Questions and Answers About Service Charges
The costs for providing health care seem so expensive. What is included in the costs to the department?
The department provides a wide variety of services, which are indeed expensive. Major expenses include room and board, nursing care, medical expenses, day treatment, family support services, and case management.
Can charges to me exceed costs of the services provided?
No. The Department of Mental Health is required by law to determine charges and redetermine them each year. When private sources are employed to provide services, costs are set through contracts. Your charges are never allowed to exceed costs of the services provided.
My child is over age 18. Am I liable for charges of services to him/her?
No. Parents are not liable from their incomes for the charges for services to their children age 18 or older. Monies received by parents for their children in a fiduciary capacity are, however, subject to charges.
My school-age child needs special education. Can I be charged for it?
No. A parent of a recipient age 3 through 18 is not liable for costs of education or special education. You may, however, be charged for certain medical expenses, including medical supplies, chiropody medication, anesthesiology, oxygen therapy, radiology, electrocardiology, and electroencephalography. In addition, operating room, laboratory, dental, and physician's expenses are also chargeable. Parents are also asked to provide personal spending money.
What items are considered personal expenses?
Clients' personal spending needs vary widely. A family may be asked to provide money for cigarettes, candy, or soft drinks. Other items, such as clothes, jewelry, games, and some toiletries are also the family's responsibility.
Two members of my family received services in the same month. Must I pay double?
No. Your monthly ability to pay is the same amount regardless of how many visits you receive in that month. It also is the same for any number of family members being seen. It is the responsibility of the client or family to notify the provider if two or more members receive services in the same month.
Am I required to provide documents to verify my income and assets?
No. A client or his family should verbally divulge financial resources and dependents.
What if I fail to comply with requests for insurance information, assigning benefits, or applying for benefits (i.e. Medicaid, Social Security, VA benefits)?
You may be charged the full cost of services with no regard to income and size of family.
My financial status changed after I submitted my income documentation and I make less money now. Must I continue to pay the same amount?
Not necessarily. If your financial situation changes, you should submit new information and request a review of your financial status. Charges to you would be adjusted, if appropriate.
What can I do if I believe my charges are unfair?
You may appeal your charges only if you believe your assessment was inaccurately calculated. An appeal to the director cannot be made because you disagree with your share of the payment. It must be based on what you believe is an inaccurate calculation of allowable exemptions under Standard Means Test rules.
What if I fail to pay the costs assigned to me through the Standard Means Test application?
The state will pursue other means to receive payment; for example, the Income Tax Intercept Program and any other means allowable under state and federal law.
I can't afford to pay for the care my family member needs. Can we be turned away?
No. The department has never refused to provide services to someone unable to pay. However, if the department finds you can pay and won't, the department reserves the right to refrain from providing services.
What if I am covered by insurance and the Department of Mental Health is not an approved provider?
You must go to an approved provider or pay full cost of services.
Where can I get further information?
You may contact the administrator of your local Department of Mental Health facility or contact the department.