 13.0%. THE UNDER 18 POVERTY RATES FOR THE TOWNS OF COLCHESTER (11.6%), PORTLAND (10.9%), MIDDLEFIELD (9.3%) AND EAST HAMPTON (8.7%) EXCEED THE MIDDLESEX COUNTY UNDER 18 POVERTY RATE OF 8.3% (CONNECTICUT DATA COLLABORATIVE, 2016-2020; MIDDLESEX COUNTY: U.S. CENSUS BUREAU, AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES 2016-2020).POVERTY RATES ARE SIGNIFICANTLY MORE PRONOUNCED AMONG BLACK OR AFRICAN AMERICAN ALONE, HISPANIC OR LATINO, AND TWO OR MORE RACES POPULATIONS IN MIDDLETOWN AND MIDDLESEX COUNTY WHEN COMPARED TO WHITE ALONE NOT HISPANIC OR LATINO FOR THE TOTAL AND UNDER 18 CATEGORIES. BLACK OR AFRICAN AMERICAN ALONE RESIDENTS ARE 2.5 TIMES MORE LIKELY (MIDDLETOWN) AND 3.2 TIMES MORE LIKELY (MIDDLESEX COUNTY) TO EXPERIENCE POVERTY WHEN COMPARED TO WHITE ALONE NOT HISPANIC OR LATINO RESIDENTS. HISPANIC OR LATINO RESIDENTS ARE 4.1 TIMES MORE LIKELY (MIDDLETOWN) AND 3.8 TIMES MORE LIKELY (MIDDLESEX COUNTY) TO EXPERIENCE POVERTY WHEN COMPARED TO WHITE ALONE NOT HISPANIC OR LATINO RESIDENTS. ASIAN ALONE RESIDENTS ARE 1.2 TIMES MORE LIKELY (MIDDLETOWN) AND 2 TIMES MORE LIKELY (MIDDLESEX COUNTY) TO EXPERIENCE POVERTY WHEN COMPARED TO WHITE ALONE NOT HISPANIC OR LATINO RESIDENTS. RESIDENTS WITH TWO OR MORE RACES ARE 2.7 TIMES MORE LIKELY (MIDDLETOWN) AND 3.1 TIMES MORE LIKELY (MIDDLESEX COUNTY) TO EXPERIENCE POVERTY WHEN COMPARED TO WHITE ALONE NOT HISPANIC OR LATINO RESIDENTS (CONNECTICUT DATA COLLABORATIVE, 2016-2020; MIDDLESEX COUNTY: CONNECTICUT DATA COLLABORATIVE, 2015-2019). UNDER AGE 18 BLACK OR AFRICAN AMERICAN ALONE YOUTH ARE 2.9 TIMES MORE LIKELY (MIDDLETOWN) AND 5.5 TIMES MORE LIKELY (MIDDLESEX COUNTY) TO EXPERIENCE POVERTY WHEN COMPARED TO UNDER 18 AGE WHITE ALONE NOT HISPANIC OR LATINO YOUTH. UNDER AGE 18 HISPANIC OR LATINO YOUTH ARE 5.1 TIMES MORE LIKELY (MIDDLETOWN) AND 5.8 TIMES MORE LIKELY (MIDDLESEX COUNTY) TO EXPERIENCE POVERTY WHEN COMPARED TO UNDER AGE 18 WHITE ALONE NOT HISPANIC OR LATINO YOUTH. UNDER AGE 18 YOUTH WITH TWO OR MORE RACES ARE 2.1 TIMES MORE LIKELY (MIDDLETOWN) AND 2.3 TIMES MORE LIKELY (MIDDLESEX COUNTY) TO EXPERIENCE POVERTY WHEN COMPARED TO UNDER AGE 18 YOUTH WHITE ALONE NOT HISPANIC OR LATINO YOUTH (CONNECTICUT DATA COLLABORATIVE, 2016-2020; MIDDLESEX COUNTY: CONNECTICUT DATA COLLABORATIVE, 2015-2019).THE COVID-19 PANDEMIC HAD A PROFOUND IMPACT ON THE UNEMPLOYMENT RATE IN CONNECTICUT. IN FEBRUARY 2020, JUST PRIOR TO THE COVID-19 LOCKDOWN, THE UNEMPLOYMENT RATE IN CONNECTICUT WAS 3.4%. BY JUNE 2020, IT HAD MORE THAN TRIPLED TO 11.1%. AS OF JUNE 2021, THE UNEMPLOYMENT RATE IN CONNECTICUT WAS STILL HIGH AT 6.7% AND EXPERIENCED A DOWNWARD TREND AS OF JUNE 2022 AT 4% (CT DEPARTMENT OF LABOR, 2022). CONNECTICUT'S OVERALL UNEMPLOYMENT RATES WERE 3.7% IN 2019 AND 7.9% IN 2020. THE UNEMPLOYMENT RATES IN THE TOWNS IN MIDDLESEX COUNTY'S SERVICE AREA INCREASED SUBSTANTIALLY WHEN COMPARING 2019 TO 2020, DEMONSTRATING THE IMPACT OF THE COVID-19 PANDEMIC. WHILE ALL TOWNS EXPERIENCED A SIGNIFICANT INCREASE IN 2020, MIDDLETOWN HAD THE HIGHEST UNEMPLOYMENT RATE AT 7.3%. (CONTINUED AT END OF SECTION)

PART VI, LINE 7, REPORTS FILED WITH STATES
CT

PART II, COMMUNITY BUILDING ACTIVITIES:
