Periodic

PAYMENTS BY NON-INDIGENT SERVICE RECIPIENTS OR RESPONSIBLE RELATIVES. (1) Service recipients and their responsible relatives, if any, shall be liable for charges incurred for care received at a RMHI during any period of non-indigence as determined under this chapter. (2) The state has a continuing claim against a service recipient or responsible relative or his or her estate for any unpaid difference between the amount owed and the amount paid for care from a RMHI for any period of non-indigence. (3) At any time, a service recipient or responsible relatives may request a periodic payment plan under which a monthly payment amount will be established. (4) In cases where the service recipient or responsible relatives have a public or private third party payor, the periodic payment plan may apply to the agreed deductible, co-payments or any portion of the charges not reimbursed by the third party provided that the RMHI has not agreed to accept the third party payment as payment in full. (5) A payment plan may be established only when the service recipient’s and all responsible relatives’ net worth is less than the sum of $50,000 plus 500% of the Federal Poverty Guidelines. (6) Person(s) designated by the RMHI Chief Officer shall determine whether a service recipient or responsible relative meets net worth requirements specified in Rule 0940-02-05-.04(5) to be eligible for a payment plan, and, if so, establish the amount of the monthly payment according to the schedule in Rule 0940-02-05-.04(11). (7) The Department may review and alter a periodic payment plan at any time. (8) If the service recipient or responsible relative does not agree with the initial or subsequent determination, either person may request that the RMHI’s Chief Officer review the decision. If the service recipient or responsible relative does not agree with the determination of the RMHI’s Chief Officer, then either person may request that the Commissioner or designee make a final determination. (9) The service recipient or responsible relative may request review and alteration of a payment plan determination any time a change in income or net worth can be demonstrated. (10) A person shall be liable for the total charges for care by an RMHI and for the amount of the state’s expense incurred in recovering the amounts, including attorney salaries or fees, unless declared eligible to receive a payment plan under this rule. In order to be declared eligible to receive a payment plan, the person or responsible relative shall: (a) Provide TDMHSAS with information TDMHSAS deems necessary to establish a payment plan; or REGIONAL MENTAL HEALTH (RMHI) CARE AT THE EXPENSE CHAPTER 0940-02-05 OF THE STATE AND PERIODIC PAYMENTS (b) Provide TDMHSAS with a written release allowing TDMHSAS to access any information TDMHSAS deems necessary to establish a payment plan. (11) A person or responsible relative who knowingly provides false information that results in an inaccurate establishment of a payment plan shall be liable for the total charges for care by an RMHI and for the amount of the state’s expense incurred in recovering the amounts, including attorney salaries or fees. (12) The following monthly payment plan shall be established for service recipients or responsible relatives who request a payment plan and meet the net worth requirement stated in Rule 0940-02-05-.04(5). Service recipient’s income as a percentage of Federal Poverty Guidelines (FPG) Formula for monthly payment amount 100% but less than 150% FPG 5% of the monthly equivalent of 100% FPG for a family size of one 150% but less than 200% FPG 5% of the monthly equivalent of 150% FPG for a family size of one 200% but less than 250% FPG 5% of the monthly equivalent of 200% FPG for a family size of one 250% but less than 500% FPG 5% of the monthly equivalent of 250% of FPG for a family size of one Over 500% FPG 5% of average monthly income