180-RICR-10-00-2. Rhode Island Veterans Home: Administrative Procedures for the Billing and Collection of Maintenance Fees (version Technical Revision, 01/12/2017 to 01/12/2017)

2.1 Introduction A. The Director of Veterans Affairs is authorized under R.I. Gen. Laws §§ 30-17.1-2, 30-17.1-5 and 30-17.1-6 to establish appropriate rules and regulations governing the maintenance fees at the Rhode Island Veterans Home. B. The Administrator of the Rhode Island Veterans Home is the responsible person delegated by the Director of Veterans Affairs to administer these rules and regulations for the billing and collection of maintenance fees at the Rhode Island Veterans Home. C. These regulations adhere to the requirements of Title VI of the Civil Rights Act of 1964 (42 U.S.C. § 200d, et seq.) and Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. § 794), and the Department of Health and Human Services implementing regulations (45 C.F.R. Parts 80 and 84). D. The Office of Veterans Affairs does not discriminate on the basis of race, color, national origin, or handicap in acceptance for or provision of services or employment in its programs and activities. Under the provisions of applicable law, the Office of Veterans Affairs does not discriminate on the basis of sex, age, creed or political belief. 2.1.1 Statutory Requirements A. Pursuant to R.I. Gen. Laws § 30-24-10, the Director shall at the end of each fiscal year, determine the net per diem expenses of maintenance of residents in the facility and shall assess against each resident who has net income, as defined herein, a fee equal to eighty percent (80%) of the resident's net income, provided that such fee shall not exceed the actual cost of care and maintenance for such resident. B. Net income is defined as gross income minus applicable federal and state taxes and minus 1. an amount equal to one hundred fifty dollars ($150) per month of residency, 2. fifty percent (50%) of any sum received due to wounds incurred under battle conditions for which the resident received the Purple Heart, 3. the amount paid by a resident for the support and maintenance of his or her spouse, parent(s), minor child(ren), or child(ren) who is/are blind or permanently and totally disabled as defined in Title XVI of the Federal Social Security Act subject to a maximum amount to be determined by rules and regulations as shall be adopted by the Director. 2.2 Domiciliary Care Program for Homeless Veterans (Veterans Transitional Supportive Program- VTSP) A. Pursuant to R.I. Gen. Laws § 30-24-10.1, the Director of Veterans Affairs is hereby authorized and empowered to establish and maintain a domiciliary care program for homeless veterans (Veterans Transitional Supportive Program, VTSP) at the Rhode Island Veterans Home. B. Any veteran admitted to the Rhode Island Veterans Home pursuant to this section shall be exempt from the maintenance fee assessment established pursuant to R.I. Gen. Laws § 30-24-10, provided, however, that the director shall assess against each veteran admitted under this program a monthly maintenance fee equal to ten percent (10%) of the veteran's monthly gross income, from whatever source derived and whether taxable or nontaxable. C. There will also be additional beds called “Extended VTSP” beds to which a monthly maintenance fee of thirty percent (30%) of the veteran's monthly gross income, from whatever source derived and whether taxable or non-taxable, will be charged. 1. Extended VTSP will be available to eligible veterans in the VTSP program, but occupancy will not exceed four (4) months. 2. The maintenance fee shall be paid monthly to the Veterans Home and shall be deposited in the Veterans Home fund. Any failure to make payment when due shall be cause for dismissal from the facility. Prior to any dismissal for non-payment of fees, the veteran shall be afforded administrative due process. 2.3 Financial Statement A. Each person shall upon admission to the Home file a financial statement. The financial statement shall be used as the basis to establish the resident's charge. B. It shall be the responsibility of the resident, guardian, or fiduciary to report to the Business Office of the Home any changes in income received for the resident within ten (10) days of receipt of such income. C. Each resident shall file a revised financial statement - no later than March 31st of each year. In addition thereto, each resident whose source or amount of income has changed shall complete a new financial statement within (10) days of receipt of such notice of change or of receipt of the income payments. The revised financial statement shall be used to reestablish the resident's monthly maintenance fee. 2.4 Gross Income Defined A. Gross income is defined as earnings, pensions, and other benefits and all other monies received, including but not limited to the following: 1. Social Security (i.e., Old-Age Survivors, and Disability Insurance) 2. Temporary disability insurance 3. Employment security benefits 