THE MAJORITY OF MIDDLESEX HOSPITAL'S COMMUNITY BASED HEALTH IMPROVEMENT WORK IS CAPTURED UNDER COMMUNITY BENEFIT CATEGORIES. THE HOSPITAL'S PARTICIPATION IN COMMUNITY BUILDING ACTIVITIES, HOWEVER, HAS A VITAL ROLE IN CONTINUING TO PROMOTE THE HEALTH, WELL-BEING AND SAFETY FOR RESIDENTS IN ITS SERVICE AREA. THE HOSPITAL OFFERS ITS RESOURCES AND EXPERTISE TO SUPPORT AND STRENGTHEN COMMUNITY ASSETS IN A VARIETY OF WAYS THAT FALL UNDER THE SCOPE OF COMMUNITY BUILDING. STAFF MEMBERS PARTICIPATE IN MULTIPLE COMMUNITY PARTNERSHIPS AND COALITIONS, THE SUCCESS OF WHICH ARE GREATLY ENHANCED BY HOSPITAL COLLABORATION - MANY COMMUNITY INITIATIVES WOULD NOT BE AS EFFECTIVE WITHOUT THE HOSPITAL'S ADMINISTRATIVE AND CLINICAL STAFF IN-KIND INVOLVEMENT, SUPPORT AND EXPERTISE.THE CRITICAL ROLE OF THE NOT-FOR-PROFIT HOSPITAL AS A SAFETY NET AND ANCHOR HEALTHCARE INSTITUTION HAS NEVER BEEN MORE APPARENT THAN DURING THE COVID-19 PANDEMIC THAT COMMENCED IN THE UNITED STATES IN THE EARLY MONTHS OF 2020 AND HAS CONTINUED THROUGH 2022 WITH NEW COVID-19 VARIANTS EMERGING AND CONTINUING TO CAUSE SURGES IN THE HEALTHCARE SYSTEM. CONTINUING TO RESPOND TO THE COVID-19 PANDEMIC IN ORDER TO TREAT ITS COVID-19 PATIENTS AND ALL ITS OTHER PATIENTS NEEDING MEDICAL CARE CONTINUED TO BE AN EXTENSIVE UNDERTAKING FOR HOSPITALS AND HEALTHCARE SYSTEMS, AND WAS NO DIFFERENT FOR MIDDLESEX HOSPITAL IN FY22.TO FURTHER ITS COMMITMENT TO DIVERSITY, EQUITY AND INCLUSION TO ADDRESS DISPARITIES IN HEALTH CARE, MIDDLESEX HEALTH OFFERS THE MIDDLESEX HEALTH MEDICAL EXPLORERS PROGRAM (WORKFORCE DEVELOPMENT). BLACK, INDIGENOUS AND LATINO/A INDIVIDUALS ARE EXTREMELY UNDERREPRESENTED IN HEALTHCARE PROFESSIONS IN THE UNITED STATES, WHICH CONTRIBUTES TO HEALTH DISPARITIES FOR PEOPLE OF COLOR. IT IS WELL DOCUMENTED THAT THE LACK OF DIVERSITY IN THE HEALTHCARE WORKFORCE HAS A NEGATIVE EFFECT ON PATIENTS OF COLOR. FOSTERING A DIVERSE AND INCLUSIVE WORKFORCE IS CRITICAL TO IMPROVING TRUST AMONG PATIENT-PROVIDER RELATIONSHIPS, INCREASING ACCESS TO CARE AND IMPROVING HEALTHCARE QUALITY AND OUTCOMES AMONG PEOPLE OF COLOR. TO ADDRESS THE LACK OF RACIAL AND ETHNIC REPRESENTATION IN HEALTHCARE, MIDDLESEX HEALTH HAS RE-LAUNCHED ITS MEDICAL EXPLORERS PROGRAM, WHICH WAS ORIGINALLY PILOTED IN 2016-2017. THE PROGRAM'S OBJECTIVE IS TO CREATE A HEALTHCARE EDUCATIONAL PIPELINE BY INTRODUCING BLACK, INDIGENOUS, AND LATINO/A STUDENTS TO A VARIETY OF HEALTH CARE PROFESSIONS THROUGH AN ENGAGED INTERACTIVE LEARNING EXPERIENCE. THE MEDICAL EXPLORERS PROGRAM OCCURS ONCE A YEAR FROM JANUARY - MAY. THE MONTHLY SESSIONS ARE VIRTUAL TO ALLOW FOR MAXIMUM STUDENT PARTICIPATION AND GEOGRAPHIC REACH BY REDUCING TRAVEL TIME AND THE NEED FOR TRANSPORTATION. TO BE ELIGIBLE FOR THE PROGRAM, STUDENTS MUST BE IN GRADES 7 - 12 OR RECENT HIGH SCHOOL GRADUATES AND IDENTIFY AS BLACK, INDIGENOUS AND LATINO/A. THE MEDICAL EXPLORERS ARE GUIDED THROUGH A SIMULATED PATIENT CASE AS IT MOVES ALONG THE HOSPITAL SYSTEM. TO MODEL A VARIETY OF PROFESSIONS, MIDDLESEX HEALTH STAFF IDENTIFYING AS PEOPLE OF COLOR ARE THE FEATURED SPEAKERS. STUDENTS LEARN ABOUT THE SPECIFICS OF EACH HIGHLIGHTED PROFESSION, THE SPEAKER'S PATHWAY TO THAT PROFESSION, AND THE SPEAKER'S CLINICAL EXPERTISE REGARDING THE CASE. ON-SITE EXPERIENCES INCLUDE A TOUR OF THE HOSPITAL WHERE MEDICAL EXPLORERS WILL GET TO MEET STAFF AND EXPERIENCE VARIOUS CLINICAL DEPARTMENTS; A PARTICIPATORY SIM LAB EXPERIENCE, ONE-ON-ONE INTERACTIONS IN AREAS OF INTEREST, AND A CELEBRATION WHERE CERTIFICATES OF COMPLETION ARE AWARDED.

