This regulation establishes administrative procedures for appeals of Reimbursement Orders issued by Oregon's Addictions and Mental Health Division, governing how patients (or their representatives) at state psychiatric and developmental disability institutions may contest determinations of their ability to pay for institutional care. It covers the process for requesting hearings, informal conferences, evidentiary rules, and final order review. It also defines terms related to ability-to-pay determinations for individuals admitted to state institutions. Facility operators at state institutions should be aware of these billing dispute and appeal procedures.
View official sourceOregon Health Authority Health Systems Division: Behavioral Health Services - Chapter 309 Division 12 ADMINISTRATIVE PRACTICE AND PROCEDURE 309-012-0025 Procedures for Appeals of Reimbursement Orders (1) Purpose. This rule prescribes procedures for appeals of Reimbursement Orders issued by the Division. (2) Statutory Authority and Procedure. This rule is authorized by ORS 179.640, 413.042 & 179.040 and carries out the provisions of ORS 179.610 to 179.770. (3) Definitions. As used in this rule: (a) “Administrator” means the Administrator of the Addictions and Mental Health Division; (b) “Authorized Representative” means those parties named in ORS 305.240, or those parties who are determined to have the authority to represent the person; (c) “Division” means the Addictions and Mental Health Division of the Oregon Health Authority; (d) “Hearing” means the hearing authorized by ORS 179.640 for the purpose of review of Reimbursement Orders and modified Reimbursement Orders issued pursuant to ORS 179.640; (e) “Hearings Officer” means any person designated by the Administrator to hold hearings on matters coming before the Division. Staff of the Reimbursement Section of the Division may not be designated as hearings officers; (f) “Informal Conference” means a proceeding held before the appeal hearing to allow the person to obtain a review of the action or proposed action without the necessity of a formal hearing; (g) “Person” means: (A) A patient who is receiving or has received treatment or care at a state institution for the mentally ill; (B) A current or former resident at a state institution for the mentally retarded; (C) The estate of the person; (D) Any other individual or entity having a financial interest in contesting a Reimbursement Order. (h) “Reimbursement Order” means the order issued to determine the person’s ability to pay pursuant to ORS 179.640; (i) “Service” means deposit of a Reimbursement Order by U.S. mail, state mail, or deposit with a state institution for hand delivery; (j) “State Institution” means Dammasch State Hospital in Wilsonville, Oregon State Hospital in Salem, Fairview Training Center in Salem, and Eastern Oregon Hospital and Training Center in Pendleton. (4) Authorization for Hearing: A hearing before the Administrator or a Hearings Officer shall be granted to a person who appeals to the Administrator in the following instances: (a) A person may appeal the Division’s determination or redetermination of the person’s ability to pay the state’s charges for institutional care and maintenance. The appeal must be submitted within 60 days of the service of the Reimbursement Order; (b) The Division, on or about the time of the person’s discharge, shall determine whether or not any of the funds previously paid by the person or on his or her behalf to the State of Oregon to cover his or her cost of care should be reimbursed to the person to satisfy his or her financial needs upon release, or whether any of the previous Reimbursement Orders for the current hospitalization should be modified. This redetermination may be appealed within 60 days of service. (5) Request for Hearing: (a) No particular format for a request for a hearing is required, but, to be considered, each request must be in writing and must specify: (A) The name and address of the person requesting the hearing; (B) The action being appealed, including: (i) The year or years involved; (ii) A reference to any Division correspondence on the subject known to the person; (iii) Why the action being appealed is claimed to be incorrect; (iv) The specific relief requested. (b) The request for a hearing must be signed by the person or his or her authorized representative; (c) All requests for hearings shall be filed by mailing or delivering the appeal to the Reimbursement Section, Addictions and Mental Health Division, 500 Summer St. NE, E-86, Salem, OR 97301; (d) If the request for a hearing is considered insufficient in content by the Division, the Division may require the request to be reasonably supplemented with additional information before any further action is taken on the appeal; (e) Prior to the time of an appeal hearing, if there is no objection by the person, the Hearings Officer may refer the matter in controversy for an informal conference for settlement or simplification of issues. (6) Authorization for Informal Conference: (a) A person who has requested an appeal hearing pursuant to section (5) of this rule may request that he or she have an informal conference with a representative from the Reimbursement Section before the formal appeal hearing. Any request for an informal conference may be granted at the discretion of the Division; (b) Such conferences are informal. A person may represent himself or herself or may choose someone to act as his or her representative. The purpose of the conference is to allow a person to obtain a review of the action or proposed action (without the necessity of a formal appeal hearing), if he or she believes that an action made or proposed by the Division is incorrect; (c) Payment of the proposed charge for institutional care and maintenance will not jeopardize a conference request or decision. (7) Request for Informal Conference: (a) A conference request may be filed either with a hearing request required in section (5) of this rule