Compilation of Rules and Regulations of the State of Georgia › Department 82 - DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL DISABILITIES › Chapter 82-7 - PATIENT COST OF CARE › Subject 82-7-1 - PATIENT COST OF CARE › Rule 82-7-1-.04 - Definitions

Current through Rules and Regulations filed through June 27, 2024
(1) Unless a different meaning is required by the context, the following terms as used in these regulations shall have the meanings hereinafter set forth:
(a) "Assessment" means a determination by the Department of the amount payable by the persons liable for cost of care for services rendered to an individual; such amount shall be either the full cost of care or, if applicable, the amount payable toward cost of care, determined in accordance with the requirements of O.C.G.A §
										37-9-5. There shall be a rebuttable presumption that the full cost of care be imposed. This presumption shall prevail until testimony, documentation, or evidence is provided pursuant to other provisions of O.C.G.A Title 37, Chapter 9.
(b) "Commissioner" means the Commissioner of the Georgia Department of Behavioral Health and Developmental Disabilities, or the Commissioner's designee.
(c) "Cost of care" means the costs incurred for the support, care, and treatment of each individual, or the per patient average of such costs as determined by the Department on the basis of the estimated current operating costs of the hospital or an identifiable part or section thereof providing such services.
(d) "Department" means the Georgia Department of Behavioral Health and Developmental Disabilities and includes its duly authorized agents and designees.
(e) "Hospital Chief Financial Officer" means that person appointed by DBHDD's Chief Financial Officer or their designee to manage the administration of the Patient Cost of Care Program.
(f) "Income," except for individuals who are residents of other states, means that amount determined by adding to the gross income as now or hereafter defined in Georgia income tax laws, minus deductions and personal exemptions as authorized by such income tax laws, in addition to the items listed in this paragraph, if such items are not already included in gross income as defined above. For an individual who is a resident of another state, "income" means the same as above except no deductions will be made for any deductions or personal exemptions as authorized by Georgia income tax laws. The following items are to be added, respectively:
1. Any amounts received by or on behalf of the person liable for cost of care from accident insurance or workers' compensation for total or partial incapacity to work, plus the amount of any damages received by or on behalf of the person liable for cost of care, whether by suit or agreement, on account of such injuries or sickness;
2. The net income from property acquired by gift, bequest, devise, or descent;
3. Interest upon obligations of the United States government or of this state or of a political subdivision thereof;
4. The net income from individual holdings of stock in banks and trust companies incorporated under the banking laws of this state or of the United States;
5. Retirement income, social security benefits, veterans' benefits, and any other benefits that could be applied for the support of the individual served;
6. The net income from any other assets, including but not limited to personal property, real property, mixed property, and any other property or estate wherever located and in whatever form, inclusive of any assets sold or transferred within a period of ninety (90) days prior to the date services were first rendered to the individual by a hospital.
(g) "Individual" (formerly referred to as client, consumer, and/or patient) means any person who is admitted to or who receives services from a state hospital, including any person who is admitted to or receives services from a facility operated by a state hospital.
(h) "Persons liable for cost of care" means:
1. The individual served or their estate;
2. The individual's spouse;
3. The parent or parents of any individual under eighteen (18) years of age who is served;
4. Any fiduciary or representative payee holding assets for the individual or on their behalf, including, in such person's representative capacity, the guardian, trustee, executor, or administrator of any trust, estate, inheritance, or fund in which an individual has a legal or beneficial interest;
5. Any person, if not otherwise liable, listed as the insured member of a contract, plan, or benefit to the extent that such contract, plan, or benefit provides payment of hospitalization, medical expenses, and other health care services for the individual as a covered beneficiary or dependent;
6. A stepparent or any other person residing with and providing support of an individual under eighteen (18) years of age who has not been legally adopted by such stepparent or other person, with maximum liability limited to the amount such stepparent or other individual is authorized by Georgia income tax laws to claim as a standard deduction and personal exemption for the individual receiving services; provided, however, that this limitation shall not apply to liability pursuant to other provisions of this chapter regarding hospital, health, and other medical insurance, program, or plan benefits or subrogation rights.
(i) "State hospital" means any state hospital which now or hereafter comes under the control of the Department and any facility operated in conjunction therewith. This includes facilities operated by state hospitals that are not located on state hospital grounds and that also provide care or services to individuals.