PART III, LINE 9B:
MIDDLESEX HOSPITAL HAS A WRITTEN DEBT COLLECTION POLICY. THE POLICY STATES THAT PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE WILL BE RESPONSIBLE FOR PAYING ANY BALANCE REMAINING AFTER THE FINANCIAL ASSISTANCE ALLOWANCE HAS BEEN APPLIED (THAT IS, IF 100% FINANCIAL ASSISTANCE HAS NOT BEEN AWARDED). THE POLICY ALSO OUTLINES THE PROCESS FOR PAYING OUTSTANDING BALANCES SHOULD THE PATIENT BE FOUND TO HAVE THE MEANS TO PAY A PARTIAL AMOUNT AFTER THE HOSPITAL'S FINANCIAL ASSISTANCE DETERMINATION CRITERIA HAS BEEN APPLIED. FOR SUCH BALANCES, THE HOSPITAL WILL NOTIFY THE PATIENT OF HIS/HER LIABILITY. IF PAYMENT IS NOT MADE, THE POLICY STATES THAT THE HOSPITAL WILL USE APPROPRIATE METHODS TO PURSUE COLLECTION, WHICH MAY INCLUDE COLLECTIONS AGENCIES. THIS PRACTICE IS BROADLY UTILIZED FOR ALL PATIENTS WITH OUTSTANDING BALANCES. THE HOSPITAL MAKES EVERY EFFORT TO ENSURE THAT ALL PATIENTS KNOW PAYMENT PLANS ARE AVAILABLE FOR ANY BALANCE, INCLUDING THOSE PATIENTS WHO HAVE A BALANCE LEFT OVER AFTER A FINANCIAL ASSISTANCE AWARD HAS BEEN APPLIED. IN ORDER TO CAPTURE THE PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE, THE HOSPITAL HAS PROVISIONS IN ITS COLLECTION POLICY. IN THE CASE WHERE PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE DO NOT COMPLETE A FINANCIAL ASSISTANCE APPLICATION AND ARE PLACED INTO COLLECTIONS, THE THIRD PARTY ORGANIZATIONS THAT WORK ON BEHALF OF THE HOSPITAL TO COLLECT BALANCES SCREEN FOR FINANCIAL ASSISTANCE ELIGIBILITY. THE THIRD PARTY ORGANIZATIONS FOLLOW HOSPITAL POLICY BY ALERTING ALL PATIENTS IN COLLECTIONS TO THE AVAILABILITY OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. WITHIN THE HOSPITAL'S COLLECTION POLICY THERE IS A PROVISION WHEREBY COLLECTION AGENCIES, USING GUIDELINES SET FORTH BY THE HOSPITAL, ASSIST THE HOSPITAL IN IDENTIFYING PATIENTS WHO DO NOT HAVE A MEANS TO PAY FOR SERVICES AND THEREFORE QUALIFY FOR THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM WHILE THESE PATIENTS HAVE NOT GONE THROUGH THE FORMAL APPLICATION PROCESS, THEY MEET THE ELIGIBILITY GUIDELINES FOR FINANCIAL ASSISTANCE AS DEFINED BY THE HOSPITAL. THESE PATIENTS ARE THEN TRANSFERRED AND INCLUDED UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE UMBRELLA. THIS PROCESS WAS PUT IN PLACE BY THE HOSPITAL IN ORDER TO CAPTURE AS MANY PATIENTS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE AS POSSIBLE.

PART III, LINE 8:
"THE MEDICARE COST REPORT IS THE COSTING METHODOLOGY SYSTEM USED TO DETERMINE THE AMOUNT REPORTED ON PART III, LINES 5 AND 6. THE HOSPITAL UTILIZES WORKSHEET 6 FOUND IN THE FORM 990 INSTRUCTIONS FOR SCHEDULE H TO CALCULATE ITS SUBSIDIZED SERVICES. THE INSTRUCTIONS STATE THAT ""THE FINANCIAL LOSS IS MEASURED AFTER REMOVING LOSSES, MEASURED BY COST, ASSOCIATED WITH BAD DEBT, CHARITY CARE, MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS"". GIVEN THAT WORKSHEET 6 DOESN'T SUGGEST REMOVING LOSSES ASSOCIATED WITH MEDICARE, A PORTION OF MEDICARE IS INCLUDED IN THE HOSPITAL'S SUBSIDIZED SERVICE CALCULATIONS. SO AS NOT TO DOUBLE COUNT MEDICARE VALUES IN PART III, SECTION B, LINES 5 AND 6, THE PORTION OF MEDICARE SHORTFALL INCLUDED IN OUR SUBSIDIZED SERVICES CALCULATIONS HAS BEEN SUBTRACTED FROM THE MEDICARE REVENUE AND COSTS DERIVED FROM THE MEDICARE COST REPORT. THE VALUES INDICATED IN PART III, LINES 5 AND 6 ARE THEREFORE WHAT REMAINS AFTER THE MEDICARE REVENUE AND COSTS INCLUDED IN THE SUBSIDIZED SERVICES CALCULATIONS HAS BEEN SUBTRACTED OUT. GIVEN THIS, THE RESULTING VALUES (PART III, LINES 5, 6 AND 7) WOULD NEED TO BE COMBINED WITH THE MEDICARE REVENUE/COSTS INCLUDED IN OUR SUBSIDIZED SERVICES TO GET THE FULL OVERVIEW OF MEDICARE REVENUE, COSTS AND ANY REMAINING SHORTFALL OR SURPLUS. WE AGREE WITH THE CURRENT SUBSIDIZED SERVICES CALCULATION METHODOLOGY THAT ALLOWS THE INCLUSION OF MEDICARE DOLLARS AS THE MEDICARE POPULATION COMPRISES AN IMPORTANT SEGMENT OF THOSE RECEIVING SUBSIDIZED SERVICES CARE. THE HOSPITAL TREATS ALL MEDICARE PATIENTS EQUALLY AND DOES NOT DISCRIMINATE AGAINST LOWER-MARGIN YIELDING SERVICES. AS