or subsequent to the hearing request but at least 14 days before the date of a scheduled hearing; (b) The conference request shall be in writing and must specify: (A) The name and address of the person requesting the conference; (B) The reason for the request, including: (i) In what respect the action or proposed action of the Division is erroneous; (ii) Reference to any prior Division correspondence on the subject. (c) If a hearing has been requested, the material submitted as part of the request for a hearing may be used at the informal conference; (d) The conference request should be addressed to the Reimbursement Section, Addictions and Mental Health Division, 500 Summer St. NE, E-86, Salem, OR 97301. (8) Conduct of Informal Conference. A conference shall be held at a place designated by the Division. To the extent practical, the conference will be held at a location convenient to the person. The conference shall begin with a statement from the Division. The person requesting the conference shall then state his or her position, the facts as he or she knows them, and his or her questions of persons present to clarify the issues. (9) Disposition of Informal Conference: (a) After the conference, the Reimbursement Section will issue a proposed order disposing of the appeal for approval by the Administrator. The written order, approved by the Administrator, will be sent to the person within 14 days of the conference, unless during the conference the Division action is conceded by the person to be correct; (b) The person’s request for a hearing will be stayed pending the outcome of the conference, at which time the request for a hearing will either be withdrawn by the person should he or she no longer desire to proceed, or the hearing will be rescheduled; (c) When a decision favors the person, the person will receive a refund; (d) The person may request within 30 days that the decision made at an informal conference be reconsidered by the Administrator. The person should set forth the specific ground or grounds for requesting the reconsideration. (10) Subpoenas and Depositions: (a) The Division shall issue subpoenas to any party to a hearing upon request. Witnesses appearing pursuant to subpena, other than parties or employees of the Division, shall receive fees and mileage as prescribed by law for witnesses in a civil action; (b) Depositions may be taken on petition of any party to a hearing. (11) Conduct of Appeal Hearing: (a) To the extent practical, the Division, in designating the location of the hearing, shall designate a place convenient for the person; (b) The hearing shall be conducted by and shall be under the control of the Hearings Officer; (c) The Hearings Officer shall administer an oath or affirmation of the witnesses; (d) A verbatim record shall be made of all testimony and rulings. Parties who wish a transcription of the proceedings should make arrangements with the Division. If the Division determines the record is no longer needed, the Division may destroy the record after 180 days following the issuance of a final order, unless within the 180-day period arrangements are made by the person for further retention by the Division; (e) The hearing shall begin with a statement of the facts and issues involved. The statement shall be given by a person requested to do so by the Hearings Officer; (f) The Hearings Officer may set reasonable time limits for oral presentation and may exclude or limit testimony that is cumulative, repetitious or immaterial. (12) Evidentiary Rules: (a) All evidence of a type commonly relied upon by reasonably prudent persons in conduct of their serious affairs shall be admissible; (b) The Hearings Officer shall receive all physical and documentary evidence presented by parties where practicable. All offered evidence is subject to the Hearings Officer’s power to exclude or limit cumulative, repetitious or immaterial matter; (c) Evidence objected to may be received by the Hearings Officer, and rulings on its admissibility or exclusion may be made at the time a final order is issued; (d) At the time of the hearing, the person will be notified that any exhibit introduced as evidence at the hearing will be destroyed after 180 days following the issuance of a final order, unless within the 180-day period, written request is made by the person presenting the exhibit for the return of the exhibit; (e) The burden of presenting evidence to support a fact or position in a hearing rests on the proponent of the fact or position. (13) Disposition of Appeal: (a) After a hearing has been held, the Hearings Officer shall issue a proposed order, including findings of fact and conclusions of law. If the proposed order is adverse to the person, it shall be served upon the person and an opportunity afforded to the person to file exceptions and present written argument to the Administrator before a final order is issued. A person has a ten-day period in which to file exceptions and/or written argument to a proposed order; (b) Final orders on a hearing shall be in writing and shall include: (A) Rulings on admissibility of offered evidence; (B) Findings of fact — Those matters which are either agreed as fact or which, when disputed, are determined by the Administrator, on substantial evidence, to be a fact over contentions to the contrary; (C) Conclusions of law — Applications of the controlling law to the facts found and the legal results arising there from; (D) The action taken by the Division as a result of the findings of fact and conclusions of law; and (E) Notice of the person’s right to judicial review of the order. (c) Parties to a hearing and their attorneys shall be mailed a copy of the final order and accompanying findings and conclusions. (14) Administrative Review of Final Order: (a) A person may file a petition for administrative review of the final order with the Division within 30 days after the order is served. The petition shall set forth the specific ground or grounds for requesting the