Section 301.515 - Payments, Collections, and Non-payment(a) Payment and collection. (1) A person (or parent) must promptly pay all charges owed to the MRA.(2) An MRA must make reasonable efforts to collect payments from all available funding sources before accessing DADS funds to pay for a person's services.(b) Financial hardship. If a person (or parent) claims financial hardship as provided in this subsection, then the MRA must determine whether a significant financial change (as defined) has occurred. If a significant financial change has occurred, then the MRA must immediately update the person's (or parent's) financial assessment as required in § 2.106(a) of this subchapter (relating to Determination of Ability to Pay). (1) If a person (or parent) claims, and provides documentation, that financial hardship prevents prompt payment of all charges owed, then the MRA may arrange for the person (or parent) to pay a lesser amount each month.(2) If a person (or parent) claims that financial hardship prevents prompt payment of all charges owed, then the MRA must arrange for the person (or parent) to pay a lesser amount each month only if the person has third-party coverage that is neither income-based public insurance nor Medicare and the person's cost-sharing exceeds the person's MMF. The lesser amount: (A) will be no more than the person's MMF, if the person's MMF is greater than zero; or(B) will be no more than $5.00, if the person's MMF is zero.(3) Although the person (or parent) may pay a lesser amount each month because a portion of the charges will be deferred, the person (or parent) is still responsible for paying all charges owed.(c) Discontinuing charges to a person (or parent) for services. If the MRA makes a decision, which is documented and includes input from the person's team, that being charged for services and receiving statements will result in a significant reduction in the functioning of the person or the person's (or parent's) refusal or rejection of the needed services, then the MRA must stop charging the person (or parent) for services and stop sending statements. The decision must be reassessed at least annually. If the MRA decides to discontinue charging the person (or parent) for services, then the MRA must develop and implement a plan to address the issues related to the person's functioning limitations or the person's (or parent's) refusal or rejection of the needed services.(d) Involuntary reduction or termination of services for non-payment by person (or parent). (1) The MRA must address the past-due account of a person (or parent) who is not making payments to ensure reasonable efforts to secure payments are initiated with the person (or parent). For example, if the MRA determines that non-payment is related to financial hardship, then the MRA may assist the person (or parent) in making arrangements to pay a lesser amount each month in accordance with subsection (a)(2) of this section or if the MRA makes a decision, which is documented and includes input from the person's team, that non-payment is related to the person's functioning limitations, then the person's service plan may be modified to address the non-payment.(2) If the MRA makes a decision, which is documented and includes input from the person's team, that non-payment is not related to the person's functioning limitations and, despite reasonable efforts to secure payment, the person (or parent) does not pay, then the MRA may propose to involuntarily reduce or terminate the person's services. The MRA may not propose to involuntarily reduce or terminate the person's services if: (A) the proposed action would result in a significant reduction in the person's functioning;(B) the proposed action would put at risk the person's health, safety, or support system; or(C) the MRA is identified as being responsible for providing court-ordered services to the person.(3) If the MRA proposes to involuntarily reduce or terminate the person's services, then the MRA must: (A) maintain documentation that the proposed action would not result in a significant reduction in the person's functioning or put at risk the person's health, safety, or support system; and(B) provide written notification to the person (or parent) in accordance with subsection (e)(1) of this section and comply with subsection (e)(2) - (3) as initiated by the person (or parent).(e) Notification, Appeal, and Review. (1) Notification. The MRA must notify the person (or parent) in writing of the proposed action (i.e., to involuntarily reduce or terminate the person's services or refer the person to third-party coverage) and the right to appeal the proposed action in accordance with § 2.46 of this chapter (relating to Notification and Appeals Process). The notification must describe the time frames and process for requesting an appeal and include a copy of this subchapter. If the person (or parent) requests an appeal within the prescribed time frame, then the MRA must not take the proposed action while the appeal is pending. The MRA may take the proposed action if the person (or parent) does not request a review within the prescribed time frame.(2) Appeal and appeal decision. The MRA must conduct the appeal in accordance with § 2.46(g) of this chapter. The MRA must notify the person (or parent) in writing of the appeal decision in accordance with § 2.46(h) of this chapter and the right to have the appeal decision reviewed by the Office of Consumer Rights and Services at DADS if the person (or parent) is dissatisfied with the appeal decision. The notification must describe the time frames and process for requesting a review.(3) Review of appeal decision. If the person (or parent) is dissatisfied with the appeal decision, then the person (or parent) may request a review by the Office of Consumer Rights and Services at DADS. A request for review must be submitted to the Office of Consumer Rights and Services, Department of Aging and Disability Services, P.O. Box 149030, MC E-249, Austin, TX 78714-9030, within 10 working days after receipt of the appeal decision. If the person (or parent) requests a review within the prescribed time frame, then the MRA must not take the proposed action while the review is pending. The MRA may take the proposed action if the person (or parent) does not request a review within the prescribed time frame and the appeal decision upholds the decision to take the proposed action. (A) A person (or parent) who requests a review may choose to have the reviewer conduct the review: (i) by telephone conference with the person (or parent) and a representative from the MRA and make a decision based upon verbal testimony made during the telephone conference and any documents provided by the person (or parent) and the MRA; or(ii) by making a decision based solely upon documents provided by the person (or parent) and the MRA without the presence of any of the parties involved.(B) The review: (i) is conducted no sooner than 10 working days and no later than 30 working days after receipt of the request for review unless an extension is granted by the director of the Office of Consumer Rights and Services;(ii) includes an examination of the pertinent information concerning the proposed action and may include consultation with DADS staff who are responsible for the policy contained in this subchapter;(iii) results in a final decision which will uphold, reverse, or modify the original decision to take the proposed action; and(iv) is the final step of the appeal process for involuntarily reducing or terminating the person's services for non-payment and for referring the person to third-party coverage.(C) Within five working days after the review, the reviewer sends written notification of the final decision to the person (or parent) and the MRA.(D) The MRA must take appropriate action consistent with the final decision.(f) Prohibition of financial penalties. The MRA must not impose financial penalties on a person (or parent).(g) Debt collection. The MRA must make reasonable efforts to collect debts before an account is referred to a debt collection agency. The MRA must document its efforts at debt collection. (1) The MRA must incorporate into a written agreement or contract for debt collection provisions that state that both parties must: (A) maintain the confidentiality of the information and not disclose the identity of the person or any other identifying information; and(B) not harass, threaten, or intimidate a person or the person's family.(2) The MRA must enforce the provisions contained in paragraph (1) of this subsection.26 Tex. Admin. Code § 301.515
Transferred from 40 TAC § 2.109 Texas Register, Volume 49, Number 24, June 14, 2024, TexReg 4433, eff. 7/15/2024