Section 0940-02-05-.03 - RMHI CARE AT THE EXPENSE OF THE STATE FOR INDIGENT SERVICE RECIPIENTS(1) Any service recipient who receives care at a RMHI while indigent under this chapter shall receive that care at the expense of the state.(2) Nothing in this rule exempts any public or private third-party payor from financial liability for any allowable charges for care from an RMHI.(3) For the purposes of this rule, a service recipient is indigent during any period of time within which both of the following are true: (a) The service recipient's income is less than 100% of the Federal Poverty Guidelines.(b) The service recipient's net worth falls below the sum of $50,000 plus 500% of the Federal Poverty Guidelines.(4) If an indigent service recipient has any responsible relatives, then an indigency determination will be made for the responsible relatives in addition to the service recipient. Only when the service recipient and all responsible relatives are found to be indigent, may a service recipient receive care at the expense of the state.(5) The determination of indigence shall be made by person(s) designated by the RMHI Chief Officer.(6) If the service recipient or responsible relative does not agree with the initial or subsequent determination, either person may request that the RMHI's Chief Officer review the decision. If the service recipient or responsible relative does not agree with the determination of the RMHI's Chief Officer, then either person may request that the Commissioner or designee make a final determination.(7) The Department may review and alter an indigency determination at any time, but shall review at least annually the indigency status of any service recipient continuously receiving care by an RMHI for one year or longer.(8) The service recipient or responsible relative may request a review and alteration of an indigency determination any time a change in income or net worth can be demonstrated.(9) The Department may access information to determine indigence from any relevant source of data, including but not limited to, state and federal agencies administering benefits to a service recipient or responsible relative.(10) The Department shall document the method by which indigence was determined in addition to all backup information used to substantiate the determination.(11) A service recipient or responsible relative shall be found to be non-indigent if: (a) A service recipient or responsible relative does not meet the criteria set forth in 0940-02-05-.03(3); or(b) Insufficient information is available to determine indigence.(12) A person shall be liable for the total charges for care by an RMHI and for the amount of the state's expense incurred in recovering the amounts, including attorney salaries or fees, unless declared indigent under this rule. In order to be declared indigent, the person or responsible relative shall:(a) Provide TDMH with information TDMH deems necessary for the determination of indigency; or(b) Provide TDMH with a written release allowing TDMH to access any information TDMH deems necessary to determine indigency.(13) A person or responsible relative shall notify TDMH of any change in status that may affect an indigency determination.(14) A person or responsible relative who knowingly provides false information that results in an inaccurate determination of indigence shall be liable for the total charges for care by an RMHI and for the amount of the state's expense incurred in recovering the amounts, including attorney salaries or fees.Tenn. Comp. R. & Regs. 0940-02-05-.03
Original rule filed March 30, 2012; effective June 28, 2012.Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-1102, 33-2-1103, 33-2-1105 and 33-2-
1109.