Presentation on theme: "8/8/2015 Charges for Community Based Services. 8/8/2015 Introduction Purpose is to establish a uniform fee collection policy that: Is equitable Provides."— Presentation transcript:
8/8/2015 Introduction Purpose is to establish a uniform fee collection policy that: Is equitable Provides for collections Maximizes contributions to local revenue
8/8/2015 Support the following principles 1. Persons are charged for services based on ability to pay. 2. Procedures are fair, equitable and consistently implemented. 3. Paying for services reinforces role as a customer. 4. Earned revenues are optimized. 5. The department is the payer of last resort.
8/8/2015 Persons eligible for services must not be denied because of inability to pay. Persons in crisis must not be denied services if financial is not assessed, past due account or has service involuntarily reduced or terminated due to non-payment. Person cannot be denied services if there is a pending resolution of an issue relating solely to payment.
8/8/2015 Hill Country MHMR is responsible to identify and access available resources Third Party coverage State and/or local governmental agency funds Qualified Medicare Beneficiary Program Indigent Pharmaceutical programs Trust funds that provide health care
8/8/2015 CHILDREN WHO MAY BE ELIGIBLE FOR CHIP OR MEDICAID Family must apply for these services. If they fail to comply, they will be charged full standard fees after 30 days. This does include medications.
8/8/2015 ADULT PERSONS WHO MAY BE ELIGIBLE FOR MEDICAID Must apply for SSI Or provide proof of denial Consumer Benefits tool must be completed when services begin and annually at a minimum. Recovery coach completes when consumer has no benefits. Support staff complete if they do have benefits
8/8/2015 Medicare Part D Consumers who are full subsidy eligible must choose and enroll in a Medicare D Plan. Hill Country MHMR support staff educate on the benefits of enrollment. Hill Country MHMR support staff educate consumers who are not eligible for full subsidy. Hill Country does not pay for drug co-pays and deductibles. Staff assist with Patient Assistance when available. If consumer is unable to enroll due to mental illness, lack of adequate notification or other circumstances, Hill Country MHMR will continue to provide medications.
8/8/2015 Financial Assessment Completed and documented for each person within first 30 days of services Updated annually Note: Hill Country procedure is that staff are required to complete the financial assessment at Intake. However the rule states 30 days.
8/8/2015 Required Financial Documentation Proof of annual or monthly income/earnings Proof of extraordinary expenses Number of family members and ages Number of family members receiving services Third party coverage
8/8/2015 Proof of income that can be accepted (all must be current) Pay stubs Income tax form Medicaid card Medicare card SSI/SSDI/Social security benefits award letter Copy of bank statement if Social Security is direct deposited (cannot be used for any other income documentation) Statement from employer Statement from consumer Statement from someone who supports consumer TANF award letter/food stamps award letter Medicare Part D card
8/8/2015 Extraordinary expenses Medical expenses – doctor, medication or hospital bills that are being paid Child care expenses – day care or babysitter Major casualty loss – house burns, flood These must be documented by a current paid receipt
8/8/2015 Failure to Provide Financial Documentation Will result in being charged full standard rate for services unless: Failure is related to person’s mental illness as determined by interdisciplinary team. Team determines enforcement could result in reduction of function. Waiver of Fees form is completed AND MUST BE SIGNED by physician/LPHA. Determination is reassessed at least every 90 days.
8/8/2015 Maximum Monthly Fee (MMF) Calculation is based on number in family Annual gross income reduced by verified extraordinary expenses paid or projected
8/8/2015 INABILITY TO PAY A MAXIMUM MONTHLY FEE OF ZERO ESTABLISHES WHO IS DETERMINED AS HAVING AN INABILITY TO PAY BASED ON FINANCIAL ASSESSMENT. NO OTHER MINIMUM FEES MAY BE ASSESSED
8/8/2015 ABILITY TO PAY A PERSON WHO HAS THIRD PARTY COVERAGE HAS THE ABILITY TO PAY
8/8/2015 WHAT IS GIVEN TO CONSUMER TO INFORM AND NOTIFY 1. BROCHURE 2. COPY OF FINANCIAL FORM WITH SIGNATURE PAGE 3. COPY OF FEE SCHEDULE WITH MMF HIGHLIGHTED 4. COPY OF SIGNED CONSENT FOR SERVICES FORM
8/8/2015 WHAT IF A CONSUMER DOES NOT WANT TO DISCLOSE THEIR INCOME 1. THEY SIGN THE PAGE FOUR OF THE FINANCIAL 2. INDICATE ON THE FINANCIAL PORTION REFUSED TO GIVE INCOME 3. HAND THEM THE COST FOR SERVICES AND EXPLAIN THEY WILL NOW BE PAYING 100% OF CHARGES 4. GIVE THEM A COPY OF THE SIGNED FINANCIAL, MMF SCALE, AND BROCHURE
8/8/2015 HOW DO WE MAKE REASONABLE EFFORTS TO COLLECT Mail statements Request payments from consumers in the clinic visit Document efforts – refer to clinic directors/business managers/recovery coaches
8/8/2015 FINANCIAL HARDSHIPS MUST BE DOCUMENTED HIGH UTILITY BILL CAR REPAIRS EDUCATION COSTS ANYTHING THAT MIGHT CAUSE A HARDSHIP – what might those be?
8/8/2015 SUMMARY IN ORDER TO COMPLETE A FINANCIAL ONE NEEDS TO HAVE THE FOLLOWING: 1. NUMBER OF FAMILY MEMBERS 2. AGE RANGES OF FAMILY MEMBERS 3. EXTRAORDINARY EXPENSES 4. THIRD PARTY COVERAGE 5. MARITAL STATUS OF FAMILY MEMBERS 6. GROSS INCOME FINANCIAL/DEMO MUST BE COMPLETED FIRST 30 DAYS OF SERVICES AND ANNUALLY
8/8/2015 FAILURE TO SUBMIT DOCUMENTATION WILL RESULT IN 100% PAY FOR SERVICES. THE CONSUMER IS GIVEN THE BROCHURE/COPY OF FINANCIAL/PAY FEE SCHEDULE. FINANCIAL HARDSHIPS ARE APPROVED BY CENTER DIRECTOR. WE COLLECT WITH CLIENT STATEMENTS. Notes on family size. A Person who is aged 18 or older is considered an adult regardless if they live with parents. Family members include children under age of 18 who are adopted or biological relation to person in service. Family members include legally married spouses regardless of age. We do not count children’s income.