review. The petition may be supported by a written argument. Examples of sufficient grounds are: (A) The Division action is not supported by the written findings, or the written findings are inaccurate; or (B) Pertinent information was available at the time of the original hearing which, through no fault of the party, was not considered; or (C) The action of the Division is inconsistent with its rules or policies or is contrary to law; and (D) The matters raised on appeal may have an effect on the original decision. (b) The Division may grant a rehearing petition if sufficient reason therefore is made to appear. The rehearing may be limited by the Division to specific matters. If a rehearing is held, an amended order shall be entered; (c) If the Division denies the appeal, it shall inform the person in writing of the denial; (d) If the administrative review has been requested, the Division order is not final until the administrative review is granted or denied. (15) Time Extensions. Where any provision of this rule specifies a particular time period in which a person must act, for good cause shown, the Hearings Officer may, in his or her discretion, allow a reasonable extension of time if so doing is not inconsistent with ORS 179.640 to 179.650. (16) Appeal. An appeal from the final order of the Division may be taken as provided by law. Caution: Either ORS 179.650 or 183.482 may be applicable. See League of Women Voters v. Lane County Boundary Commission, 32 Or. App. 53, 573P.2d 1255, rev. denied, 283 Or. 503 (1978). Statutory/Other Authority: ORS 179.770, 413.042 & 430.021 Statutes/Other Implemented: 179.610 – 179.770 History: MHD 1-1980, f. & ef. 1-14-80 MHD 6-1979(Temp), f. & ef. 9-20-79 309-012-0030 Purpose and Statutory Authority (1) Purpose. Individuals admitted to the Division institutions are liable for the full cost of their care, but are required to pay only what they are able to pay. This rule establishes guidelines for determining a person’s ability to pay for the cost of care in a state institution. (2) Statutory Authority. This rule is made necessary by ORS 179.610, authorized by ORS 413.042 and carries out the provisions of ORS 179.610 to 179.770. Statutory/Other Authority: ORS 179.770 & 413.042 Statutes/Other Implemented: ORS 179.610 – 179.770 History: MHD 9-1991, f. 12-13-91, cert. ef. 12-16-91 MHD 14-1980, f. & ef. 6-24-80 MHD 5-1980(Temp), f. & ef. 4-18-80 309-012-0031 Definitions As used in these rules: (1) “Ability to Pay” means the ability of a person in a state institution to pay past, current, or ongoing cost of care, as determined by the Division in accordance with these rules. (2) “Assets” means, excluding income, the total value of an individual’s equity in real and personal property of whatever kind or nature. Assets include, but are not limited to the individual’s stocks, bonds, cash, accounts receivable, moneys due, or any other interests, whether they are self-managed, or held by the individual’s authorized representative, or by any other individual or entity on behalf of the individual. “Assets” held in trust are subject to laws generally applicable to trusts. (3) “Authorized Representative” means an individual or entity appointed under authority of ORS 125, as guardian or conservator of a person, who has the ability to control the person’s finances, and any other individual or entity holding funds or receiving benefits or income on behalf of any person. (4) “Benefits from Health Insurance” means payments from insurance programs with the limited purpose of paying for the cost of care provided to an individual by a hospital or other health care provider. Benefits of this type include, but are not limited to payments from: (a) Private and group health insurance policies; (b) The Medicare and Medicaid programs; (c) Any other policies or programs with the purpose of paying for the costs of inpatient and/or outpatient care. (5) “Charges” means the amount the Division has determined that the person is required to pay toward the cost of care based on his or her ability to pay. (6) “Cost of Care” means the person’s full liability for care as determined by the Division using the rates established in accordance with ORS 179.701. (7) “Dependents” means individuals whom a person has a legal duty to support. “Dependents” may include non-emancipated children and spouse of a person, as well as any other individual for whom a person would be allowed a personal exemption under federal or Oregon personal income tax laws. (8) “Division” means the Addictions and Mental Health Division of the Oregon Health Authority. (9) “Fair Market Value” means the cash price a capable and diligent individual could obtain in a reasonable amount of time for an asset after negotiating with those accustomed to buying such property. (10) “Funds for Personal Support Following Release” means the cash that a person will need following his/her release from a state institution to live in the community in a reasonable manner for a period of time, not normally to exceed six months. (11) “Income” means all funds received by an individual, or for an individual by his or her authorized representative, from any source, whether earned or unearned, after making applicable deductions for state and federal taxes. “Income” includes benefits from both income protection insurance which replaces the person’s earned income when he or she is unable to work, and governmental retirement or disability insurance, such as Social Security, Veterans, and Railroad Retirement benefits. (12) “Legal Obligations” means any financial duty imposed by law. “Legal obligations” include, but are not limited to, loan or mortgage contracts for which an individual is responsible, as well as liabilities arising out of other contracts or legal duties to pay money. “Legal obligations” include administratively or judicially ordered child and/or spousal support. (13) “Moral Obligations” means any payments that an individual feels a moral duty to pay, but for which the individual