Appeal from Computation of Adjusted Income and or Determination of Assessment

A patient who is aggrieved by a computation of adjusted income or by a determination of reduced charge assessment or by the denial of free care shall have the right to appeal to an intra-hospital committee composed of the superintendent of the hospital, a member of the social service department and three other persons appointed by the superintendent. (A) The patient shall receive written notice of this appeal right along with the written determination of assessment, (or denial of assessment) required by 105 CMR 920.007(D). The notice shall briefly outline the appeal procedure set forth herein. (B) The patient shall submit a written statement to the committee explaining his disagreement with the determination. He shall include any other written documentation that he believes to be relevant. (C) The patient shall not be granted ahearing before this committee unless he requests the opportunity to appear personally or through a representative. (D) The Committee may, considering all available evidence, make a determination of reduced charge assessment, usingeither the methods set forth in 105 CMR 920.005 and 105 CMR 920.006, and/or any other relevant factors relating to ability to pay. (E) If the Committee upholds the initial determination made with respect to the patient, no further appeals shall be granted.