DAR File No. 32183

Human Services, Substance Abuse and Mental Health

R523-1-5

Fee for Service

NOTICE OF PROPOSED RULE

DAR File No.: 32183
Filed: 12/01/2008, 03:15
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

These amendments have been made to increase clarity for the local mental health authorities when they engage in the fee setting process, and to assure uniformity in fees that are charged to consumers within a local authority's jurisdiction.

Summary of the rule or change:

The division is no longer informed of changes in fee policies within ninety days. This change was made to emphasize the division's role as a monitor, and this process will be tracked and reviewed through the annual site visits. Additional guidance has been provided to ensure that fees do not exceed the average cost of delivering services. Finally, clarification around the definition of reasonable costs has been provided.

State statutory or constitutional authorization for this rule:

Subsections 62A-15-105(5) and 62A-15-713(7), and Sections 17-43-204 and 17-43-306

Anticipated cost or savings to:

the state budget:

There will be no impact on state budgets since the Division of Substance Abuse and Mental Health neither provides direct services nor collects fees for services.

local governments:

No impact on local government budgets. This rule provides clarification and additional guidance to statutes that govern funds collected by contractors of local authorities who provide mental health and substance abuse services, and does not affect funds held by local governments.

small businesses and persons other than businesses:

Currently all service providers, including those that would be considered small businesses, charge fees, have a fee policy, and have a sliding fee scale. Nothing in these amendments dictate the need to change what is already in place so no cost saving or increases are anticipated.

Compliance costs for affected persons:

No anticipated compliance costs for these amendments. Fees by their very nature can impact a budget, but there is nothing in these amendments that would require programs to increase or decrease fees to clients who are already paying a certain amount for services, or assess fees to anyone who receives services now and do not pay a fee.

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 the amendment to 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 TDUNFORD@utah.gov

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:

01/14/2009

This rule may become effective on:

01/21/2009

Authorized by:

Mark I Payne, Director

R523. Human Services, Substance Abuse and Mental Health.

R523-1. Procedures.

R523-1-5. Fee for Service.

(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]to set and collect 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) Fees assessed to clients shall not exceed the average cost of delivering the service.

(5) All fees assessed to clients, including upfront administrative fees, shall be reasonable as determined by the local authority.

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

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

[(6)](8) 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: [May 14, 2007]2009

Notice of Continuation: March 31, 2008

Authorizing, and Implemented or Interpreted Law: 17-43-302; 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-15-103; 62A-15-105(5); 62A-15-603; 62A-15-612(2), 62A-15-713(7), 17-43-204, 17-43-306