Rule 82-7-1-.10 - Reassessments/Redeterminations(1) The Department shall reexamine the individual's assessment periodically and adjust such assessment as hereinafter provided in accordance with changes in the ability to pay of the person liable for cost of care and in a manner that complies with the Patient Cost of Care Act. If the Department determines that the economic circumstances of a person liable for cost of care have improved to an extent justifying an increase in the assessment, any such increase shall apply only to cost of care for services rendered for the individual after the effective date of the increase in assessment. No such increase shall cause the assessment to exceed the total cost of care. The Department may not increase an assessment without affording the person liable for cost of care an opportunity for a hearing on the increase in the assessment. A person liable for cost of care may apply to the Department for a change in the assessment when the person's economic circumstances have changed sufficiently to adversely affect their future ability to pay. If an assessment for services previously rendered for an individual is being paid in accordance with a scheduled plan of payments approved by the Department, then a reduction in assessment because of a change in the economic circumstances affecting the ability to pay of the person liable for cost of care may apply to that portion of the assessment which remains unpaid as of the date of the reduction, as well as to the assessment for cost of services rendered after the date of the reduction. However, no such reduction shall require the refund of any payments made on an assessment prior to the date of the reduction. After investigation and hearing, the Department shall act upon the application made by the person liable for cost of care. Any redetermination of the assessment pursuant to this subsection shall be subject to the requirements of O.C.G.A § 37-9-6. Notwithstanding any reexamination or corresponding adjustment of an assessment which might be afforded, each assessment shall be valid for a period of twelve (12) months from the date of the initial assessment or any reassessment thereafter. No reduction, increase, or opportunity for hearing shall be allowed after the assessment period.(2) All assessments determined under the provisions of the Patient Cost of Care Act, and in accordance with the standards prescribed in Rule 82-7-1-.09 above, shall be subject to redetermination under any of the following circumstances: (a) On request of any person who has been notified of liability for payment of cost of care in either their personal or representative capacity;(b) On discovery by the Department of error, omission, or false statements which were relied upon by the Hospital Chief Financial Officer in determining assessments for cost of care;(c) On discovery by the Department of changes in economic circumstances of any person liable for cost of care assessments; and(d) At the end of a period not to exceed twelve (12) months from the date an assessment was originally made.(3) Except as determined under the provisions of paragraph (2) above, no redetermination shall increase the assessment for cost of care for services received prior to such redetermination. Such redetermination may decrease assessments for care previously received if a change in economic or other circumstances so dictates. However, no such reduction shall require the refund of any payments made on an assessment prior to the date of the reduction of the assessment.(4) The Department may accept payment for full cost of care if any person liable for cost of care offers such payment in lieu of declaring financial circumstances and having an assessment determined by hearing.(5) The Department shall adopt and comply with procedures to inform adequately individuals served and other persons liable for the cost of care of their right to hearings and of their right to request reassessments.Ga. Comp. R. & Regs. R. 82-7-1-.10
O.C.G.A. §§ 37-9-4, 37-9-5.
Original Rule entitled "Reassessments/Redeterminations" adopted. F. Dec. 15, 2021; eff. Jan. 4, 2022.