| (a) Payment and collection. (1) Persons (and parents) are responsible for promptly paying all charges owed to the LMHA. (2) The LMHAs are responsible for making reasonable efforts to collect payments from all available funding sources before accessing the department's funds to pay for persons' services. (b) Financial hardship. If a person (or parent) claims financial hardship as provided in this subsection, then the LMHA must determine whether a significant financial change (as defined) has occurred. If a significant financial change has occurred, then the LMHA must immediately update the person's (or parent's) financial assessment as required in §412.106(a) of this title (relating to Determination of Ability to Pay). (1) If a person (or parent) claims, and provides documentation, that financial hardship prevents prompt payment of all charges owed, then the LMHA may arrange for the person (or parent) to pay a lesser amount each month. (2) If a person (or parent) claims that financial hardship prevents prompt payment of all charges owed, then the LMHA must arrange for the person (or parent) to pay a lesser amount each month only if the person has third-party coverage that is neither income-based public insurance nor Medicare and the person's cost-sharing exceeds his/her MMF. The lesser amount: (A) will be no more than the person's MMF, if the person's MMF is greater than zero; or (B) will be no more than $5.00, if the person's MMF is zero. (3) Although the person (or parent) may pay a lesser amount each month because a portion of the charges will be deferred, the person (or parent) is still responsible for paying all charges owed. (c) Discontinuing charges to persons (or parents) for services. If the LMHA makes a decision, based on a clinical determination that is documented and includes input from the person's team, that being charged for services and receiving statements will result in a reduction in the functioning level of the person or the person's (or parent's) refusal or rejection of the needed services, then the LMHA will discontinue charging the person (or parent) for services and stop sending statements. The clinical determination must be reassessed at least every three months. If the LMHA decides to discontinue charging the person (or parent) for services, then the LMHA must develop and implement a plan to address the issues related to the person's functioning level or the person's (or parent's) refusal or rejection of the needed services. (d) Involuntary reduction or termination of services for non-payment by person (or parent). (1) The LMHA will address the past-due account of a person (or parent) who is not making payments to ensure reasonable efforts to secure payments are initiated with the person (or parent). For example, if the LMHA determines that non-payment is related to financial hardship, then the LMHA may assist the person (or parent) in making arrangements to pay a lesser amount each month in accordance with subsection (a)(2) of this section or if the LMHA makes a decision, based on a clinical determination that is documented and includes input from the person's team, that non-payment is related to the person's mental illness, then the person's treatment/service plan may be modified to address the non-payment. (2) If the LMHA makes a decision, based on a clinical determination that is documented and includes input from the person's team, that non-payment is not related to the person's mental illness and, despite reasonable efforts to secure payment, the person (or parent) does not pay, then the LMHA may propose to involuntarily reduce or terminate the person's services. The LMHA may not propose to involuntarily reduce or terminate the person's services if the proposed action would cause the person's mental or physical health to be at imminent risk of serious deterioration or the LMHA is identified as being responsible for providing court-ordered outpatient services to the person. (3) If the LMHA proposes to involuntarily reduce or terminate the person's services, then the LMHA must: (A) maintain clinical documentation that the proposed action would not cause the person's mental or physical health to be at imminent risk of serious deterioration; (B) provide written notification to the person (or parent) in accordance with subsection (e)(1) of this section and comply with subsection (e)(2) - (3) as initiated by the person (or parent). (e) Notification, Appeal, and Review. (1) Notification. The LMHA will notify the person (or parent) in writing of the proposed action (i.e., to involuntarily reduce or terminate the person's services or refer the person to his/her third-party coverage) and the right to appeal the proposed action in accordance with §401.464 of this title (relating to Notification and Appeals Process). The notification will describe the time frames and process for requesting an appeal and include a copy of this subchapter. If the person (or parent) requests an appeal within the prescribed time frame, then the LMHA may not take the proposed action while the appeal is pending. The LMHA may take the proposed action if the person (or parent) does not request a review within the prescribed time frame. (2) Appeal and appeal decision. The appeal is conducted in accordance with §401.464(g) of this title. The local mental health authority will notify the person (or parent) in writing of the appeal decision in accordance with §401.464(h) of this title and the right to have the appeal decision reviewed by the department's Mental Health and Substance Abuse Client's Rights Office (1-800-252-8154) if the person (or parent) is dissatisfied with the appeal decision. The notification must describe the time frames and process for requesting a review. (3) Review of appeal decision. If the person (or parent) is dissatisfied with the appeal decision, then the person (or parent) may request a review by the department's Mental Health and Substance Abuse Client's Rights Office. A request for review must be submitted to the department's Mental Health and Substance Abuse Client's Rights Office, Mail Code 2019, P.O. Box 12668, Austin, TX 78751, within 10 working days of receipt of the appeal decision. If the person (or parent) requests a review within the prescribed time frame, then the LMHA may not take the proposed action while the review is pending. The LMHA may take the proposed action if the person (or parent) does not request a review within the prescribed time frame and the appeal decision upholds the decision to take the proposed action. (A) A person (or parent) who requests a review may choose to have the reviewer conduct the review: (i) by telephone conference with the person (or parent) and a representative from the LMHA and make a decision based upon verbal testimony made during the telephone conference and any documents provided by the person (or parent) and the LMHA; or (ii) by making a decision based solely upon documents provided by the person (or parent) and the LMHA without the presence of any of the parties involved. (B) The review: (i) will be conducted no sooner than 10 working days and no later than 30 working days of receipt of the request for review unless an extension is granted by the director of the department's Mental Health and Substance Abuse Client's Rights Office; (ii) will include an examination of the pertinent information concerning the proposed action and may include consultation with the department's Mental Health and Substance Abuse Client's Rights Office clinical staff and staff who are responsible for the policy contained in this subchapter; (iii) will result in a final decision which will uphold, reverse, or modify the original decision to take the proposed action; and (iv) is the final step of the appeal process for involuntarily reducing or terminating the person's services for non-payment and for referring the person to his/her third-party coverage. (C) Within five working days after the review, the reviewer will send written notification of the final decision to the person (or parent) and the LMHA . (D) The LMHA will take appropriate action consistent with the final decision. (f) Prohibition of financial penalties. The LMHA may not impose financial penalties on a person (or parent). (g) Debt collection. Local authorities must make reasonable efforts to collect debts before an account is referred to a debt collection agency. Local authorities must document their efforts at debt collection. (1) Local authorities must incorporate into a written agreement or contract for debt collection provisions that state that both parties shall: (A) maintain the confidentiality of the information and not disclose the identity of the person or any other identifying information; and (B) not harass, threaten, or intimidate persons and their families. (2) Local authorities will enforce the provisions contained in paragraph (1) of this subsection. |