A NOT-FOR-PROFIT HOSPITAL, MIDDLESEX HOSPITAL IS THE SAFETY-NET IN THE COMMUNITY FOR ALL MEDICARE PATIENTS, REGARDLESS OF LEVEL OF MEDICARE COVERAGE AND REGARDLESS IF A SURPLUS OR DEFICIT RESULTS. THIS OPEN ACCESS FOR MEDICARE PATIENTS PROMOTES ACCESS TO CARE, A FUNDAMENTAL TENET OF THE HOSPITAL'S COMMUNITY BENEFIT PROGRAM.THERE REMAINS A DISPROPORTIONATE PERCENTAGE OF OLDER ADULTS IN MIDDLESEX COUNTY WHEN COMPARED TO STATE AVERAGES. MIDDLESEX HOSPITAL'S MOST RECENTLY COMPLETED (2022) COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOUND THAT, WHEN EXTRACTING THE AGE 65+ POPULATION, MIDDLESEX COUNTY (19.0%) EXCEEDS CONNECTICUT (17.2%), AND THE MAJORITY OF THE TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA CONTINUE TO HAVE A GREATER CONCENTRATION OF OLDER ADULTS WHEN COMPARED TO CONNECTICUT. THE TOWNS OF COLCHESTER, MARLBOROUGH AND MIDDLETOWN FALL BELOW THE STATE AVERAGE OF 17.2%. PORTLAND IS ON PAR WITH THE STATE AVERAGE, WHILE CHESTER, CLINTON, CROMWELL, DEEP RIVER, DURHAM, EAST HADDAM, EAST HAMPTON, HADDAM, KILLINGWORTH, AND MIDDLEFIELD EXCEED THE STATE AVERAGE WITH AN AGE 65+ RANGE OF 19.1%-24.8%, AND ESSEX, LYME, OLD LYME, OLD SAYBROOK, AND WESTBROOK CONSIDERABLY EXCEED THE STATE AVERAGE WITH AN AGE 65+ RANGE OF 26.2%-30.9% (CT DATA COLLABORATIVE, 2016-2020). THE TREND OF A DISPROPORTIONATELY HIGHER 65+ OLDER ADULT POPULATION IN THE MAJORITY OF TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA WHEN COMPARED TO THE STATE AVERAGE CONTINUES TO BE EVIDENT FOR POPULATION PROJECTIONS FOR 2030. EXCLUDING MIDDLETOWN (AT 14.9%), THE EXPECTED GROWTH FOR AGE 65+ BY 2030 RANGES FROM 19.5% TO 34.9% IN THE REMAINING 18 TOWNS IN MIDDLESEX HEALTH'S SERVICE AREA COMPARED TO 17.9% FOR CONNECTICUT (CT DATA COLLABORATIVE, AGE 65+ POPULATION PROJECTIONS, 2030). AS MIDDLESEX COUNTY HAS A DISPROPORTIONATE LEVEL OF COMMUNITY MEMBERS AGE 65+ WHEN COMPARED TO STATE AVERAGES, THE SHORTFALL THAT THE HOSPITAL EXPERIENCES IN PROVIDING CRITICAL HEALTHCARE SERVICES TO THE MEDICARE POPULATION SHOULD BE CONSIDERED A COMMUNITY BENEFIT WITHIN THE HOSPITAL'S SUBSIDIZED SERVICES, WHICH THOSE AGE 65+ ALSO RELY HEAVILY ON FOR CARE. THE HOSPITAL FILLS A HEALTHCARE DELIVERY GAP FOR MEDICARE PATIENTS, ONE WHICH WOULD BE DETRIMENTAL TO THE COMMUNITY IF THE HOSPITAL WAS NOT PRESENT."

PART VI, LINE 2:
SINCE THE INCEPTION OF MIDDLESEX HEALTH'S COMMUNITY BENEFIT POLICY IN 2007, AND PRIOR TO THE MANDATE OF THE AFFORDABLE CARE ACT, CONDUCTING A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN ORDER TO PRIORITIZE SPECIFIC COMMUNITY BENEFIT INITIATIVES HAS BEEN A CORE ELEMENT OF THE HOSPITAL'S COMMUNITY BENEFIT PROGRAM. IN ADDITION TO COMPLETING A CHNA, THE HOSPITAL ASSESSES THE NEEDS OF THE COMMUNITIES IT SERVICES ON AN ON-GOING BASIS THROUGH A VARIETY OF METHODS. EXAMPLES INCLUDE UNDERSTANDING THE LOCAL AND STATE-WIDE NEEDS DERIVED FROM: 1) PARTICIPATION IN COMMUNITY HEALTHCARE COALITIONS AND BOARDS, WHICH INCLUDE STRATEGIC PLANNING THAT IS RESPONSIVE TO COMMUNITY NEED; 2) PARTICIPATION IN THE LEADERSHIP TEAM OF THE GREATER MIDDLETOWN HEALTH ENHANCEMENT COMMUNITY (GMHEC), A PLACE-BASED INITIATIVE THAT SUPPORTS LONG-TERM, COLLABORATIVE, AND CROSS-SECTOR EFFORTS TO IMPROVE COMMUNITY HEALTH AND WELL-BEING THROUGH BROAD, SYSTEMIC CHANGE BY BUILDING HEALTHY AND EQUITABLE COMMUNITIES THAT ACTIVELY WORK TOGETHER TO PREVENT THE DEVELOPMENT OF DISEASE; 3) PARTICIPATION IN THE STATE'S HOSPITAL ASSOCIATION POPULATION AND COMMUNITY HEALTH INITIATIVES BASED ON STATE-WIDE AND LOCAL COMMUNITY HEALTH ISSUES; 4) ANY REAL-TIME COMMUNITY BASED INPUT, FEED-BACK, RECOMMENDATIONS AND SUGGESTIONS; AND 5) CONTINUOUS ASSESSMENT AND ADJUSTMENTS, WHEN NECESSARY, OF THE HOSPITAL'S COMMUNITY BENEFIT PROGRAMS THROUGH SURVEYS AND PATIENT/PARTICIPANT FEED-BACK. HAVING A STRONG PRESENCE IN COMMUNITY COALITIONS AND PARTNERSHIPS, IN ADDITION TO BEING RESPONSIVE TO THE NEEDS EXPRESSED BY OUR COMMUNITY RESIDENTS, ALLOWS MIDDLESEX HOSPITAL TO CONTINUALLY ASSESS THE HEALTHCARE NEEDS OF OUR COMMUNITY IN BETWEEN COMMUNITY HEALTH NEEDS ASSESSMENT CYCLES.

