Ability-to-Pay Services Agreement Sample Contracts

OSHPD AB 774 Requirements• Hospital Application Forms
Ability-to-Pay Services Agreement • October 23rd, 2019

OSHPD Requirement Los Angeles County Armlication Form 1) Charity Care Ability-to-Pay (ATP) Services Agreement 2) Discount Payment Policy Ability-to-Pay (ATP) Services Agreement intended for LA County Residents Discount Payment Plan Agreement intended for non-LA County Residents. Also intended for LA County Residents for non- medically necessary cosmetic surgery and infertility related care, which is not covered by ATP.

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