Oregon Administrative Rules › Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES › Division 12 - ADMINISTRATIVE PRACTICE AND PROCEDURE › Section 309-012-0033 - Procedures for Determining Ability-to-Pay for Cost of Care

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Ability-to-Pay
			 Orders - Based on the financial information received or obtained, the Division
			 will determine the person's ability to pay. If the person, and/or the person's
			 authorized representative fails to provide sufficient information to show the
			 person cannot pay the full cost of care, the Division may determine the person
			 has the ability to pay the full cost of care. The determination of the person's
			 ability to pay shall be set forth in an Ability-to-Pay Order. The four types of
			 Ability-to-Pay orders are Determination of Charges, Modification to Charges,
			 Return of Funds for Personal Support Following Release, and Waiver of Charges.
			 Each Order shall be given one of these titles to identify the type of
			 determination it sets forth, and it shall be based on the factors and criteria
			 described in the following sections.
(2) Limit on Charges - The amount determined
			 by the Division to be the person's charges shall not exceed the full cost of
			 care for the dates of service covered by the Ability-to-Pay Order, less
			 payments and/or credits from any other sources the Division has received, or
			 reasonably anticipates receiving.
(3) Determination of Charges - An
			 Ability-to-Pay Order which sets forth a determination of the person's charges
			 for the care received which is made either while the person is in the state
			 institution, or after the person's release from the state institution. A
			 Determination of Charges may be issued any time during the person's stay in the
			 state institution. A Determination of Charges will be issued after the person's
			 release if none was issued during the person's stay, or if the person's
			 financial circumstances change to enable the person to pay cost of care which
			 exceeds amounts charged by previous Ability-to-Pay Orders. When issuing a
			 Determination of Charges, the Division will consider the following factors:
(a) Factors relating to the person's
			 eligibility for and coverage by benefits from health insurance;
(b) Factors relating to the person's assets:
(A) Except as otherwise provided in this
			 section, charges will be assessed using the person's equity in all assets
			 whether the asset is controlled by the person, or by the person's authorized
			 representative. The Division will determine the person's equity in each asset
			 by deducting from the fair market value of the asset any bona fide encumbrance
			 against the asset;
(B) Charges will
			 be assessed using the person's equity in a primary personal residence only if:
(i) Information is provided by the treatment
			 staff at the state institution stating the person cannot reasonably be expected
			 to return to the residence to live at any time following discharge from the
			 institution; and
(ii) None of the
			 following individuals is residing in the residence:
(I) The person's spouse;
(II) The person's child or children under age
			 21, or blind or disabled;
(III) The
			 person's sibling or siblings who own an interest in the residence, and who
			 lived in the residence for at least one year immediately prior to the person's
			 admission to the state institution;
(IV) The person's parents or emancipated
			 children who are unable to work to maintain themselves as declared in ORS
			 109.010.
(C) No charge will be assessed
			 using the person's equity in a primary personal automobile;
(D) The value of an asset which has great
			 sentimental value to the person (such as a family heirloom or gift from a loved
			 one) may be disregarded if selling the asset would cause the person great
			 emotional distress. The Division shall confer with the person's treatment staff
			 to decide whether or not to make this disregard;
(E) When assets are used as the basis for
			 ongoing charges, the Division will estimate the length of time the assets are
			 expected to last. During the final 60 days of that time period, the Division
			 will review the person's financial circumstances in preparation for modifying
			 the person's charges.
(c)
			 Factors relating to the person's income:
(A)
			 Charges will be assessed using the total amount of all income received either
			 by the person, or for the person by the person's authorized
			 representative;
(B) Income received
			 at intervals other than monthly may be prorated for use in a calculation of a
			 monthly charge to the person.
(d) Factors relating to the person's legal
			 and moral obligations:
(A) For legal
			 obligations other than administratively or judicially ordered child and/or
			 spousal support, the person must have demonstrated an intent to pay the
			 obligation, either by showing a history or regular payments toward the full
			 amount owing, or by providing a plan showing dates and amounts of payments to
			 be made in the future;
(B) The
			 Division shall seek the advice of treatment staff as to whether or not, in the
			 interest of the person's rehabilitation, welfare, and/or treatment, the
			 person's need to satisfy declared moral obligations should be given priority
			 over the person's obligation to pay the cost of care;
(C) Any deduction allowed by the Division for
			 legal or moral obligations must be used to satisfy the current obligation. It
			 may not be accumulated by, or on behalf of the person, or used for purposes
			 other than that for which it was approved.
(e) Factors relating to the person's
			 obligation to provide financial support for dependents:
(A) Before approving a deduction for
			 financial support for a dependent, the Division shall determine how much money
			 is required to reasonably support the dependent. From that amount, the Division
			 shall subtract any funds available from sources other than the person, such as
			 the dependent's own income and assets, or any form of governmental aid such as
			 public assistance payable to, or on behalf of the dependent;
(B) Any deduction allowed by the Division for
			 the financial support of dependents must be used to provide current support. It
			 may not be accumulated by, or on behalf of the person, and it may not be used
			 for other purposes.
(f)
			 Factors relating to the person's personal and special authorized expenses while
			 in the state institution:
(A) The personal
			 expense allowance while the person is in the state institution shall be
			 established by the Division to reflect the Supplemental Security Income
			 Program's payment limit for institutionalized individuals (The allowance was
			 $30 per month as of July 1, 1988.);
(B) Special authorized expense allowances
			 while the person is in the state institution shall be approved based on the
			 following criteria:
(i) The state institution
			 treatment staff's advice that satisfying the need will not interfere in any way
			 with the successful treatment or general welfare of the person, and it may
			 enhance the person's ability to meet the goals of the treatment plan;
			 and
(ii) There are no other
			 resources available to meet the need.
(g) Factors related to the person's need for
			 funds for personal support following release from the state institution when
			 the Division is issuing any Ability-to-Pay Order after release or when release
			 is scheduled within 30 days:
(A) As
			 necessary, funds for personal support following release will be allowed to pay
			 for the following items:
(i) Rental costs
			 including the monthly rent payment, as well as one time deposits or fees, or
			 mortgage payments related to the purchase of a residence;
(ii) Food for the person and
			 dependents;
(iii) Utilities such as
			 heating fuel, water, electricity, garbage service, basic telephone service, and
			 basic television cable service;
(iv) Transportation and related insurance
			 coverage;
(v) Routine household
			 maintenance and insurance coverage;
(vi) Health and dental care and related
			 insurance coverage for the person and dependents;
(vii) Clothing and entertainment for the
			 person and dependents; and
(viii)
			 Other personal expenses which the person shows to be reasonable and necessary,
			 including payments toward moral obligations and legal obligations (other than
			 mortgage contracts), as described in subsection (d) of this
			 section.
(B) The funds
			 allowed for personal support following release shall be based on what a
			 reasonable and prudent individual would spend for the items given the resources
			 available to the individual;
(C)
			 The amount approved for support of the dependents shall take into consideration
			 all other resources available to meet the dependent's needs.
(h) Factors relating to
			 the time period during which the Division may assess charges, and the time
			 period during which the person is required to pay assessed charges:
(A) Ability-to-Pay Orders issued after
			 release which establish an ongoing monthly charge based on the person's ability
			 to pay after release shall not add new charges beyond the 36th month following
			 the month in which the person was released from the state
			 institution;
(B) The person is
			 required to pay beyond the 36 month period, any assessed charges not paid prior
			 to release or during the 36 month period after release.