PART VI, LINE 3:
GREAT CONCERN IS TAKEN TO ENSURE THAT PATIENTS ARE APPRISED OF THE AVAILABILITY OF FEDERAL/STATE/LOCAL GOVERNMENT PROGRAMS AND THE HOSPITAL'S FINANCIAL ASSISTANCE PLAN. NOTICE OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM IS DISPLAYED CONSPICUOUSLY IN ENGLISH AND SPANISH AT THE ENTRY OF EACH FACILITY AND AT ALL PATIENT REGISTRATION POINTS. THE NOTIFICATION INCLUDES AN OVERVIEW OF THE HOSPITAL'S FINANCIAL AID PROGRAM; THE AVAILABILITY OF FREE BED FUNDS AND OTHER FINANCIAL ASSISTANCE; SLIDING SCALE; AND FINANCIAL COUNSELOR CONTACT INFORMATION. AT THE TIME OF REGISTRATION, HOSPITAL ACCESS STAFF REVIEWS THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM AND ASKS THE PATIENT IF HE/SHE WOULD LIKE A FINANCIAL ASSISTANCE PACKAGE. BUILT INTO THE REGISTRATION DATABASE IS A REQUIRED FINANCIAL ASSISTANCE FIELD WHICH MUST BE COMPLETED AS PART OF THE ADMISSIONS PROCESS. ONCE THE PATIENT EXPRESSES THE DESIRE TO RECEIVE A FINANCIAL ASSISTANCE PACKAGE, PAPERWORK WITH PATIENT NAME AND MEDICAL RECORD IS AUTOMATICALLY PRINTED AT THE REGISTRATION STATION AND HANDED TO THE PATIENT. OTHER METHODS OF COMMUNICATION TO INCREASE AWARENESS REGARDING THE FINANCIAL ASSISTANCE AND FREE BED FUND PROGRAM INCLUDE 1) A FINANCIAL ASSISTANCE BROCHURE THAT AIDS PATIENTS IN THE PROCESS, ANSWERS KEY QUESTIONS AND PROVIDES EASY ACCESS FOR HELP (AVAILABLE AT MULTIPLE HOSPITAL DEPARTMENTS AND LOCATIONS, INCLUDING KIOSKS AT EVERY HOSPITAL ENTRY POINT); 2) A SEPARATE AND DISTINCT FINANCIAL ASSISTANCE SERVICES SECTION ON THE HOSPITAL'S WEB-SITE (HTTPS://MIDDLESEXHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE-SERVICES) WHICH INCLUDES APPLICATION, INSTRUCTIONS, AND SLIDING SCALE; 3) INCLUSION OF FINANCIAL ASSISTANCE INFORMATION IN THE HOSPITAL'S INPATIENT ADMISSIONS BOOKLET; 4) NOTICE OF THE PROGRAM AND FINANCIAL COUNSELOR CONTACT INFORMATION ON EVERY BILLING STATEMENT; 5) NOTIFICATION AT DISCHARGE; AND 6) A LETTER OUTLINING THE PROGRAM SENT TO EVERY SELF-PAY PATIENT FOLLOWING DISCHARGE. THE HOSPITAL HAS A TEAM OF FINANCIAL COUNSELORS WHO ARE AVAILABLE TO ASSIST THE PATIENT THROUGH THE APPLICATION PROCESS EITHER BY PHONE OR VISIT. THE ROLE OF THE COUNSELORS IS TO HELP PATIENTS NAVIGATE THE HOSPITAL'S FINANCIAL ASSISTANCE PROCESS AND TO AID IN APPLICATION FOR MEDICAID/STATE PROGRAMS. ALL COUNSELORS RECEIVE DEPARTMENTAL TRAINING ON THE IMPORTANCE OF ASSISTING PATIENTS IN NEED OF STATE/GOVERNMENTAL OR HOSPITAL FINANCIAL ASSISTANCE, THE HOSPITAL'S FINANCIAL ASSISTANCE PROTOCOLS, SYSTEMS, NEW PROGRAM ENHANCEMENTS, AND HOW TO PROVIDE SUPPORT AND FOLLOW-UP FOR MEDICAID/STATE ENROLLMENT. THE HOSPITAL'S SOCIAL WORKERS ALSO ASSIST PATIENTS WITH COMPLETION OF HOSPITAL FINANCIAL ASSISTANCE APPLICATIONS AS WELL AS MEDICAID/STATE APPLICATIONS. AN IMPORTANT ADDITION TO MIDDLESEX HOSPITAL'S FINANCIAL ASSISTANCE PROCESS HAS BEEN THE DEVELOPMENT OF THE FINANCIAL ASSISTANCE WORKGROUP SEVERAL YEARS AGO. WORKGROUP TASKS INCLUDE: INCREASING AWARENESS REGARDING FINANCIAL ASSISTANCE AVAILABILITY; CONTINUOUS MONITORING OF APPROPRIATENESS, FEASIBILITY AND ACCESSIBILITY OF THE HOSPITAL'S FINANCIAL ASSISTANCE PRACTICES; AND A COMPREHENSIVE COMMUNICATIONS STRATEGY FOR INCREASING AWARENESS FOR FINANCIAL ASSISTANCE. IN FY21, MIDDLESEX HOSPITAL GRANTED $2,301,326 IN FINANCIAL ASSISTANCE TO 1,276 UNIQUE RECIPIENTS AND ABSORBED $29,755,083 IN UNPAID COSTS OF MEDICAID (TOTAL OF MEDICAID INCLUDING MANAGED CARE AND LIA), SERVING 20,745 INDIVIDUALS.