4. Veterans administration benefits 5. Railroad retirement benefits 6. Civil Service annuity 7. Worker's compensation 8. Prizes (Monetary) 9. Awards (Monetary) 10. Inheritance (Monetary) 11. Gifts (Monetary) 12. Rents 13. Interest 14. Dividends 15. Royalties 16. Alimony 17. Insurance proceeds 18. Allotments 19. Military Retirement 20. Trust accounts 21. Gains on sale of real and personal property including the sale of home 22. Any other source of income B. Retroactive benefits payments shall be subject to the maintenance fee for the period of time covered by the benefit award and shall be added to all other income previously reported for the benefits period. The Home will then re-compute the maintenance fee previously determined for the benefit period and the resident will be billed for the full amount of any additional maintenance fee due for the benefit period. C. Interest and dividends shall be prorated over a 12-month period commencing with the first month of each calendar year based on the amount received by the resident during the previous 12-month period. D. All residents shall be required to apply for any income benefit to which the resident may be entitled. If requested by the Home, the resident or his/her guardian, conservator, or fiduciary shall authorize the Home to process the necessary application to secure such benefit. 2.5 Deductions from Gross Income A. Prior to the determination and collection of any maintenance fee, the following deductions shall be allowed: 1. Federal and State taxes. 2. An amount equal to $150 per month for personal needs. 3. Patient Employee pay and therapeutic earnings. 4. Fifty percent (50%) of any sum received due to wounds incurred under battle conditions for which the resident received the Purple Heart. 5. Guardianship Fees. 6. Support allowance. 7. Medicare Part B. 2.5.1 Federal and State Taxes A. It shall be the responsibility of the resident to provide evidence of amounts paid for federal and state taxes by submitting to the Home's Business Office a true copy of the federal and state tax forms or submission of a canceled check or money order made payable to the federal and/or state governments for such taxes. B. Such amounts paid for federal and state taxes shall be deducted from gross income for the month in which the verification is submitted to the Home's Business Office prior to determining the maintenance fee. Any tax payments in excess of gross income in a particular month shall be carried forward and deducted from the following month(s) gross income. 2.5.2 One Hundred Fifty Dollar Deduction An amount equal to one hundred fifty dollars ($150) per month shall be deducted from the resident's gross income prior to determining the maintenance fee and any patient employee pay. 2.5.3 Special Therapeutic Personal Needs Deduction A. Therapeutic employment in the public and private sector or sheltered workshops shall be subject to the maintenance fee as specified below. 1. Such employment must be part of a written plan with the resident. 2. In addition to the basic personal needs (Section 106) of $150 allowed by state law an additional $85 plus one-half (1/2) the remainder of earned income per month may be protected for personal needs. The maximum combined personal needs deduction cannot exceed $330 per month. Example: $150 + $85 + ($129 maximum) = $330) 2.5.4 Purple Heart Deduction A. An amount equal to fifty percent (50%) of any sum received due to wounds incurred under battle conditions for which the resident received the Purple Heart shall be deducted from gross income prior to determining the maintenance fee. B. It is the responsibility of the resident to provide evidence such as the Purple Heart order or any service records which states that the Purple Heart was awarded to the resident. The Business Office will assist the resident in the verification of the Purple Heart Award. 2.5.5 Guardianship Income/Fees A. For purpose of these regulations "Guardianship Fees" shall mean: guardian fees, attorney fees, probate filing fees, and related expenses such as guardians, bonds. B. As state law requires the guardian to file an accounting each year with the appropriate court, it shall be the guardian's responsibility to submit a copy of said annual accounting to the Rhode Island Veterans Home in the same month as approved by the court. C. From the accounting the guardianship fees as stated above shall be used to determine the amount to be subtracted each month from the resident's gross income. 2.5.6 Support Deduction A. For purpose of determining the maintenance fee, there shall be a deduction from the gross income the amount paid by a resident for the support and maintenance of his or her spouse, parent(s) or minor child(ren). For purposes of this regulation, determinations for a common law spouse will be based on Rhode Island law and 38 U.S.C. § 103(c). This amount is subject to a maximum to be computed based on the supported person's income as related to the cost of living scale below. B. For purpose of determining the maintenance fee, there shall be a deduction from gross income the amount paid by a resident for the support and maintenance of his or her adult child who is permanently and totally disabled as defined in Title XVI of the Federal Social Security Act, subject to a maximum amount to be computed based on the supported person's income as related to the adopted cost of living scale. C. Verification of Support 1. The resident must provide support prior to admission. 