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<regulation prefix="Regulation" num=".03" citation="COMAR 10.04.02.03" title_num="10" subtitle_num="04" chapter_num="02" heading="Determination of the Ability of a Recipient of Services to Pay.">
  <paragraph num="A.">
    <text>A recipient of services' primary liability-to-pay in-patient charges established in accordance with COMAR 10.02.01.04 shall be determined by conducting a financial investigation of the individual's income, assets, and expenses.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Notwithstanding any other provision of law to the contrary, the Department or its designated financial agent may obtain and use financial information and, if and when necessary, a summary of medical and psychological diagnoses regarding a recipient of services. If the obtaining and use of this information is connected to the Department's billing and collection functions under Health-General Article, Title 16, Annotated Code of Maryland:</text>
    <paragraph num="(1)">
      <text>The Department shall obtain a release from the recipient of services or a chargeable person to secure information from a financial institution;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The Department shall request either copies of the recipient of services' most recently filed federal and state income tax returns or an affidavit that the recipient of services did not file tax returns for the previous tax year;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The failure of the recipient of services to provide the Department with the required documents of financial status, including the most recently filed federal and state income tax returns, may result in the Department charging and the recipient of services being liable for the full per-capita daily charge for services as set forth in COMAR 10.02.01.04; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Except as provided in §C of this regulation, all information obtained by the Department or its designated agent shall be treated as confidential.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>If the financial information is connected to the treatment or care of a recipient of services, the Department or its designated financial agent may disclose the financial information to a designated clinical representative of a facility.</text>
  </paragraph>
  <paragraph num="D.">
    <text>The Department may set the amount of payments retroactively:</text>
    <paragraph num="(1)">
      <text>For a period of not more than 6 months from the date when the Department sets the amount of payments; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>After inquiry by the Department, for a greater period, if the recipient of services, the responsible relatives of the recipient, or any other person, agency, or organization having a summary of financial information or medical or psychological diagnoses about the recipient of services has failed or refused to give that information to the Department when the obtaining and use of this information is connected to the Department's billing and collection functions under this subtitle.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>The Department shall make a claim against all available income or assets, or both, of a recipient of services.</text>
  </paragraph>
  <paragraph num="F.">
    <text>Health insurance coverage and other third party reimbursements correctly paid, or to be paid, for services provided by the Department shall be considered available for billing purposes.</text>
  </paragraph>
  <paragraph num="G.">
    <text>For purposes of determining a recipient of services' financial capacity to contribute towards the cost of his or her care, the Department shall consider all of the recipient of services' assets and income to be available for billing purposes subject to certain billing reductions. In recognition of an individual's ongoing financial needs, the Department shall consider a reduction in a recipient of services' billing by permitting the income allowances, asset exemptions, and allowable expenses indicated below. A billing reduction may not be permitted unless and until the recipient of services submits appropriate written documentation demonstrating his or her entitlement to the billing reduction. Permitted billing reductions are as follows:</text>
    <paragraph num="(1)">
      <text>Exempted Assets. The following assets shall be excluded from the Department's ability to pay determinations:</text>
      <paragraph num="(a)">
        <text>A primary residence, occupied by spouse or dependents.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A primary residence unoccupied by a spouse or dependents. The assessed value of a recipient of services' primary residence may not be considered for the purpose of establishing charges incurred by the recipient of services during the first 6 months of the individual's hospitalization. An additional 6 months exemption may be allowed if the recipient of services provides written verification from the Department clinician who is primarily responsible for the individual's care which indicates that there is a reasonable clinical likelihood that the individual will be discharged from the facility not later than 12 months following his or her admission to the facility.</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Household furnishings.</text>
      </paragraph>
      <paragraph num="(d)">
        <text>One motor vehicle plus other motor vehicles necessary for employment, education, medical care, or maintenance of family life.</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Liquid assets including but not limited to cash, certificates of deposit, savings and checking accounts, stocks and bonds whose total value does not exceed $2,500.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Income allowances. The following sources of income shall be excluded from the Department's ability to pay determinations:</text>
      <paragraph num="(a)">
        <text>Therapeutic work activity income earned in a Department sponsored or approved program which may not exceed $100 per month;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>If the recipient of services is not involved in a therapeutic work activity program, a monthly personal income allowance of $40.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Allowable Expenses. The following documented expenses shall be deducted from the countable gross income in determining a person's ability-to-pay:</text>
      <paragraph num="(a)">
        <text>Reasonable transportation expenses incurred by a recipient of services' relatives and designated visitors during the course of visits to a facility. Mileage allowances shall be calculated in accordance with the prevailing travel allowances permitted for State employees.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Health insurance premiums.</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Life insurance premiums for policies which have a maximum face value which does not exceed $2,500.</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Reasonable allowances shall be made for necessary and appropriate purchases of clothing and other personal items which may be used by the recipient of services while in a residence or during the course of a clinically sponsored activity. Clinicians responsible for the recipient of services care and treatment shall be consulted to determine the appropriateness of the requested item.</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Reasonable income allowances reflecting the actual expenses incurred by a recipient of services in maintaining his or her primary residence or apartment provided that when the recipient of services:</text>
        <paragraph num="(i)">
          <text>Is unmarried and has no dependents, the income allowance shall be permitted only for that period of time that the residence is afforded exempt status pursuant to Regulation .03G(1)(b); and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Income constitutes the primary source of financial support for a spouse or other individual claimed as dependents on that individual's federal income tax return, an additional monthly income allowance shall be permitted in an amount equal to the appropriate base monthly deduction as set forth in Regulation .04C(8).</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="H.">
    <text>Monthly Rate. If a combined income is available, the monthly rate charged to the recipient of services and spouse will be computed according to Regulation .04, of this chapter.</text>
  </paragraph>
</regulation>