does not have a legal duty to pay. (14) “Person” means: (a) A current or former patient at a state institution for the mentally and emotionally disturbed; (b) A current or former resident at a state institution for the developmentally disabled. (15) “Person’s Representative” means: (a) Any individual who is the person’s authorized representative as defined in section (3) of this rule; and/or (b) Any other individual who has the person’s written authority to represent the person. (16) “Personal Expense Allowance” means the cash allowed for the reasonable miscellaneous expenses the person has while he or she is in the state institution, including but not limited to expenses for personal grooming and hygiene items; books, newspapers, or other publications; snacks or refreshments not provided by the state institution; and minor entertainment or excursions. (17) “Primary Personal Automobile” means the automobile, if the person has more than one, which the person would choose to keep if required to sell all but one. If the person has only one, it is the primary personal automobile. (18) “Primary Personal Residence” means the home the person owns, or is purchasing, and in which the person lived prior to entering the state institution, and/or in which the person will live after leaving the state institution. (19) “Special Authorized Expense Allowance” means the cash needed for the reasonable personal expenses of the person which cannot be met by the personal expense allowance, and which the Division determines are necessary. (20) “State Institution” means Dammasch State Hospital in Wilsonville; Eastern Oregon Psychiatric Center in Pendleton; Eastern Oregon Training Center in Pendleton; Fairview Training Center in Salem; and Oregon State Hospital in Salem. (21) “Support for Dependents” means the cash necessary to meet the reasonable needs of the dependents, less the amounts the dependents receive from any other sources. Support for dependents excludes administratively or judicially ordered child and/or spousal support. Statutory/Other Authority: ORS 179.770 & 413.042 Statutes/Other Implemented: ORS 179.610 – 179.770 History: MHD 9-1991, f. 12-13-91, cert. ef. 12-16-91 MHD 14-1980, f. & ef. 6-24-80 MHD 5-1980(Temp), f. & ef. 4-18-80 309-012-0032 Requirements for Obtaining Financial Information (1) Information Obtained from the Person and/or the Person’s Representative. The Division shall require the person and/or the person’s representative to submit financial information on forms provided by the Division. Financial information required by the Division shall include, but shall not be limited to the following: (a) A description of the person’s assets, and their values; (b) A description of the person’s liabilities, the dates they were incurred, the total amounts owing, and a schedule of actual or planned payment dates and amounts; (c) The sources and amounts of the person’s income; (d) The sources of available benefits from health insurance; (e) A description and the amounts of the person’s expenses; (f) The names and ages of any dependents, and the sources and amounts of income and assets, other than those of the person, which are available for their support; and (g) The income, assets, and liabilities of the person’s spouse or other individual who shares the person’s expenses; (h) Other information the person and/or the person’s representative considers important to the determination of the person’s ability to pay. (2) Information Obtained from Other Sources. In addition, the Division may obtain financial information regarding the person from other sources the Division considers to be reliable. These sources may include, but are not limited to, the Social Security and Veterans Administrations, Oregon Department of Revenue, and other Oregon Health Authority agencies. Statutory/Other Authority: ORS 179.770 & 413.042 Statutes/Other Implemented: ORS 179.610 – 179.770 History: MHD 9-1991, f. 12-13-91, cert. ef. 12-16-91 MHD 14-1980, f. & ef. 6-24-80 MHD 5-1980(Temp), f. & ef. 4-18-80 309-012-0033 Procedures for Determining Ability-to-Pay for Cost of Care (1) Ability-to-Pay Orders — Based on the financial information received or obtained, the Division will determine the person’s ability to pay. If the person, and/or the person’s authorized representative fails to provide sufficient information to show the person cannot pay the full cost of care, the Division may determine the person has the ability to pay the full cost of care. The determination of the person’s ability to pay shall be set forth in an Ability-to-Pay Order. The four types of Ability-to-Pay orders are Determination of Charges, Modification to Charges, Return of Funds for Personal Support Following Release, and Waiver of Charges. Each Order shall be given one of these titles to identify the type of determination it sets forth, and it shall be based on the factors and criteria described in the following sections. (2) Limit on Charges — The amount determined by the Division to be the person’s charges shall not exceed the full cost of care for the dates of service covered by the Ability-to-Pay Order, less payments and/or credits from any other sources the Division has received, or reasonably anticipates receiving. (3) Determination of Charges — An Ability-to-Pay Order which sets forth a determination of the person’s charges for the care received which is made either while the person is in the state institution, or after the person’s release from the state institution. A Determination of Charges may be issued any time during the person’s stay in the state institution. A Determination of Charges will be issued after the person’s release if none was issued during the person’s stay, or if the person’s financial circumstances change to enable the person to pay cost of care which exceeds amounts charged by previous Ability-to-Pay Orders. When issuing a Determination of Charges, the Division will consider the following factors: (a) Factors relating to the person’s eligibility for and