2. The resident and/or person to be supported must provide evidence as to manner/method, amount and beginning of support. D. Amount of Support 1. When the supported person's income is below the cost of living scale for the family size, the resident will be allowed a deduction in an amount that will, when added to the supported person's income, provide the supported person total income equal to the cost of living scale for the family size. 2. Any support allowance authorized for a minor shall be provided to that responsible person having custody of the minor. 3. A support allowance may not be authorized for any person who is confined to a private or public institution when payment for their care is from a public agency. E. When supported person(s) income is in excess of the cost of living scale, no deduction will be granted for that person. F. It shall be the responsibility of the resident to provide evidence of amounts paid for the support and maintenance of any person and to submit a supported person's statement of income (Bus. 18 for each person). G. Each resident shall file a revised supported persons Statement of Income (Bus. 18) -no later than March 31st each year. In addition, the resident shall file a revised supported persons Statement of Income (Bus. 18) for each person whose source or amount of income changes. H. Any change in support status shall be reported immediately by the resident. I. Failure to report correct financial data of the supported person resulting in the determination/granting of an erroneous support allowance shall be cause for the discontinuance of the resident's support allowance. Any indebtedness owed the State of Rhode Island shall be paid in full or by other appropriate arrangements before a support allowance is authorized again. 2.5.7 Cost of Living Scale INCOME* MONTHLY INCOME ANNUALLY 1. $1,980 $23,760 2. $2,670 $32,040 3. $3,360 $40,320 4. $4,050 $48,600 5. $4,740 $56,880 6. $5,430 $65,160 Reference: U.S. Department of Health & Human Services and the RI Executive Office of Health & Human Services: Income Qualification Guidelines *Income as used in this instance means the gross earned or unearned income. 2.6 Verification of Data The Home reserves the right to verify and confirm any data from any agency or person having custody of such data the resident or dependent has submitted on the Financial Statement (Bus. 17) and/or the supported person's Statement of Income (Bus. 18) to insure the proper determination of the maintenance fee. 2.7 Per Diem Cost A. The Director shall, at the end of each fiscal year (June 30), determine the net per diem expenses of maintenance of residents in the facility for nursing and domiciliary care which shall be used as the basis for all maintenance fees assessed during the twelve (12) month period commencing the following January 1 of each year. PER DIEM COST Fiscal Year Ending June 30, 2016 Nursing Care (per day) Actual Cost Less VA Allowance $449.21 $103.61 $345.60 B. It shall be the responsibility of each resident or his/her fiduciary to see that his/her established maintenance fee is paid in full at the Home's business office on/or before the tenth (10th) calendar day of each month. 2.8 Maintenance Fees A fee equal to eighty percent (80%) of the resident's net income shall be assessed against each resident who net income provided that such fee shall not exceed the actual cost of care and maintenance for such residents. 2.8.1 Payment of Maintenance Fees A. Each resident shall be billed on the first day of each month on his or her Statement of Charges for the maintenance fee assessed for the current month of residency. B. A resident whose funds are on deposit with the Home's designated bank may sign an automatic withdrawal slip to have his/her maintenance fee automatically withdrawn from his/her account. Said resident shall not receive a Statement of Charges each month. C. Monthly maintenance fees in an amount under one dollar ($1.00) shall be exempt from the collections process. D. All residents (admitted after July 1, 2001) will be billed on the tenth day of each month on Statement of Charges for the number of days in the current month. E. When a resident is admitted after the first day of the month, the first month's maintenance fee shall be based on the number of days remaining in the month including the day of admission. 