Current through Register 1531, September 27, 2024
(1)
Scope.
104
CMR 30.01 shall apply to Department
facilities and inpatient units contracted for by the Department. It shall apply
to the maintenance and expenditure of patient funds which are located within
the facility or which are deposited with the facility director or his or her
designee. For purpose of 104 CMR 30.00, any reference to facility shall include
a Department contracted inpatient unit.
(2)
Definitions. In
addition to the terms defined in
104
CMR 25.02: Definitions, the
following terms shall have the meanings throughout
104
CMR 30.01, unless the content clearly
provides otherwise.
Dependent Funds. Those funds belonging
to a patient that are located at a facility or received by a facility
if:
(a) the patient is unable to manage
these funds himself or herself as determined by an evaluation in accordance
with 104 CMR
30.01(4);
(b) the patient is unable to manage these
funds as determined by a court of competent jurisdiction;
(c) the patient is unable to manage these
funds as determined by the Social Security Administration or Veterans
Administration in accordance with their requirements;
(d) the funds were received from a legally
authorized representative of the patient for the patient; or
(e) the funds belong to a patient who is a
minor.
Financial Manager. The individual
appointed by the person in charge of a facility to manage patient funds held by
the facility.
Funds. Cash, checks, negotiable
instruments, or other income or liquid assets.
Independent Funds. All of a patient's
funds which are located at the facility and which are not dependent
funds.
Liquid Assets. Cash and all property
capable of ready conversion into cash, such as stocks and bonds, whether held
jointly or solely. Liquid assets do not include life insurance or its cash
value, nor assets subject to an irrevocable trust with the patient or client as
named beneficiary, unless those assets are available to the patient or client
or fee payer on demand.
(3)
Upon Admission and Prior to
Evaluation. All of a patient's funds shall be deemed to be
independent funds, unless such funds have been determined to be dependent as
defined in
104
CMR 30.01(2).
(4)
Evaluation of Ability to
Manage Funds.
(a) Unless a
legally authorized representative has been appointed with authority to manage
all of the patient's funds, or the patient is a minor, the clinical staff of
the facility shall evaluate the patient as soon as possible after admission
(but no later than 30 days after admission); at least once during the second
three months after admission; and at least every 12 months thereafter; and upon
the patient's request, to determine his or her ability to manage and spend his
or her funds. No patient shall be found unable to manage and spend his or her
funds unless it is determined by a clinical evaluation that the patient is
unable to manage and spend money to satisfy his or her needs and desires
because:
1. he or she lacks a basic
understanding of the value of money; or
2. his or her fiscal judgment is
significantly impaired due to behavioral health or medical condition or due to
a lack of appreciation of his or her needs and desires, as shown by actual past
example or by strong medical evidence.
The evaluation shall be conducted pursuant to any guidelines
established by the Department. The evaluation shall be a part of the periodic
review of the patient pursuant to M.G.L. c. 123, § 4 and
104
CMR 27.11: Periodic
Review.
(b) The evaluation shall take into
consideration the amount of the patient's present and future funds and shall
determine:
1. whether the patient is able to
manage and spend all of his or her funds;
2. if the patient is not able to manage and
spend all of his or her funds, how much of such funds he or she is able to
manage and spend and how much of such funds he or she is not able to manage and
spend; and
3. in regard to funds
the patient is not able to manage and spend himself or herself, how such funds
can best be used to benefit the patient, consistent with
104
CMR
30.01(8).
(c) The results of the evaluation shall
become part of the patient's record and a copy shall be provided to the patient
and his or her legally authorized representative, if any.
(d) At least seven days prior to the
evaluation, the patient shall receive both written and oral notice of the
evaluation which includes a description of the evaluation process. At the
evaluation, the patient shall have the right to present any information on his
or her behalf, and to be assisted by a person of his or her choice. The patient
shall be informed that the facility's Human Rights Officer is available to
assist him or her. In addition, the patient shall be informed of the right to
seek legal assistance. The facility director or his or her designee, may waive
the requirement of seven days written and oral notice to the patient of such
evaluations only pursuant to the provisions of
104
CMR 30.01(4)(e).
(e)
Emergency
Evaluation. Facilities shall have procedures for situations where
a patient's use of his or her funds present a significant risk to the patient,
others, or may result in damage to or loss of the funds themselves. These
procedures may include an emergency evaluation of the patient's ability to
manage his or her funds by the facility's clinical staff, without prior notice
as described in
104
CMR 30.01(4)(d) if the
circumstances so require. The reasons for any such emergency evaluations shall
be explained to the patient at the time of the evaluation and shall be
documented in the patient's record. In addition, within 14 days of an emergency
evaluation, the patient must be given another evaluation of his or her ability
to manage funds with the notices and other protections described in
104
CMR 30.01(4)(d). Funds which
are determined at an emergency evaluation to be dependent funds may be spent by
the facility director only with the approval of the patient or his or her
legally authorized representative, if any.
(5)
Evaluation of Need for a
Legally Authorized Representative.
(a) If a patient is determined to be unable
to manage his or her funds, pursuant to
104
CMR 30.01(4), a further
determination shall be done as to whether or not the appointment of a legally
authorized representative to manage the patient's funds is indicated and if so,
the type of legally authorized representative that is needed. The determination
and the reason(s) for it shall be documented in the patient's record.
(b) If a determination is made that a legally
authorized representative is needed, or if in accordance with M.G.L. c. 123,
§ 25, a patient has been under the care of the Department for at least six
months and it has been determined pursuant to
104
CMR 30.01(4) that the
patient is not able to manage and spend any of his or her funds independently
and the patient does not have a legally authorized representative, the
Department shall notify the patient and the patient's nearest living relative
to recommend that the necessary steps be taken to appoint an appropriate
legally authorized representative.
