BILLING

USHAI 360P-2 Adult Patient and Patient’s Spouse Assessment - Procedures

New 03/03 Revised 09/24/03

UCA 26-19-6; UCA 62A-15-607; UCA 62A-15-617; UCA 62A-15-619

 

Statutory Authority

 

In accordance with UCA 62A-15-607(1), “The division shall estimate and determine, as nearly as possible, the actual expense per annum of caring for and maintaining a patient in the state hospital, and that amount or portion of that amount shall be assessed to and paid by the applicant, patient, spouse, parents, child or children who are of sufficient financial ability to do so, or by the guardian of the patient who has funds of the patient that may be used for that purpose.”

 

UCA 62A-15-617 states, “The expense for the care and treatment of voluntary patients shall be assessed to and paid in the same manner and to the same extent as is provided for involuntary patients under the provisions of Section 62A-15-607.”

 

UCA 62A-15-619 states, “The provisions made in this part for the support of mentally ill persons at public expense do not release the estates of those persons from liability for their care and treatment, and the division is authorized and empowered to collect from the estates of those persons any sums paid by the state in their behalf.”

 

The Office of Recovery Services (ORS) has a contract with the Utah State Hospital (USH) to assess an obligation for both the patient and the patient’s spouse (if applicable) according to his or her financial ability to repay some or all of the patient’s USH costs.  Base the patient’s portion of the obligation using income and asset information and determine the spouse’s portion using his/her gross income less allowed expenses.  Complete the “Assessment Worksheet” (form SHIA) to calculate the patient and spouse’s (if applicable) obligation and combine the obligation if the patient is married.  The patient and patient’s spouse (if applicable) may request a waiver or reduction in their obligation from the USH during the assessment process.

 

Procedures - Assessment

 

In accordance with UCA 26-19-6(1), “Within 30 days after commencing an action under Section 26-19-5, the department shall give the recipient, his guardian, personal representative, estate, or survivor, whichever is appropriate, written notice of the action by personal service or certified mail to the last known address of the person receiving the notice. Proof of service shall be filed in the action…”

 

NOTE:  A Power of Attorney document allows one person to designate another person to handle their business, financial, and legal affairs.  When a patient has an agent with Power of Attorney, send all assessment forms to the person with Power of Attorney, and do not send documents to the patient personally.  The person with Power of Attorney is responsible for completing and submitting all required forms to ORS on the patient’s behalf.     

 

1.         Send the H50A:  If the case does not meet closure criteria (see USHAI 061 Case Closure policy), generate and send separate H50A letters to the patient and the patient’s spouse (if applicable) along with the “Income/Asset Information sheet” (form SHAI).  Send the spouse’s documents by certified mail to the last known address and route the patient’s documents to the USH.  If the patient is no longer at the USH, send the H50A to the best available address by certified mail.

a.         Completed SHAI form returned: Complete the “ORS/USH Medicare, Asset and Income Assessment Worksheet” (form SHIA) based on the information submitted by the patient and/or spouse.  Refer to the Department of Health Medicaid Volume III-M for assessment criteria.

b.         SHAI form not returned:  Complete the “ORS/USH Medicare, Asset and Income Assessment Worksheet” (form SHIA) based on the best available information.  Refer to the Department of Health Medicaid Volume III-M for assessment criteria.           

 

2.         Determine if insurance will pay most or all of the cost of care.  Most, if not all costs, may be paid if the patient has Medicare coverage plus additional coverage, or both primary and secondary insurance coverage.                 

            a.         Insurance will pay all or most of the USH costs.

i.          After the patient is discharged, obtain the unpaid balance from the USH (amount due after all third party payments are deducted).

ii.          If the amount is paid in full, close the case (refer to USHAI 061 Case Closure policy).

iii.                  If a balance is owed, follow the procedures in number (b) below, “Insurance will Probably Not Cover all the USH Costs.”

 

b.                  Insurance will probably not cover all the USH costs. 

i.                     Generate and send the “Voluntary Payment Agreement” (form HVPA) by certified mail to the patient and the patient’s spouse, if applicable, for the assessed amount.

 

NOTE:  If the patient is married and resides at a different residence than his/her spouse, mail two separate voluntary payment letters (form HVPA) to each address by certified mail.  The patient and patient’s spouse will still have a combined obligation.

ii.          If both the patient and spouse sign and return the HVPA agreement letter, add the obligation to the case (see USHAI 510a Adding a Current Support Debt and Accruing Debt to ORSIS) and monitor the case for future payments.

iii.                  If the HVPA is not signed and returned, contact the USH for authorization to proceed with a referral to the AG’s office for judicial enforcement action. 

A.        If the USH authorizes ORS to proceed with the AG referral, notify the appropriate attorney in the Attorney General’s Office (AGO) of the pending action.

(1)               Coordinate the preparation of the case with the AGO.

(2)               Provide supporting material to the appropriate attorney when required.

(3)        The AGO will forward the case to team 78 to monitor for future payments after a judgment is obtained. 

B.        If the USH denies authorization to proceed with an AG referral, close the case (refer to USHAI 061 Case Closure Policy).

 

NOTE:  The patient and patient’s spouse (if applicable) may request a reassessment through team 78; however, they must provide new financial information.

 

Veterans Benefits

 

Patients receiving Veterans benefits may assign a trustee or guardian to allocate the funds.  Obtain trustee or guardian information from the USH or Veterans Administration representative at the VA hospital.  After receiving location information, contact the trustee or guardian to make payment arrangements to ORS.  The trustee or guardian pays the bills for the patient and determines the amount available to pay toward the USH charges.