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THE ORGANIZATION IS PART OF AN AFFILIATED HEALTH CARE SYSTEM. MIDDLESEX HEALTH IS A FULLY COMPREHENSIVE NETWORK OF EXPERT HEALTH CARE PROVIDERS THAT HAS CONVENIENT LOCATIONS THROUGHOUT CENTRAL CONNECTICUT AND THE SHORELINE. MEMBERS OF THE COMMUNITY ARE ALWAYS CLOSE TO CARE FOR EVERY FAMILY MEMBER AT EVERY AGE. MIDDLESEX HEALTH PROVIDES THE BEST CARE POSSIBLE FOR JUST ABOUT ALL YOUR HEALTH AND WELLNESS NEEDS.THE ORGANIZATIONS INCLUDED IN THE AFFILIATED HEALTH CARE SYSTEM ARE AS FOLLOWS:MIDDLESEX HOSPITAL - A NON-PROFIT, ACUTE CARE, COMMUNITY HOSPITAL IN MIDDLETOWN, CT.MIDDLESEX HEALTH SERVICES PROVIDING INTEGRATIVE MEDICINE SERVICES TO THE COMMUNITY.MHS PRIMARY CARE - PROVIDES PATIENT-CENTERED COMPASSIONATE CARE TO ALL MEMBERS OF THE COMMUNITY.MIDDLESEX HOSPITAL FOUNDATION - SUPPORTS MIDDLESEX HOSPITAL.MIDDLESEX HEALTH SYSTEM - PARENT OF AND PROVIDES FUNDRAISING SERVICES FOR MIDDLESEX HOSPITAL.

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UNDER THE CONNECTICUT GENERAL STATUTES 19A-127K, HOSPITALS THAT HAVE A COMMUNITY BENEFIT PROGRAM IN PLACE, AS SPECIFIED BY THE STATUTE, ARE REQUIRED TO REPORT BIENNIALLY TO THE STATE OF CT. THIS BIENNIAL COMMUNITY BENEFIT REPORTING IS CURRENTLY UNDER THE AUSPICES OF THE STATE OF CONNECTICUT'S OFFICE OF HEALTH STRATEGY. AS MIDDLESEX HOSPITAL MEETS THE STATUTE AS HAVING A COMMUNITY BENEFIT PROGRAM IN PLACE, IT REPORTS BIENNIALLY TO THE STATE OF CT'S OFFICE OF HEALTH STRATEGY. EFFECTIVE JANUARY 1, 2023, SECTION 19A-127K OF THE GENERAL STATUTES WAS REPEALED AND WAS REPLACED BY PUBLIC ACT NO. 22-58 (AN ACT CONCERNING THE DEPARTMENT OF PUBLIC HEALTH'S RECOMMENDATIONS REGARDING VARIOUS REVISIONS TO THE PUBLIC HEALTH STATUTES). SECTION 50 OF PUBLIC ACT NO. 22-58 OUTLINES THE COMMUNITY BENEFIT REPORTING REQUIREMENTS. ON OR BEFORE OCTOBER 1, 2023, AND ANNUALLY THEREAFTER, EACH HOSPITAL SHALL SUBMIT TO THE OFFICE OF HEALTH STRATEGY A STATUS REPORT ON SUCH HOSPITAL'S COMMUNITY BENEFIT PROGRAM.

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AS MIDDLESEX HOSPITAL IS A COMMUNITY HOSPITAL, INVOLVING COMMUNITY MEMBERS IN KEY FUNCTIONS HAS ALWAYS BEEN A PRIORITY. MIDDLESEX HOSPITAL'S BOARD IS COMPRISED MAINLY OF COMMUNITY MEMBERS WHO ARE NEITHER EMPLOYEES, FAMILY MEMBERS NOR CONTRACTORS OF THE ORGANIZATION, BUT ARE LONG-TERM RESIDENTS WHOSE PRIMARY INTEREST IS THE HEALTH AND WELL-BEING OF THE COMMUNITY AT LARGE. MIDDLESEX HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY BASED ON THE HOSPITAL'S CURRENT AND PROJECTED PATIENT CARE, TEACHING AND RESEARCH NEEDS, AND OVERALL COMMUNITY NEED. MEDICAL STAFF INPUT AND PARTICIPATION IS HIGHLY VALUED BY THE HOSPITAL AS EVIDENCED BY INCLUSION IN THE HOSPITAL'S MEDICAL EXECUTIVE COMMITTEE, THE MEDICAL STAFF COUNCIL AND COUNTLESS OTHER WORKING COMMITTEES. MIDDLESEX HOSPITAL HAS A FORMAL PROCESS FOR ALLOCATION OF SURPLUS FUNDS; A MULTIDISCIPLINARY CAPITAL BUDGETING COMMITTEE MEETS AND SETS PRIORITIES FOR INVESTMENTS IN PATIENT CARE, EDUCATION AND RESEARCH, AND PHYSICAL STRUCTURE. THE APPROACH TAKES INTO CONSIDERATION PATIENT, COMMUNITY AND STAFF NEEDS. EACH YEAR THE HOSPITAL ALLOCATES A PORTION OF SURPLUS FUNDING TO A WIDE ARRAY OF COMMUNITY BENEFIT PROGRAMS AND SERVICE LINES, INCLUDING SUBSTANTIAL HEALTH AND WELLNESS ACTIVITIES AND INITIATIVES, SUBSIDIZED