Idaho Administrative Code
Title IDAPA 16 - Health and Welfare, Department of
Rule 16.07.01 - BEHAVIORAL HEALTH SLIDING FEE SCHEDULES
Section 16.07.01.400 - CALCULATING INCOME TO APPLY THE SLIDING FEE SCHEDULE FOR CHILDREN'S MENTAL HEALTH AND ADULT MENTAL HEALTH SERVICES

Universal Citation: ID Admin Code 16.07.01.400

Current through September 2, 2024

The fee determination process includes consideration of the following subsections in this rule.

01. Application and Fee Determination Form. Prior to the delivery of behavioral health services, an application for services and a "Fee Determination" form must be completed.

a. A child's parent(s) must complete the application and fee determination form when requesting Children's Mental Health services.

b. An adult requesting Adult Mental Health services must complete the application and fee determination form.

02. Ability to Pay. Financial obligations are based upon the number of persons in the family household and the adjusted gross income of those persons as determined using the following:

a. An ability to pay determination will be made at the time of the voluntary request for services or as soon as possible, thereafter.

b. Redetermination of ability to pay will be made at least annually or upon request or at any time changes occur in family size, income, or allowable deductions.

c. In determining the family's ability to pay for services, the Department will deduct annualized amounts for the following:
i. Court-ordered obligations;

ii. Dependent support;

iii. Child care expenses necessary for parental employment;

iv. Medical expenses;

v. Transportation;

vi. Extraordinary rehabilitative expenses; and

vii. State and federal tax payments, including FICA taxes.

03. Required Information. Information regarding third-party payors and other resources, including Medicaid or private insurance, must be identified and developed in order to fully determine the child's parent(s) or adult individual's ability to pay and to maximize reimbursement for the cost of services provided. It is the responsibility of the parents, legal guardian, or adult individual to obtain and provide information not available at the time of the initial financial interview whenever that information becomes available.

04. Time of Payment. Payment for services will be due upon delivery of services unless other arrangements are made.

05. Financial Obligation. A financial obligation for each service not covered by third party liable resources or payments, including private insurance and Medicaid, will be established in accordance with Section 300 and Subsection 400.01 of these rules but in no case will the amount owed exceed the cost of the service. In no case will the annual financial obligation exceed five percent (5%) of adjusted gross income of the family household.

06. Fees Established by the Department. The maximum hourly fees or flat fees charged for Behavioral Health services are established by the Department of Health and Welfare.

a. The fees for Children's Mental Health Services and Adult Mental Health Services are based on the cost for services set in Department contracts with service providers. Current information regarding services and fee charges can be obtained from regional Children's Mental Health and Adult Mental Health offices specified online.

b. The fees for Substance Use Disorders Services are based on the cost for services set in Department contracts with the Management Services Contractor. Current information regarding services and fee charges can be obtained from the Department office described in Section 005 of these rules.

Effective March 15, 2022

Disclaimer: These regulations may not be the most recent version. Idaho may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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