Section 5121.36 - Application for discount - determination - notice(A) A patient, patient's estate, or liable relative may apply for a discount by completing an application form prescribed by the director of mental health and addiction services. The department of mental health and addiction services may require a patient, estate, or relative to furnish any of the following with an application form: (1) A copy of the patient's, estate's, or liable relative's federal income tax return for the year preceding the date of application or, if that is not yet available, the preceding year;(2) A copy of the patient's, estate's, or liable relative's employee tax withholding return (form W-2) for the year preceding the date of application;(3) Any other relevant documents prescribed by the director of mental health and addiction services.(B) To be considered, an application must be submitted to the department not later than ninety days after the date the patient is admitted to a hospital.(C) From the information provided by a patient, estate, or relative, the department shall determine whether the department will charge the person a discounted amount in accordance with sections 5121.40 and 5121.41 of the Revised Code. In making this determination, the department shall consider whether the patient is covered by an insurance policy or other contract that provides for payment of expenses and treatment for mental illness. If the department determines that the patient has coverage, the department shall require payment in accordance with section 5121.43 of the Revised Code.(D) The department shall notify the patient, executor or administrator of the patient's estate, or liable relative who submitted the application form in writing regarding whether that person will be charged a discounted amount and the per diem rate to be charged.(E) In accordance with section 5121.42 of the Revised Code, the department may, at any time, modify an amount charged or change the per diem rate to be charged if the department learns of countable assets or income that was not previously disclosed or was acquired after the application form was submitted. Within a reasonable time, the department shall notify in writing any person affected by a modification or change.Amended by 130th General Assembly, HB 59,§101.01, eff. 9/29/2013.Effective Date: 01-01-2006 .