SERVICES, MEDICAL EDUCATION, RESEARCH AND HEALTH ASSESSMENT COSTS. CONTINUOUS DEDICATION TO THE COMMUNITIES IT SERVES REMAINS THE HALLMARK OF MIDDLESEX HOSPITAL'S VISION, MISSION, AND STRATEGIC PLANNING. AMBITIOUS COMMUNITY BENEFIT GOALS, THE INCORPORATION OF COMMUNITY BENEFIT INTO ANNUAL ORGANIZATIONAL PLANNING, AND THE PROVISION OF COMMUNITY BENEFIT PROGRAMS THAT TARGET THE COMMUNITY'S MOST VULNERABLE AND AT-RISK POPULATIONS HAS ALLOWED THE HOSPITAL TO PUT A FORMAL STRUCTURE AROUND ITS FUNDAMENTAL PURPOSE. THE HOSPITAL'S COMMUNITY BENEFIT TOTAL FOR FY21 WAS $67,067,572 (EXCLUDING COMMUNITY BUILDING) WITH 65,214 SERVED (EXCLUDING COMMUNITY BUILDING). THE FOLLOWING IS AN OVERVIEW OF THE HOSPITAL'S COMMUNITY BENEFIT PROGRAM: COMMUNITY HEALTH IMPROVEMENT SERVICES: THE HOSPITAL UNDERWRITES A VAST RANGE OF COMMUNITY HEALTH EDUCATION AND HEALTH IMPROVEMENT PROGRAMS, NONE OF WHICH ARE DEVELOPED FOR MARKETING PURPOSES, ALL OF WHICH ARE SUPPORTED AS A MEANS OF FULFILLING THE HOSPITAL'S MISSION TO SERVE ITS COMMUNITY. ALMOST 100% OF THE TIME THESE SERVICES ARE OFFERED FREE OF CHARGE; IN THE RARE INSTANCE WHERE A NOMINAL FEE IS ASSESSED THE COST OF PROVIDING THE SERVICE IS NOT COVERED. COMMUNITY HEALTH EDUCATION IS PROVIDED TO THE COMMUNITY AT LARGE. SOME OF THE PROGRAMS REPRESENT ONE TIME EVENTS, HOWEVER MOST ARE ONGOING AND OVER THE YEARS HAVE BECOME ENTRENCHED IN THE COMMUNITY AS A SOURCE OF SUPPORT AND CONTINUED EDUCATION FOR A HEALTHFUL FUTURE. EXAMPLES OF COMMUNITY HEALTH IMPROVEMENT SERVICES INCLUDE (BUT ARE NOT LIMITED TO): 1) HEALTH EDUCATION (COMMUNITY EDUCATION PRESENTATIONS; HEALTH AND WELLNESS EVENTS/HEALTH FAIRS; SUPPORT GROUPS; LARGE SCALE CANCER AWARENESS AND EDUCATIONAL EVENTS; AND THE AVAILABILITY OF HEALTH LITERATURE); 2) COMMUNITY-BASED CLINICAL SERVICES (CLINICS AND SCREENINGS; ANNUAL FLU SHOTS; BLOOD PRESSURE CLINICS); AND 3) HEALTHCARE SUPPORT SERVICES OFFERED TO INCREASE ACCESS AND QUALITY OF CARE TO INDIVIDUALS, ESPECIALLY THOSE LIVING IN POVERTY AND/OR OTHER VULNERABLE POPULATIONS. IN FY21, THE HOSPITAL'S COMMUNITY HEALTH IMPROVEMENT SERVICES SERVED 15,222 INDIVIDUALS AT A TOTAL COST OF $2,531,038 TO THE HOSPITAL. HEALTH PROFESSIONS EDUCATION: HELPING TO PREPARE FUTURE HEALTH CARE PROFESSIONALS IS A LONG-STANDING COMMITMENT OF MIDDLESEX HOSPITAL AND DISTINGUISHING CHARACTERISTIC THAT CONSTITUTES A SIGNIFICANT COMMUNITY BENEFIT. THE HOSPITAL'S FAMILY MEDICINE RESIDENCY PROGRAM GRADUATES FAMILY PRACTICE PHYSICIANS, MANY OF WHOM CONTINUE TO PRACTICE IN THE MIDDLESEX COUNTY AREA AFTER THEIR TRAINING IS COMPLETE. THIS IS ESPECIALLY IMPORTANT GIVEN THAT MIDDLESEX COUNTY HAS BEEN DESIGNATED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) TO BE A MEDICALLY UNDERSERVED AREA (MUA) EXPERIENCING A SHORTAGE OF SELECT HEALTH SERVICES WHICH INCLUDES TOO FEW PRIMARY CARE PROVIDERS. IN ADDITION, HRSA REPORTS THAT MIDDLESEX COUNTY IS A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) FOR PRIMARY MEDICAL CARE. THE HOSPITAL ALSO WELCOMES MEDICAL AND NURSING STUDENT INTERNS AND PROVIDES ON-SITE TRAINING DURING CLINICAL ROTATIONS. NURSING STUDENTS FROM LOCAL COLLEGES AND PROGRAMS RECEIVE HANDS-ON MENTORSHIP IN THE MAJORITY OF CLINICAL SERVICE LINES YEAR-ROUND. OTHER HEALTHCARE PROFESSIONAL EDUCATION INCLUDES THE HOSPITAL'S RADIOLOGY SCHOOL (WHICH OPERATES AT A LOSS FOR THE