coverage by benefits from health insurance; (b) Factors relating to the person’s assets: (A) Except as otherwise provided in this section, charges will be assessed using the person’s equity in all assets whether the asset is controlled by the person, or by the person’s authorized representative. The Division will determine the person’s equity in each asset by deducting from the fair market value of the asset any bona fide encumbrance against the asset; (B) Charges will be assessed using the person’s equity in a primary personal residence only if: (i) Information is provided by the treatment staff at the state institution stating the person cannot reasonably be expected to return to the residence to live at any time following discharge from the institution; and (ii) None of the following individuals is residing in the residence: (I) The person’s spouse; (II) The person’s child or children under age 21, or blind or disabled; (III) The person’s sibling or siblings who own an interest in the residence, and who lived in the residence for at least one year immediately prior to the person’s admission to the state institution; (IV) The person’s parents or emancipated children who are unable to work to maintain themselves as declared in ORS 109.010. (C) No charge will be assessed using the person’s equity in a primary personal automobile; (D) The value of an asset which has great sentimental value to the person (such as a family heirloom or gift from a loved one) may be disregarded if selling the asset would cause the person great emotional distress. The Division shall confer with the person’s treatment staff to decide whether or not to make this disregard; (E) When assets are used as the basis for ongoing charges, the Division will estimate the length of time the assets are expected to last. During the final 60 days of that time period, the Division will review the person’s financial circumstances in preparation for modifying the person’s charges. (c) Factors relating to the person’s income: (A) Charges will be assessed using the total amount of all income received either by the person, or for the person by the person’s authorized representative; (B) Income received at intervals other than monthly may be prorated for use in a calculation of a monthly charge to the person. (d) Factors relating to the person’s legal and moral obligations: (A) For legal obligations other than administratively or judicially ordered child and/or spousal support, the person must have demonstrated an intent to pay the obligation, either by showing a history or regular payments toward the full amount owing, or by providing a plan showing dates and amounts of payments to be made in the future; (B) The Division shall seek the advice of treatment staff as to whether or not, in the interest of the person’s rehabilitation, welfare, and/or treatment, the person’s need to satisfy declared moral obligations should be given priority over the person’s obligation to pay the cost of care; (C) Any deduction allowed by the Division for legal or moral obligations must be used to satisfy the current obligation. It may not be accumulated by, or on behalf of the person, or used for purposes other than that for which it was approved. (e) Factors relating to the person’s obligation to provide financial support for dependents: (A) Before approving a deduction for financial support for a dependent, the Division shall determine how much money is required to reasonably support the dependent. From that amount, the Division shall subtract any funds available from sources other than the person, such as the dependent’s own income and assets, or any form of governmental aid such as public assistance payable to, or on behalf of the dependent; (B) Any deduction allowed by the Division for the financial support of dependents must be used to provide current support. It may not be accumulated by, or on behalf of the person, and it may not be used for other purposes. (f) Factors relating to the person’s personal and special authorized expenses while in the state institution: (A) The personal expense allowance while the person is in the state institution shall be established by the Division to reflect the Supplemental Security Income Program’s payment limit for institutionalized individuals (The allowance was $30 per month as of July 1, 1988.); (B) Special authorized expense allowances while the person is in the state institution shall be approved based on the following criteria: (i) The state institution treatment staff’s advice that satisfying the need will not interfere in any way with the successful treatment or general welfare of the person, and it may enhance the person’s ability to meet the goals of the treatment plan; and (ii) There are no other resources available to meet the need. (g) Factors related to the person’s need for funds for personal support following release from the state institution when the Division is issuing any Ability-to-Pay Order after release or when release is scheduled within 30 days: (A) As necessary, funds for personal support following release will be allowed to pay for the following items: (i) Rental costs including the monthly rent payment, as well as one time deposits or fees, or mortgage payments related to the purchase of a residence; (ii) Food for the person and dependents; (iii) Utilities such as heating fuel, water, electricity, garbage service, basic telephone service, and basic television cable service; (iv) Transportation and related insurance coverage; (v) Routine household maintenance and insurance coverage; (vi) Health and dental care and related insurance coverage for the person and dependents; (vii) Clothing and entertainment for the person and dependents; and (viii) Other personal expenses which the person shows to be reasonable and necessary, including payments toward moral obligations and legal obligations (other than mortgage contracts), as described in subsection (d) of this section. (B) The funds allowed for personal support following