Illinois Administrative Code › Title 59 - MENTAL HEALTH › Part 106 - SERVICES CHARGES › Section 106.45 - Determination of ability to pay services charges

Current through Register Vol. 48, No. 28, July 12, 2024
a) The Department, in determining the ability
			 of the responsible person (recipient, responsible relative, guardian, trustee
			 and/or payee) to pay services charges, shall assemble any necessary information
			 pertaining to his or her financial status and shall then set the amount for
			 which the responsible person shall be held liable. Recipients and all
			 responsible persons must furnish financial information on admission or as soon
			 thereafter as possible to enable the Department to make a proper determination
			 of the sources available for the cost of services charges. The liability for
			 payment of services charges shall be based on information available at the time
			 of determination. (Such data may include savings, trusts, wills, evidence of
			 indebtedness, evidence of court-ordered payments, and the like.) Each person
			 for whom a determination has been made shall be issued a form DMHDD-612, Notice
			 of Determination, notifying the person of his or her liability. Such notice
			 shall be issued even when current determined liability is $0.00.
b) When there is a demonstrated ability to
			 pay, payment for services is an obligation established by Sections 5-100
			 through 5-117 of the Mental Health and Developmental Disabilities Code [405
			 ILCS 5/5-100 through 5 -117] against the recipient, responsible relatives,
			 guardians, trustees and/or payees.
c) If the responsible person fails to submit
			 financial information as requested, the Department may assess services charges
			 at the maximum rate of charge as provided in Section
			 106.25 until
			 such information is supplied and an actual assessment can be determined. In the
			 absence of billing during the period covered in such instances, the Department
			 may consider that notices and requests for information as previously sent shall
			 constitute ample notice of liability and indebtedness for such period. However,
			 in subsequent review or annual redetermination involving responsible relatives,
			 no services charges shall be retroactively established prior to the date of
			 contact for financial information.
d) Subsequent review could be initiated by
			 the recipient of services prior to the annual redetermination due to changes in
			 ability to pay or as a result of an administrative hearing or by the Board of
			 Reimbursement Appeals. Recipients and responsible relatives have a
			 responsibility to inform the Department of any changes.
e) Liability of responsible relatives shall
			 be reviewed annually and such responsible relatives shall be requested to
			 submit copies of their most recent U.S. Individual Income Tax Return. This
			 information will be used as a basis for determining services charges in
			 accordance with this Part and the schedule of charges in Section 106.Table A of
			 this Part.
f) The determination by
			 the Department of the liability of a responsible person to pay an amount up to
			 the maximum rate as established in Sections
			 106.25 and
			 106.25(b)
			 shall continue in force until the Department determines a different amount on
			 the basis of changes in circumstances surrounding the person's ability to pay,
			 or until a change has been made in the standards of ability to pay set forth in
			 Sections
			 106.25 and
			 106.25(b)
			 or until a release from or a modification of services charges is granted upon a
			 hearing on the petition of a person liable in accordance with Section
			 106.75
			 and Section 5-111 of the Mental Health and Developmental Disabilities Code
			 [405 ILCS
			 5/5-111 ].
g) The determination of the ability to pay
			 and amount of liability of the recipient for services charges, up to the
			 prevailing maximum rate established for recipients in Section 106.25, shall be
			 based on all assets and income of the recipient. After considering the
			 recipient's legal dependent's financial needs as covered in subsection (k) of
			 this Section, all resources and assets are reduced to the allowable reserve
			 exemption in accordance with subsection (h) of this Section.
h) The allowable reserve exemption, as
			 provided for in Section 5-106 of the Mental Health and Developmental
			 Disabilities Code [405 ILCS 5/5-106 ], is
			 determined by the amount of assets owned at the time of the recipient's
			 admission except that the allowable reserve exemption from all sources cannot
			 exceed that established by the Illinois Department of Public Aid at 89 Ill.
			 Adm. Code
			 120.382. The
			 recipient's allowable reserve exemption can only be increased by the unused
			 portions of the monthly personal and clothing allowance or unspent workshop or
			 other monetary incentive funds , such as living skills program funds. Payments
			 to be paid by the recipient for services charges may not be deferred to build a
			 reserve up to the maximum amount allowed.
i) If the recipient becomes eligible and is
			 approved for Medicaid ( 42 U.S.C.A. 1396a(1996) ), 42 CFR 430(1996) and the
			 Department of Public Aid's rules at 89 Ill. Adm. Code
			 120.40
			 and
			 120.382 govern
			 the allowable reserve and personal and clothing allowance.
j) The Department shall allow deductions from
			 income for a community spouse maintenance needs allowance and a family
			 maintenance needs allowance for each dependent family member who does not have
			 enough income to meet his or her needs. Family members include dependent
			 children under age 21, dependent adult children, dependent parents or dependent
			 siblings of either spouse who are living with the community spouse. To
			 determine the amount of the deduction:
1) The
			 deduction for the community spouse maintenance needs allowance, as set forth in
			 the Department of Public Aid's rule at 89 Ill. Adm. Code
			 120.61(d),
			 is equal to the community spouse maintenance needs standard less any non-exempt
			 monthly income of the community spouse. The deduction is allowed only to the
			 extent that income of the spouse who is receiving services at a
			 Department-operated facility is contributed to the community spouse. However,
			 the deduction for the community spouse maintenance needs allowance shall not be
			 less than the amount ordered by the court for support of the community spouse
			 or the amount determined as the result of the fair hearing.
2) The deduction for the family maintenance
			 needs allowance for each dependent family member is equal to one-third of the
			 difference between the family maintenance needs standard and any non-exempt
			 income of the family member as set forth in the Department of Public Aid's rule
			 at 89 Ill. Adm. Code
			 120.61(d).