(6)
Training Patients to Manage
Their Own Funds. A patient's treatment team shall develop a plan
to teach or assist the patient to manage all, or a portion, of his or her own
funds according to his or her capabilities and the level of supports available
to him or her.
(7)
Use
of Independent Funds by the Patient. The patient shall have an
unrestricted right to manage and spend, at his or her sole discretion, all of
his or her independent funds. Independent funds, at the patient's discretion,
may be deposited with the facility director or his or her designee.
(8)
Management and Expenditure of
Dependent Funds.
(a)
Facility Director. In accordance with M.G.L. c. 123,
§ 26(a) and federal regulations, the facility director shall be
responsible for the management and expenditure of all dependent
funds.
(b)
Designated
Staff. To carry out his or her responsibility as to the proper
management and expenditure of dependent funds, the facility director shall
designate staff within the facility who shall be directly responsible to the
facility director and who shall determine on a day-to-day basis how to best
manage and spend a patient's dependent funds, consistent with
104
CMR 30.01(8). These
designated staff shall have sufficient contact with the patient to have
firsthand knowledge of the patient and to be responsive to the patient's
day-to-day needs and desires. Designated staff shall consult with a patient
prior to making a purchase for him or her. The facility director may establish
a committee to make recommendations regarding the expenditure of dependent
funds.
(c)
Appropriate
Expenditures. Dependent funds shall be used only for purposes
which directly benefit the patient. Generally, dependent funds should be used
to facilitate the patient's earliest possible rehabilitation and discharge to
the community, for personal needs to improve the patient's condition while in
the facility, and to help the patient live as normal and comfortable a life as
practicable. The patient's desires, as well as needs, will be considered. Where
the patient has unmet current needs, continued saving of dependent funds is not
in the patient's interest unless such saving is for a foreseeable and
appropriate future purpose such as to pay for living expenses upon discharge. A
patient's current needs include paying the facility's charge for services
provided to the patient, as determined in accordance with
104
CMR 30.04 and other applicable law. Dependent
funds shall not be expended for any item or service which the facility is
obligated to supply the patient and which would already have been included with
the usual and customary charge for service or which the patient is otherwise
entitled to receive without charge.
(d)
Group Purchases.
Dependent funds of a patient may be used together with funds of other patients
to allow for a group purchase. However, a group purchase may be made only if
all patients in the group shall benefit from such purchase, and contribute a
fair amount to the purchase. Patients and their legally authorized
representatives, if any, should be consulted prior to any such group
purchase.
(9)
Maintenance of Bank Accounts; Records and Accountings.
(a) Pursuant to M.G.L. c. 123, § 26(a),
the facility director or his or her designee may maintain individual bank
accounts on behalf of the facility's patients. These accounts shall be interest
bearing accounts if commercially available and fiscally prudent. Interest
earned in any such account shall be credited to the patient. Alternatively, the
facility may deposit up to a set amount, established by the Department by
policy, of a patient's funds in a group bank account so long as an individual
record is maintained of each patient's deposits and withdrawals, and interest
is appropriately apportioned among the patients in the group.
(b) The facility must have written policies
and procedures concerning internal controls and accounting procedures for the
management of patient funds on deposit with the facility.
(c) The facility director or designee must
file an annual report with the Department's Chief Financial Officer, or
designee, listing all group accounts and individual bank accounts that were
maintained by the facility during the year. The report shall include the
beginning and ending balances of each account and the name of the individual(s)
and facility listed on the account. Each annual report shall be in the form and
manner prescribed by the Department's Chief Financial Officer.
(d)
Record of Funds.
All funds received from a patient or received on his or her behalf shall be
accounted for, and a record made showing the amount of funds received, date
received and source of the funds. Additionally all funds disbursed shall be
accounted for, and a record made showing the amount of funds disbursed, date
disbursed, reason for disbursement and to whom funds were disbursed.
(e)
Accounting for
Funds. The following persons shall, upon their request, be
provided a complete written account of all funds of a patient or, if requested,
a written or oral statement of the current balance of funds of the patient:
1. the patient;
2. if the patient is determined unable to
manage or spend all or part of his or her funds, the staff designated as
responsible for expenditures for the patient under
104
CMR 30.01(8)(a) and
(b);
3. the patient's legally authorized
representative;
4. the patient's
treatment team;
5. other person who
has deposited funds with the facility for the patient's benefit, but, in this
instance, the accounting will be limited to an accounting for the funds
actually deposited with the facility by said person: and
6. the Department's Chief Financial Officer
or designee.
(10)
Making Purchases on Behalf
of Patients. The facility shall have an obligation to assist
patients in making purchases, and to inform patients of the availability of a
shopping service for those patients who are unable to leave the facility. The
shopping service shall be responsive to the individual needs and tastes of the
patients.
(11)
Social
Security and Veterans Administration Income. When the facility
director is designated by the Social Security Administration or the Veterans
Administration as the representative payee of a patient, federal regulations
govern the use of such funds. Accordingly, the facility director must comply
with any policy directives or letters from the Social Security Administration
or the Veterans Administration in regard to the use of these funds and income.
To the extent allowed by Social Security or Veterans Administration
requirements, the facility director may delegate the actual management of such
funds to appropriate facility staff in accordance with the facility's written
policies and procedures. In addition,
104
CMR 30.01 shall be followed to the extent
that it is not inconsistent with Social Security or Veterans Administration
requirements.