release shall be based on what a reasonable and prudent individual would spend for the items given the resources available to the individual; (C) The amount approved for support of the dependents shall take into consideration all other resources available to meet the dependent’s needs. (h) Factors relating to the time period during which the Division may assess charges, and the time period during which the person is required to pay assessed charges: (A) Ability-to-Pay Orders issued after release which establish an ongoing monthly charge based on the person’s ability to pay after release shall not add new charges beyond the 36th month following the month in which the person was released from the state institution; (B) The person is required to pay beyond the 36 month period, any assessed charges not paid prior to release or during the 36 month period after release. (4) Modification to Charges — An Ability-to-Pay Order which sets forth a modification to the person’s charges established by a prior Ability-to-Pay Order. A Modification to Charges will be made to reflect either a change in the person’s financial circumstances which affects the person’s ability-to-pay ongoing monthly charges, or the Division’s receipt of benefits from health insurance that were not recognized in a prior Ability-to-Pay Order, which cause established charges to exceed the maximum cost of care chargeable to the person in accordance with section (2) of this rule. When issuing a Modification to Charges, the Division will consider the same factors used for a Determination of Charges as described in section (3) of this rule. (5) Return of Funds for Personal Support Following Release — An Ability-to-Pay Order which sets forth a determination by the Division regarding the return of funds paid toward the person’s charges to provide the person with adequate funds for personal support following his or her release from the state institution. When issuing a Return of Funds for Personal Support Following Release, the Division will use the following criteria: (a) A Return of Funds for Personal Support Following Release is subject to the following conditions: (A) The person or the person’s representative has made payments toward the cost of care provided by the state institution. NOTE: Returned funds for personal support following release cannot exceed the total amount paid from the person’s own income and assets. Benefits from health insurance are not included in the amounts paid. If charges are due, but the person or the person’s representative has made no payment, funds for personal support following release will be considered under the provisions for Waiver of Charges; (B) The person will be discharged from the state institution within the next 30 days, or he/she was discharged from the state institution within the last 60 days; (C) The person has financial obligations following release from the state institution as described in subsection (3)(g) of this rule which cannot be immediately satisfied with other available resources. (b) Funds for personal support following release will be provided for a limited amount of time, not normally to exceed six months, during which time the person will be expected to become otherwise supported through employment, public assistance, or other available programs; (c) Funds for personal support following release for a period of time exceeding six months will be considered only if the Division receives information which shows the person’s circumstances require such consideration. (6) Waiver of Charges — An Ability-to-Pay Order which sets forth a determination by the Division regarding waiver of collection of part or all of the person’s unpaid charges based upon the best interest of the person or the Division: (a) A waiver of charges should be granted when the Division, after considering information regarding extraordinary circumstances pertaining either to the person’s financial situation, or the person’s physical, psychological, or sociological well-being, determines: (A) Charges assessed by prior Ability-to-Pay Orders are unpaid, and a subsequent change in the person’s circumstances shows that collection of all or part of the unpaid charges would be detrimental to the best interests of the person or of the Division; (B) Charges assessed by prior Ability-to-Pay Orders are unpaid, and the Division either receives a written statement from the person’s treating physician, or accepts, on a case-by-case basis, a non-physician mental health professional’s written statement, which indicates the person’s physical, psychological, and/or sociological condition is interfering with the person’s ability to satisfy the outstanding obligation, and further efforts by the Division to collect the unpaid charges would be harmful to the person; or (C) Charges have not been assessed by a prior Ability-to-Pay Order extraordinary circumstances as described in paragraph (A) and/or (B) of this subsection are present, and based on those circumstances the charges should not be assessed. (b) In accordance with ORS 179.640(4), charges may be assessed or reassessed at a later time by a new Determination of Charges Ability-to-Pay Order if the basis for waiver under this section ceases to exist. Statutory/Other Authority: ORS 179.770 & 413.042 Statutes/Other Implemented: ORS 179.610 – 179.770 History: MHD 9-1991, f. 12-13-91, cert. ef. 12-16-91 MHD 14-1980, f. & ef. 6-24-80 MHD 5-1980(Temp), f. & ef. 4-18-80 309-012-0034 Delivery of Ability-to-Pay Orders and Factors Relating to Appeals (1) Delivery to the Person — The original Ability-to-Pay Order shall be delivered to the person, unless the person has an authorized representative. (2) Delivery to the Authorized Representative — If the person has an authorized representative, the original Ability-to-Pay Order shall be delivered to the authorized representative, and a copy shall be delivered to the person. Any Ability-to-Pay Order delivered to an authorized representative shall include an explanation of the