HOSPITAL) AND CLINICAL/NON-CLINICAL EDUCATIONAL STUDENT TRAINING IN MULTIPLE FIELDS. IN FY21, THE HOSPITAL'S HEALTH PROFESSIONS EDUCATION CATEGORY SERVED 1,080 INDIVIDUALS AT A TOTAL COST OF $11,624,148 TO THE HOSPITAL. SUBSIDIZED HEALTH SERVICES: THE HOSPITAL'S SUBSIDIZED HEALTH SERVICES REPRESENT A SIGNIFICANT PORTION OF MIDDLESEX HOSPITAL'S ANNUAL COMMUNITY BENEFIT AGGREGATE FINANCIALS AND NUMBERS SERVED. SUBSIDIZED SERVICES ARE PARTICULAR CLINICAL PROGRAMS PROVIDED TO THE COMMUNITY DESPITE A FINANCIAL LOSS, WITH NEGATIVE MARGINS REMAINING AFTER SPECIFIC DOLLARS (FINANCIAL ASSISTANCE AND BAD DEBT) AND SHORTFALLS (MEDICAID) ARE REMOVED. IN ORDER TO QUALIFY AS A SUBSIDIZED SERVICE, THE PROGRAM MUST MEET CERTAIN HEALTH DELIVERY CRITERIA; MEET AN IDENTIFIED NEED IN THE COMMUNITY; AND WOULD BECOME UNAVAILABLE OR THE RESPONSIBILITY OF A GOVERNMENTAL OR ANOTHER NOT-FOR-PROFIT AGENCY TO PROVIDE IF THE HOSPITAL DISCONTINUED THE SERVICE. MIDDLESEX HOSPITAL'S SUBSIDIZED SERVICES INCLUDE FAMILY PRACTICE SERVICES, BEHAVIORAL HEALTH (INPATIENT AND OUTPATIENT), HOMECARE, PARAMEDICS, HOSPICE, CENTER FOR CHRONIC CARE MANAGEMENT DISEASE MANAGEMENT OUTPATIENT PROGRAMS (ADULT ASTHMA; CHILD ASTHMA; DIABETES EDUCATION AND DISEASE MANAGEMENT; MEDICAL NUTRITION THERAPY; SMOKING CESSATION; CHRONIC HEART FAILURE; AND CHILDHOOD WEIGHT MANAGEMENT); AMBULATORY INFUSION, CARDIAC REHAB, AND WOUND CARE. IN FY21 THE HOSPITAL'S SUBSIDIZED SERVICES SERVED 25,392 PEOPLE WITH A TOTAL COST OF $20,023,422 TO THE HOSPITAL. RESEARCH: MIDDLESEX HOSPITAL CONDUCTS RESEARCH IN THE DOMAINS OF CLINICAL AND COMMUNITY HEALTH. CLINICAL EXAMPLES INCLUDE NATIONAL TRIALS BY THE HOSPITAL'S CANCER CENTER FOR BREAST, LUNG, PROSTATE, COLORECTAL, AMONG OTHERS. FOR FY21, THE HOSPITAL'S ASSOCIATED COSTS FOR ALL (NON-INDUSTRY) RESEARCH PROJECTS TOTALED $294,902 AND SERVED 160 INDIVIDUALS. FINANCIAL AND IN-KIND CONTRIBUTIONS: MIDDLESEX HOSPITAL SUPPORTS THE COMMUNITY IN THE FORM OF FINANCIAL AND IN-KIND CONTRIBUTIONS. THE HOSPITAL'S MAIN CAMPUS AND SATELLITE LOCATIONS MAKE MEETING SPACE AVAILABLE, FREE-OF-CHARGE AND ON AN ON-GOING BASIS, FOR MANY COMMUNITY GROUPS THAT WOULD OTHERWISE STRUGGLE TO PAY FOR SPACE. IN ADDITION, EACH YEAR THE HOSPITAL MAKES SUBSTANTIAL CASH DONATIONS TO CAREFULLY SELECTED MISSION-DRIVEN COMMUNITY ORGANIZATIONS THROUGHOUT ITS SERVICE AREA. THE HOSPITAL'S FY21 SUPPORT FOR FINANCIAL AND IN-KIND CONTRIBUTIONS TOTALED $404,622, SERVING 1,339 INDIVIDUALS. COMMUNITY BENEFIT OPERATIONS: COMMUNITY BENEFIT OPERATIONS INCLUDE ACTIVITIES AND COSTS ASSOCIATED WITH COMMUNITY BENEFIT STRATEGIC PLANNING, ADMINISTRATION, ANNUAL GOAL ATTAINMENT, AND COMMUNITY HEALTH NEEDS ASSESSMENT PRODUCTION AND IMPLEMENTATION. MIDDLESEX HOSPITAL HAS A DEDICATED DIRECTOR OF COMMUNITY BENEFIT AND A REPORTING STRUCTURE THAT OVERSEES COMMUNITY BENEFIT PLANNING AND OPERATIONS. OUTSIDE OF ON-GOING COMMUNITY BENEFIT ACTIVITIES, KEY COMPONENTS OF THE HOSPITAL'S COMMUNITY BENEFIT PROGRAM IS CONDUCTING A COMMUNITY HEALTH NEEDS ASSESSMENT AND DEVELOPING A CHNA IMPLEMENTATION STRATEGY EVERY THREE TAXABLE YEARS, ENSURING THAT THE CHNA IMPLEMENTATION STRATEGY GOALS ARE ADDRESSED THROUGH COLLABORATION WITH COMMUNITY PARTNERS, AND FOCUSING ON HEALTH EQUITY AND HEALTH-RELATED SOCIAL NEEDS. THE HOSPITAL'S FY21 COMMUNITY BENEFIT OPERATIONS EXPENSE TOTALED $133,031.