Code of Massachusetts Regulations
105 CMR - DEPARTMENT OF PUBLIC HEALTH
Title 105 CMR 920.000 - Establishing A Uniform Schedule Of Assessments For Direct Pay Patients At The Department Of Public Health Hospitals
Section 920.003 - Definitions
Adjusted Income. The combined gross incomes as defined in 105 CMR 920.003(E) herein of the patient and all financially responsible persons related to him as adjusted to the patient's prospective fiscal year in accordance with the following:
(1) The following expenses, hereinafter referred to as exceptional expenses are to be subtracted from the gross income figure if they will be paid during the patient's prospective fiscal year.
(a) Second mortgage payments, If the second mortgage is secured for rehabilitation purposes.
(b) Loan payments for loan secured due to unemployment or sickness.
(c) Special educational expenses, such as tuition for private school for special needs students.
(d) Special transportation expenses for handicapped or special needs members of the household.
(e) Child care or day care expenses.
(f) Health insurance premiums.
(g) Medical costs (other than those to be paid to the hospital) not covered by health insurance, Medicaid or Medicare.
(h) Payments for dependents who do not reside with the payor pursuant to court order or by agreement.
(i) Bankruptcy expenses.
(j) Dental expenses.
(k) Funeral expenses.
(2) If the combined gross income of the patient and the financially responsible persons related to him has changed since the gross income year, the change should be added to or deducted from gross income in computing adjusted income.
(3) The liquid assets of the patient and the financially responsible persons related to him shall be added to the gross income.
Assessment. This shall refer to the amount of money billed to patient and/or the financially responsible persons related to him who must make direct payments to the hospital for the patient's health care. An assessment shall represent the portion of the full charge for medical service which the direct pay patient is obligated to pay. Such assessment shall be computed according to the schedule adopted by these regulations.
Direct Payment. A payment for medical care made directly by the patient to the hospital, including payment of co-insurance and payment for services not covered by the patient's health insurance policy. Payment of a deductible under an insurance policy shall not be considered a direct payment for the purposes of 105 CMR 720.000.
Family of "0" Individuals. This term refers to an unmarried patient who is permanently institutionalized and does not maintain a private household.
Financially Responsible Individuals. This term refers to the spouse of patients and the parents of minor patients.
Gross Income. The before-tax income of the patient and all financially responsible individuals related to the patient for the tax year terminating the December 31 prior to the date of the patient's hospitalization.
(1) In computing gross income, all income, from whatever source, shall be combined. Sources of income shall include:
(a) Wages or salaries;
(b) Earnings from self-employment;
(c) Unearned income including:
1. Social Security Benefits
2. Black Lung Benefits
3. Federal Civil Service Annuity
4. Railroad Retirement Benefits
5. State or Local Government Pensions
6. Unemployment Compensation Benefits
7. Workmen's Compensation Benefits
8. Private Pension
9. Insurance Annuity or Proceeds
10. Cash Support or Expenses Paid by Another including Alimony and Child Support
11. Rent, Dividends, Interest or Royalties
12. Veteran's Administration Pension
13. Veteran's Administration Compensation
14. Assistance Payments Based on Need (AFDC and GR)
15. SSI
16. Any other Income
Gross Income Year. The tax year terminating the December 31 prior to the date that medical service is rendered to the patient.
Liquid Assets. This term shall refer to the following assets: Cash, bank deposits, stocks, bonds or other securities.
Number of Persons in Family. The number of persons in the family (referred to in 105 CMR 920.005(A)(2) ) shall be the number reached by adding the patient, the financially responsible persons related to the patient, and the number of their dependents as defined in the Internal Revenue Code as it now reads and as it may hereafter be amended. This term shall have the same meaning as the term "family size" appearing in 105 CMR 920.006(A)(1).
Prospective Fiscal Year. This term shall refer to the 365 day period commencing with the first day that the patient is hospitalized, and/or is rendered outpatient services.
Outpatient Services. Outpatient services refers to those services rendered to ambulatory patient in the outpatient clinic, the dialysis unit and/or the adult day care program.