Division’s right to demand payment of the charges assessed by the Order, and the consequences to the authorized representative of failing to comply, as provided by ORS 179.653. (3) Appeal Rights — The Ability-to-Pay Order shall include an explanation of the person’s right to appeal the determination set forth by the Order. (4) Successor Authorized Representative — If the person’s authorized representative does not pay or appeal the charges assessed by an Ability-to-Pay Order, and he or she is subsequently replaced by a new authorized representative, the successor authorized representative shall be provided with the opportunity to either pay the assessed charges, or to appeal the determination set forth by the Order. The Division will take the following actions when notified there is a successor authorized representative: (a) Deliver copies of all Ability-to-Pay Orders not fully paid to the successor authorized representative with a letter which describes the delivery of the Order(s) to the previous authorized representative(s), and any actions taken by the previous representative(s) with regard to the Order(s); (b) Include with the Order copies, an explanation of the successor authorized representative’s right to appeal the determination(s) set forth by the Ability-to-Pay Order(s). (5) Resolving Appeals — If the person or the person’s authorized representative appeals a determination set forth by an Ability-to-Pay Order, the Division will attempt to resolve the appeal by issuing a new Ability-to-Pay Order which takes into consideration the information on which the appeal is based. If the appeal cannot be resolved by issuing a new Order, it will be addressed through the contested case appeal process. Statutory/Other Authority: ORS 179.770 & 413.042 Statutes/Other Implemented: ORS 179.610 – 179.770 History: MHD 9-1991, f. 12-13-91, cert. ef. 12-16-91 309-012-0035 Enforcement of Recoupment Liens (1) Purpose. This rule establishes procedures for implementing recoupment liens used in carrying out Reimbursement Orders issued by the Division. (2) Statutory Authority and Procedure. This rule is authorized by ORS 179.770 and carries out the provisions of ORS 179.653 and 179.655. (3) Definitions. As used in this rule: (a) “Cost of Care” means the cost determined by the Division in accordance with ORS 179.701; (b) “Division” means the Addictions and Mental Health Division of the Oregon Health Authority; (c) “Person” means: (A) A patient who is receiving or has received treatment or care at a state institution for the mentally ill; (B) A current or former resident at a state institution for the mentally retarded. (d) “Person’s Representative” means a conservator, guardian of the person, or estate of the person in a state institution, or an individual who has been appointed by a court in this or another state or by Federal Court to serve as the legal representative of a person in a state institution, and also includes an individual whom a person in a state institution has designated to receive the notice of information involved in the particular transaction; (e) “Recoupment Lien” means a charge or security or encumbrance upon real or personal property that can be used to satisfy the amount due for the person’s cost of care; (f) “Reimbursement Order” means the order issued to determine the person’s ability to pay pursuant to ORS 179.640(1) and (2); (g) “State Institution” means Dammasch State Hospital in Wilsonville, Oregon State Hospital in Salem, Fairview Training Center in Salem, and Eastern Oregon Hospital and Training Center in Pendleton; (h) “Warrant” means the document issued by the Division directed to the sheriff of any county of the state commanding the sheriff to levy upon and sell the real and personal property which is subject to satisfaction of the recoupment lien. (4) Enforcement of Lien by Issuance of Warrant. The Division shall enforce its recoupment lien created by ORS 179.653 by issuance of a warrant in the manner stated in 179.655. Any warrant issued by the Division pursuant to 179.655 shall clearly provide that the sheriff or other person executing the warrant shall not levy upon and sell any real or personal property that would be exempt under Oregon law from execution pursuant to a judgment. However, the Division shall not issue a warrant pursuant to 179.655 where: (a) The amount due to the Division for the cost of care of a person in a state institution is not at least 30 days overdue; (b) Provision has been made to secure the payment by bond or deposit or otherwise in conformance with section (5) of this rule; (c) The person has exercised the right to appeal the Reimbursement Order pursuant to OAR 309-012-0025(6) and that appeal is still pending; (d) Sixty-one days have not passed since the issuance of the Reimbursement Order; (e) The person or the person’s representative has not been given at least ten days’ prior written notice that the Division intends to issue such a warrant. (5) Methods of Securing Satisfaction of Reimbursement Order: (a) The issuance of a warrant to the sheriff to enforce collection of delinquent money due the Division for the cost of care for a person in a state institution will be stayed either by paying the amount due and accrued interest after it becomes due or by securing payment of that amount by bond or deposit or otherwise; (b) The bond given by the person must be for an amount not less than the amount due, plus interest for a reasonable period determined by the Division: (A) The bond must be executed by: (i) A surety company which is registered with, and under the supervision of, the Insurance Commissioner of the State of Oregon; or (ii) By two or more individual sureties, each of whom shall be a resident and homeowner or holder of an interest in land within the state and each of whom shall be worth sums specified in the under-taking, exclusive of property exempt from execution and over and above all valid debts and liability. (B) The Division may allow more than two sureties to justify