No. 29245 (Amendment): R523-1-5. Fee for Service

DAR File No.: 29245
Filed: 11/21/2006, 10:18
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

With the merger of the State Divisions of Substance Abuse and Mental Health, it is necessary to merge rules that are redundant. Currently, there are two separate rules in Utah Administrative Code that cover the collection of fees, one for substance abuse providers under Section R523-20-2, and one for mental health providers under Section R523-1-5. This change moves both sections into one rule under Section R523-1-5 and updates the rule to current practice. (DAR NOTE: The proposed amendment to Section R523-20-2 is under DAR No. 29246 in this issue, December 15, 2006, of the Bulletin.)

Summary of the rule or change:

The Mental Health (MH) and Substance Abuse (SA) providers fee sections will be placed in one rule, making the requirements consistent. The following are substantial changes for each provider from current rule. The changes for SA are: 1) all clients must be given written explanation of the fee policy; 2) clients who have been assessed and require services will not be denied based on ability to pay; and 3) the policy will include a fee reduction plan based on the client's ability to pay for services. The changes for MH are: 1) the State Board of Substance Abuse and Mental Health will no longer approve the fee schedule, it will be determined by community mental health centers based on a "usual and customary rate"; 2) a written notice must be given to clients on the fee policy; and 3) clients who have been assessed and require mental health treatment will not be denied services based on the ability to pay. Currently, both SA and MH providers have fee polices that include a sliding scale for clients. This rule standardizes the process across the system.

State statutory or constitutional authorization for this rule:

Subsection 62A-15-713(7) and Section 17-43-204

Anticipated cost or savings to:

the state budget:

The costs associated with this rule have no impact on the state budget, since the Division of Substance Abuse and Mental Health neither provides direct substance abuse and mental health services nor collects fees for services provided through the local mental health and substance abuse agencies.

local governments:

Currently, all programs that charge fees have a fee policy and have a sliding fee scale. No cost saving is anticipated. The only anticipated increase to local governments would be the cost of printing a written statement of the fee policy for clients. This cost would be difficult to determine since it is based on the size of the program and the number of clients who are served.

other persons:

All programs collect fees when applicable and have a fee policy and sliding fee schedule. There is nothing in this rule change that would require programs to increase fees to clients who are already paying a certain amount for services, or assess fees to anyone who receives services now and does not pay a fee.

Compliance costs for affected persons:

The only anticipated cost increase would be the requirement that each client be given a written explanation of the fee policy. There might be a slight cost in printing this statement. Currently, clients are charged a fee when applicable and all programs have a sliding fee schedule and ability to waive fees in case of financial hardships, so there is no anticipated increase in the cost of service to the client.

Comments by the department head on the fiscal impact the rule may have on businesses:

After careful review, the Department of Human Services has determined that this rule will have no financial impact on businesses in the state of Utah. Lisa-Michele Church, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Human Services
Substance Abuse and Mental Health
120 N 200 W
SALT LAKE CITY UT 84103-1500

Direct questions regarding this rule to:

Thom Dunford at the above address, by phone at 801-538-4519, by FAX at 801-538-9892, or by Internet E-mail at [e-mail]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

01/15/2007

This rule may become effective on:

01/23/2007

Authorized by:

Mark I Payne, Director

RULE TEXT

R523. Human Services, Substance Abuse and Mental Health.

R523-1. Procedures.

R523-1-5. Fee for Service.

[(1) All consumers of community mental health centers within the state of Utah shall be charged the actual cost of services rendered to them by personnel of the centers.

(2) There shall be a dual fee schedule approved by the State Board of Substance Abuse and Mental Health:

(a) intensive services - uniform fee schedule as attached;

(b) outpatient services - Local cost will be based on actual unit cost as determined by the center's annual study and in accordance with the minimum discount fee schedule attached.

(c) the mental health center may waive the charging of a fee if they determine that the assessment of a fee would result in a financial hardship for the recipient of services.

(3) Unless otherwise prohibited by law, all differences between the actual cost of services rendered and third-party payments shall be charged to the consumers receiving the service. These charges may not exceed the adjusted fee, if any, based on the above mentioned fee schedules.

(4) Fee adjustments may be made following locally determined procedures. The procedures will be available in writing.

(5) Except for emergency services, all consumers are to be informed of the actual cost of services to be received and of the adjusted fee, if any, before the commencement of services.](1) Each local authority:

(a) Shall require all programs that receive federal and state funds from the Division of Substance Abuse and Mental Health (Division) and provide services to clients to establish a policy for the collection of fees.

(i) Each fee policy shall include:

(A) a fee reduction plan based on the client's ability to pay for services; and

(B) a provision that clients who have received an assessment and require mental health treatment or substance abuse services will not be denied services based on the lack of ability to pay.

(ii) Any adjustments to the assessed fee shall follow the procedures approved by the local authority.

(iii) Any change to the fee policy will be made in writing to the Division within ninety days.

(b) Shall approve the fee policy; and

(c) Shall set a usual and customary rate for services rendered.

(2) All programs shall provide a written explanation of the fee policy to all clients at the time of intake except in the case of emergency services.

(3) All clients shall be assessed fees based on:

(a) the usual and customary rate established by the local authorities, or

(b) a negotiated contracted cost of services rendered to clients.

(4) All programs shall make reasonable effort to collect outstanding fee charges and may use an outside collection agency.

(5) All programs may reduce the assessed fee for services if the fee is determined to be a financial hardship for the client.

(6) The Division shall annually review each program's policy and fee schedule to ensure that the elements set for in this rule are incorporated.

 

KEY: bed allocations, due process, prohibited items and devices, fees

Date of Enactment or Last Substantive Amendment: [March 7, 2005]2007

Notice of Continuation: December 11, 2002

Authorizing, and Implemented or Interpreted Law: 62A-12-102; 62A-12-104; 62A-12-209.6(2); 62A-12-283.1(3)(a)(i); 62A-12-283.1(3)(a)(ii); 62A-15-612(2)