Code of Massachusetts Regulations › 104 CMR - DEPARTMENT OF MENTAL HEALTH › Title 104 CMR 30.00 - Fiscal Administration › Section 30.04 - Charges for Services

Current through Register 1525, July 5, 2024
(1)
Scope
.
			 104
			 CMR 30.04 applies to services for which the
			 Department has an approved rate and that are provided by Department operated or
			 contracted for facilities or programs. This includes the provision of room and
			 board in a facility. Charges for room or board other than for that provided in
			 a facility are governed by
			 104
			 CMR 30.06.
(2)
Purpose
. To
			 maximize revenue for costs of services provided by Department operated or
			 contracted for facilities and programs from federal and state benefits and
			 private health insurance reimbursements as required by M.G.L. c. 6A, § 16,
			 the Department must charge patients, clients or fee payers for the services it
			 provides, contracts for, or otherwise funds. The purpose of
			 104
			 CMR 30.04 is to establish how the Department
			 will charge for the services for which it has approved rates and to allow for
			 such charges to be adjusted on an individualized basis based on the ability to
			 pay of the patient, client, or fee payer as determined in accordance with
			 104
			 CMR 30.04(6).
(3)
Definitions
. In
			 addition to the terms defined in
			 104
			 CMR 25.02:
Definitions
, the
			 following terms shall have the meanings set forth in
			 104
			 CMR 30.04(4)  throughout
			 104
			 CMR 30.04, unless the content clearly
			 provides otherwise.
Approved Rate
. The charge for a
				service which is established by the Department in accordance with applicable
				law.
Fee Payer
. Any of the following
				persons, each of whom may be liable for charges for services:
(a) the spouse of a patient or client, unless
			 such spouse is separated, then only to the extent provided by a judicial order
			 or a judicially approved separation agreement;
(b) the parent(s) of a minor child who is not
			 an emancipated minor or a mature minor; or
(c) the legally authorized representative or
			 other person who controls assets of a patient or client, or the patient's or
			 client's spouse or parent(s); provided however, that the legally authorized
			 representative or other person shall be responsible only to the extent he or
			 she has control of a patient's or client's assets, or the assets of the
			 patient's or client's spouse or parent(s), and only to the extent of such
			 assets.
Income
. Any monies received by or on
				behalf of a client, including earned income, recurrent payments, payments in
				kind or lump sum payment. Income shall not include the following:
(a) Financial aid provided to full or part
			 time students. This includes scholarships and stipends for housing or earnings
			 from work-study programs that are included in a student's financial aid
			 package;
(b) Payments made to and
			 held by a client from the Supplemental Nutrition Assistance Program;
			 or
(c) Income that is directly
			 deposited into a Plan to Achieve Self-support (PASS) approved by the Social
			 Security Administration.
Liquid Assets
. Cash and all property
				capable of ready conversion into cash, such as stocks and bonds, regardless of
				whether such assets are held jointly or solely. Liquid assets do not include
				life insurance or its cash value, or assets subject to an irrevocable trust
				with the patient or client as named beneficiary, unless those assets are
				available to the patient or client or fee payer on demand.
Patient or Client
. A person who
				receives services from a Department operated or contracted for facility or
				program.
Third-party Payer
. An insurer,
				entitlement agency, or similar entity, which is obligated to pay for services
				provided to a patient or client.