§2030.450. Client Fees

All providers with Department grant-in-aid funded treatment programs shall establish a client fee and third party payment policy consisting of fee schedules, documentation and collection procedures.

 

The policy shall assure the maximization and diversification of revenue sources, shall encourage client participation in the service by payment based on the ability to pay, but shall also assure that no person is denied services by any program funded under the Alcoholism and Other Drug Dependency Act because of inability to pay, and that services shall be afforded to such person on the same terms and conditions as services afforded to persons who are able to pay.  Providers shall follow their policy and the requirements herein.

The policy shall:

 

a)         be initially approved by the Board of Directors of the program, and reviewed and approved by the Board when any change is made.  Proof of Board approval, as well as the policy itself, shall be maintained and made available to the Department upon request;

 

b)         be in place prior to the time at which the provider charges the client fee or invoices second or third party payors, or prior to January 1, 1992, whichever of the two comes first;

 

c)         establish criteria for determination of financial capability based on household income, adjusted for family size;

 

d)         establish methods for documenting client income and determining eligibility for third party payment;

 

e)         provide for adjustment to or waiver of the fee based upon financial capability of the client or third party payment accessibility;

 

f)         provide a process for the client to appeal the fee determination and to appeal denial of service based on refusal to pay;

 

g)         require that prior to the imposition of an individual client fee, the client is informed in writing of the program's policy, the requirements of this Section and his right to appeal the fee determination, and require that a statement signed by the client specifying the amount of the charges agreed to be placed and maintained in the client's records;

 

h)         establish methods of documenting and recording charges and collecting accounts receivable fees from clients, responsible relatives and third parties.

 

Fees and ancillary charges shall be based on a sliding fee scale unless another method of fee determination, consistent with requirements herein, is previously approved in writing by the Department (see Subpart C of this Part).

Front-end or pre-admission fees are not encouraged but may be used if the policy meets the requirements of this Section.  The recipient must be able to demonstrate that the fees do not create a barrier to admission, based on ability to pay.