several amounts less than that expressed in the undertaking, if the whole justification is equivalent to that of two sufficient undertakings. (c) Any one of the following items, or combination of items acceptable to the Division, equal to the amount due, plus accrued interest thereon, may be deposited with the Division: (A) A deposit of money; (B) A certified check or checks on any state or national bank within the State of Oregon payable to the Division; (C) Satisfactory bonds negotiable by delivery, or obligations by the U.S. Government negotiable by delivery; or (D) Any other security satisfactory to the Division. (d) The Division may require additional security whenever, in its opinion, the value of the security pledged is no longer sufficient to adequately secure the payment of the amount due, plus accrued interest thereon. (6) Release of Tax Lien and Clouds on Title. Any request made to the Division for the release of a warrant, where such warrant is not in fact a lien on title to the real property in question but merely a cloud on the title to such real estate, shall be accompanied by a statement. This statement shall show the facts affecting the title to the real property in question that render the Division’s warrant a cloud on the title to such real property and the reasons the warrant does not actually constitute a lien thereon: (a) This type of request for release of a warrant should be accompanied by a current title report; (b) The Division may require other documentary proof showing the present condition of the title to the property in question. Statutory/Other Authority: ORS 179.770 & 413.042 Statutes/Other Implemented: ORS 179.610 – 179.770 History: MHD 15-1980, f. & ef. 6-24-80 MHD 8-1980(Temp), f. & ef. 4-18-80 309-012-0070 Policy (1) Requests for copies of medical records must be made in writing with proper consent and must be specific to assure that only the essential portions of the medical record are copied and released. (2) A patient or resident shall not be denied access to the medical record because of inability to pay. The patient may review his or her record in the Medical Record Department at no charge. (3) A copy of the most recent release summary shall be furnished free of charge to authorized persons or agencies providing follow-up care. (4) A copy of required portions of medical records may be provided without charge to the following agencies and individuals. When a substantial part or all of a medical record is requested, the Division may charge for copies in accordance with OAR chapter 943-003: (a) Community mental health programs; (b) Courts; (c) Hospitals; (d) Individuals or agencies providing follow-up care for the patient; (e) Insurance carriers paying for patient's or resident's care; and (f) Physicians. (5) All other requests for public records shall be charged in accordance with OAR 943-003. Statutory/Other Authority: ORS 179.770, 413.042 & 431.120 Statutes/Other Implemented: ORS 179.610 – 179.770 History: MHS 4-2007, f. & cert. ef. 5-25-07 MHD 10-1983, f. & ef. 6-8-83 MHD 2-1983(Temp), f. & ef. 2-18-83 309-012-0100 Purpose and Statutory Authority (1) Purpose. These rules establish the amount of earned income the Division excludes when calculating ability-to-pay for cost of care at a mental health institution. The purpose of this earned income exclusion is to reduce the disincentive to work for patients and residents. (2) Statutory Authority. These rules are authorized by ORS 413.042 and carry out the provisions of ORS 179.770. Statutory/Other Authority: ORS 179.770 & 413.042 Statutes/Other Implemented: ORS 179.610 – 179.770 History: MHD 11-1985, f. & ef. 6-19-85 309-012-0105 Definitions As used in these rules: (1) “Earned Income” means money received by a patient or resident in a mental health institution in return for services rendered, while receiving care or treatment at the institution. (2) “Mental Health Institution” means Dammasch State Hospital in Wilsonville, Oregon State Hospital in Salem, Fairview Training Center in Salem, and Eastern Oregon Psychiatric Center and Eastern Oregon Training Center in Pendleton. Statutory/Other Authority: ORS 179.770 & 413.042 Statutes/Other Implemented: ORS 179.610 – 179.770 History: MHD 11-1985, f. & ef. 6-19-85 309-012-0110 Earned Income in Calculation of Ability-to-Pay The Division includes earned income as income in the calculation of ability-to-pay, as described in OAR 309-012-0030. Statutory/Other Authority: ORS 179.770 & 413.042 Statutes/Other Implemented: ORS 179.610 – 179.770 History: MHD 11-1985, f. & ef. 6-19-85 309-012-0115 Earned Income Exclusion The Division allows a patient or resident to retain a portion of any income earned while in a mental health institution. The amount of earned income to be excluded in the calculation of ability-to-pay is determined by subtracting $65 from earned income. An additional $25 will be subtracted from the total income (both earned and unearned) as an allowance for personal need. Statutory/Other Authority: ORS 179.770 & 413.042 Statutes/Other Implemented: ORS 179.610 – 179.770 History: MHD 11-1985, f. & ef. 6-19-85 309-012-0235 Termination of Relative Foster Care Funding (1) This rule is adopted in coordination with the Oregon Health Authority’s (Authority) work with counties to transition participating individuals from relative adult foster care to Medicaid-funded services or other available programs. (2) Effective December 31, 2017, the Authority shall no longer fund relative adult foster care directly or through Service Element 34A of its contracts with community mental health programs. (3) Relative adult foster care does not include the services provided in licensed adult foster homes pursuant to OAR chapter 309, division 040. Statutory/Other Authority: ORS 413.042 & ORS 430.640 Statutes/Other Implemented: ORS 413.042 & ORS 430.610-430.651 History: MHS 16-2017, adopt filed 12/26/2017, effective 12/31/2017 MHS 14-2017, temporary adopt filed 11/21/2017, effective 11/21/2017 through 05/19/2018