Section 276.37 - Copayment and Room and Board(a) Amount. The facility must collect the copayment and room and board amounts indicated on the Texas Department of Human Services' (DHS's) Notification of Community Care Services form or DHS's Notification of Community Based Alternatives (CBA) Services form. This subsection does not apply to clients who receive Community Care for Aged and Disabled emergency care service.(b) Due date. (1) The facility must designate a due date for copayment and room and board in writing. The due date must be during the same month the copayment and room and board is applied.(2) The facility must collect the entire copayment and room and board on or before the due date. If the due date falls on a weekend or a holiday, the facility must collect the entire copayment and room and board on or before the first working day thereafter.(3) If the client or the client's representative fails to pay the entire copayment and room and board by the due date, the facility must notify the client or the client's representative and the case manager in writing no later than the first working day after the due date.(c) Credit balances. (1) A credit balance is an amount due to the client or the client's representative when there is an overpayment by the client or the client's representative.(2) The facility must handle credit balances as follows: (A) The facility must provide written notice of a credit balance (client notice) to the client or the client's representative within 35 days of receipt of the payment resulting in a credit balance. The client notice may be the first monthly statement following the receipt of the payment resulting in a credit balance, if the monthly statement specifies the credit balance.(B) The facility must offer the client or the client's representative the following options in the client notice: (i) the client or the client's representative may choose to provide the corrected payment, and the facility will return the original amount paid;(ii) the facility will provide the client or the client's representative with a refund of the credit balance; or(iii) the client or the client's representative may choose to have the credit balance applied to the following month's payment. The client may choose to spread the credit balance over several months.(C) If the client or the client's representative fails to contact the facility within 35 days of the date of the client notice, the facility must, on the 35th day: (i) provide the client or the client's representative with a refund of the credit balance or apply the credit balance to the following month's payment; and(ii) provide written notice of the facility's choice of action to the client or the client's representative. The written notice of the facility's choice of action may be a monthly statement if the monthly statement specifies the facility's choice of action.(d) Copayment and room and board receipts. (1) The facility must provide receipts for all copayment and room and board payments received from or on behalf of clients at the time the payment is received.(2) The facility must keep a copy of all copayment and room and board receipts.(3) Copayment and room and board receipts must contain the following elements if the elements are not contained in the copayment and room and board ledger described in subsection (e) of this section: (A) the name of the client;(B) the month, day, and year the payment was received;(C) the total amount collected;(D) the specific amounts of copayment and room and board collected; and(E) the month and year of the coverage period for the payment received.(4) Copayment receipts may be in any format.(e) Copayment and room and board ledger. The facility must maintain a copayment and room and board ledger system in any format for each client. (1) The facility may keep the copayment and room and board ledger systems as separate ledgers, or the facility may combine both ledgers into a single ledger system. If the facility chooses to keep a single ledger system, a separate entry must be made for each copayment and room and board entry.(2) The copayment and room and board ledger system must reflect the following: (A) all charges for copayment and room and board by client;(B) all payments for copayment and room and board made by or on behalf of a client;(C) all credits for copayment and room and board by client, including the: (i) specific amount credited;(ii) month and year of the coverage period of the credit;(iii) type of payment credited; and(iv) reason for the credit; and(D) a running balance by client.(3) The facility must record all activities on the copayment and room and board ledger system within 35 days or by the next billing cycle, whichever is sooner.(4) The copayment and room and board ledger must be maintained in accordance with generally accepted accounting principles (GAAP).(f) Refunds upon discharge. The facility must refund the client's copayment and room and board for the remaining days of the month following the date of discharge or death. The refund must be made within ten working days of awareness that the client will be discharged or is deceased. The facility must document the date of awareness of the client's discharge from the facility.26 Tex. Admin. Code § 276.37
Transferred from 40 TAC § 46.37 Texas Register, Volume 49, Number 38, September 20, 2024, TexReg 7640, eff. 10/18/2024