2.8.2 Hospitalized Residents A. When a resident is hospitalized, his/her maintenance fee shall not be decreased, abated, or otherwise affected by the hospitalization unless the resident is discharged from the Home. B. However, if the hospitalized resident elects to relinquish a bed, that resident shall be discharged. Once the resident has been discharged he shall have the right to reapply for admission subject to the procedures for the application and admission of veterans to the Rhode Island Veterans Home. C. If no election to relinquish a bed is made by either the resident or his nominee within fifteen (15) days from the date of absence, the resident shall be maintained on the roles subject to the procedure for billing and collection of maintenance fees at the Rhode Island Veterans Home. 2.8.3 Inter-ward Transfers Should a resident be transferred from one area of care to another, his/her maximum maintenance fee charge shall be adjusted to reflect the area of care the resident is receiving the new rate shall take effect the day after the transfer. 2.8.4 Resident on Pass, Leave or AWOL A. The maintenance fee for a resident who is absent from the Home on pass, extended leave, or absent without official leave (AWOL) shall not be decreased, abated, or otherwise affected unless the resident is discharged from the Home. B. If such resident chooses to relinquish a bed, that resident will be discharged. Once the resident has been discharged he shall have the right to reapply for admission subject to the procedures for the application and admission of veterans to the Rhode Island Veterans Home. C. If no election to relinquish a bed is made by either the resident or his nominee within fifteen (15) days from the date of absence, the resident shall be maintained on the roster subject to the procedures for billing and collection of maintenance fees at the Rhode Island Veterans Home. 2.8.5 Discharges A. Upon being discharged the resident shall be responsible to make full payment of all maintenance fees incurred through the day of discharge. B. The resident's per diem rate for the month of discharge shall be based on the number of days the resident was carried on the books. 2.8.6 Failure to Pay Maintenance Fees A. Maintenance fees shall be paid monthly to the Home and any failure to make payment when due shall be the cause for dismissal from the facility. Prior to dismissal, the resident shall be afforded administrative procedural due process in accordance with § 2.10 of this Part. B. A veteran who has been discharged for non-payment of maintenance fees or who has left the Home without paying his/her maintenance fees, who applies for readmission to the Home must pay any indebtedness owed the State of Rhode Island in full prior to readmission. 2.9 Net Income Net income is defined as gross income minus federal and state taxes, minus an amount equal to one hundred fifty dollars ($150) per month of residency for personal needs, minus any patient employee pay, minus an amount equal to fifty percent (50%) of any sum received due to wounds incurred under battle conditions for which the resident received the Purple Heart, minus guardianship fees allowed in § 2.5.5 of this Part, and minus the amount paid by a resident for the support and maintenance of a dependent(s) subject to the maximum dependent deduction allowed in § 2.5.6 of this Part. 2.10 Rights to Appeal A. A resident or his/her fiduciary who is not in agreement with the maintenance fee assessment or any other determination made pursuant to these rules and regulations may request an informal review by the Assistant Administrator. 1. A resident or his/her fiduciary shall make an oral or written request for such an informal review at the Business Office of the Home within ten (10) days of receipt of the maintenance fee assessment or other determination. The determination of the Assistant Administrator is subject to further informal review by the Associate Director upon oral or written request to the Office of the Associate Director within ten (10) days of the determination of the Assistant Administrator. 2. If a resident or his/her fiduciary is aggrieved by the determination of the Associate Director, he/she may within ten (10) days thereof file a written request for a formal hearing before the Director of Veterans Affairs or his or her designee. This formal hearing shall be conducted in accordance with the provisions of the Rhode Island Administrative Procedures Act (R.I. Gen. Laws Chapter 42-35) which require, in part, that a record of hearing be made and that all parties be afforded the opportunity to respond and present evidence and argument on all issues involved. The decision of the Director or his or her designee shall be in writing and a copy thereof delivered or mailed to each party. 3. If a resident or his/her fiduciary is aggrieved by the decision of the Director or her designee, he/she may seek judicial review of the decision in the Superior Court of the State. 4. If a resident or his/her fiduciary requests an informal review or formal hearing, he/she may be represented by an authorized representative, such as legal counsel, relative, friend, or other person.