Washington Administrative Code › Title 388 - Social and Health Services, Department of › MENTAL HEALTH › Chapter 388-855 - Liability for costs of care and hospitalization of the mentally ill › Section 388-855-0065 - Determination of liability

Current through Register Vol. 24-14, July 15, 2024
(1) In
				determining the ability of the estate of the patient and responsible relative
				to pay hospitalization charges, first priority shall be given to any third
				party benefits which might be available. The availability of third party
				benefits, such as medical insurance, health insurance, medicare, medicaid,
				CHAMPUS, CHAMPVA, shall be considered as an available asset of the estate and
				shall justify a finding for actual costs of hospitalization during such period
				as the coverage is in effect.
(2)
				In the absence of third party benefits, charges shall be based upon the
				available assets of the estate giving consideration to any unusual and
				exceptional circumstances and other pertinent factors. No financial
				determination of the ability of the estate to pay hospitalization charges shall
				conflict with the eligibility requirements for medicaid for those patients who
				are eligible or potentially eligible for such benefits.
(3) The ability of the estate to pay adjusted
				charges will be determined by applying the following formula:
X
=
(Z-E)F
Where Z
=
(A-Y-N-R)/D
Z
=
available income per family member
X
=
adjusted charges (daily)
A
=
gross income
Y
=
mandatory deductions
N
=
allowance for unusual and exceptional
								circumstances
R
=
allowance for other pertinent factors
D
=
number of dependents
E
=
exempt income
F
=
a factor which converts the monthly figures to a
								daily rate (.0328767).
All calculations are expressed in monthly terms except the
				  final adjusted charge which is converted to a daily rate. All final figures are
				  rounded out to the nearest cent.
(4) The adjusted gross income (A-Y) is
				determined by first developing the gross income of the estate of the patient
				and the responsible relative. Gross income (A) includes not only gross wages
				for services rendered, and/or net earnings from self-employment, but all other
				available assets which have been divided by twelve months to convert them to a
				monthly cash equivalent figure. All mandatory deductions (Y), such as income
				tax and social security, are deducted from the gross income to arrive at the
				adjusted gross income.
(5) Approved
				allowances for unusual and exceptional circumstances (N) and for other
				pertinent factors (R) are then subtracted from the adjusted gross
				income.
(6) The available income
				(A-Y-N-R) is then divided by the number of dependents in the household of the
				patient (D) to determine the available income per family member.
(7) Exempt income (E) as defined in WAC
				388-855-0045 is then subtracted
				from the available income per family member to arrive at the monthly adjusted
				charges.
(8) The monthly adjusted
				charges are multiplied by the factor of .0328767 which converts the monthly
				figure to a daily rate.
Statutory Authority:
					 RCW
					 43.20B.335,
					 43.20B.325,
					 72.01.090. 01-01-007, amended and
					 recodified as § 388-855-0065, filed 12/6/00, effective 1/6/01. Statutory
					 Authority: RCW 81.02.412 [71.02.412]. 81-08-020 (Order 1627), §
					 275-16-065, filed 3/25/81.