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 920.005 - Method of Determining the Patient's Assessment

Universal Citation: 105 MA Code of Regs 105.920

Current through Register 1531, September 27, 2024

The following steps shall be taken in order to determine the patient's assessment:

(A) The "Low Budget of Family of Four" published by the U.S. Department of Labor Statistics for Boston for the most current period available shall be used as a starting figure.

(1) This figure shall be multiplied by .92 to remove the medical care factor in this budget.

(2) The figure resulting from the calculation performed under CMR 920.005(A)(1) above shall be multiplied by the following factors depending upon the number of persons in the family
(a)

Number in Family Factor
0 .04
1 .04
2 .05
3 .07
4 .08
5 .09
6 .11
7+ Add .01 or each additional family member.

(b) The figure resulting from this calculation represents the low monthly budget for a family of one, two, three, etc. persons.

(B) Exceptional Method for Computing Low Budget for a Family of "0" Individuals. According to statistics published by the U.S. Department of Labor 30.8% of the low budget for a family of four is spent for food 19.4% of the low budget for a family of four is spent for housing. Because a person constituting a family of "0" individuals does not maintain a household he does not have these expenses. They are, therefore, to be subtracted, in the appropriate percentages, from the "low budget of family of four" figure prior to performing the calculations in 105 CMR 920.005(A).

(C) The gross income of the patient and the financially responsible individuals related to him shall be computed in accordance with 105 CMR 920.003(F).

(D) The gross income is then adjusted in accordance with the adjustments outlined in 105 CMR 920.003(A), resulting in a figure representing the patient's (and financially responsible persons') adjusted yearly income.

(E) The adjusted yearly income is then divided by 12 in order to calculate the adjusted income on a monthly basis.

(F) The low monthly budget figure (calculated pursuant to 105 CMR 920.005(A) and/or 920.005(B)) is then subtracted from the patient's adjusted monthly income.

(1) The figure resulting represents the maximum amount of money the individual will be required to pay for inpatient and/or outpatient medical services in any given month, no matter what service is rendered.
(a) If the full charge for the inpatient and/or outpatient medical care rendered to the patient is less than the monthly maximum, the patient may be required to pay the full charge and may be denied an assessment, at the discretion of the Superintendent or his designee(s), by authority of the Commissioner of Public Health or upon the findings of the Committee as set forth in the outlined appeal procedures in 105 CMR 920.008.

(b) A schedule of monthly maximums to be assessed direct pay patients is appended hereto as exhibit A. The schedule is based upon the "Low Budget of Family of Four" for 1978, $12,500. Because this figure may change from year to year, the schedule will also change. New schedules may be issued without hearing and will be deemed to be approved by the Department of Public Health, provided that the procedures set forth herein are followed in establishing the new schedule, (including the percentages stated in 105 CMR 920.005(B).)

(G) Example to illustrate computation of Assessment for a family of four:

Low budget for family of four

$12,500.00

Family's adjusted income

$13,500.00

Monthly adjusted income (13,500 : 12)

=

$ 1,125.00

Monthly low budget ($12,500 x .92 x .08)

=

$ 920.00

Assessment ($1,125 - $920)

=

$ 205.00
(1) For the month in which the service is rendered, the maximum amount that can be assessed the patient is $205.00, even though the charge for the care may be in excess of $205.00.

(2) If the full charge for the care rendered to the patient is less than $205.00, the patient will be required to pay the full charge.

(3) The determination of a monthly Assessment does not require the patient to pay the amount assessed within the month the service is rendered. (Nor is full payment in the service month precluded.) 105 CMR 920.000 does not alter the practices of the hospitals with respect to the establishment of payment plans allowing for payment of bills over an extended period of time.

Disclaimer: These regulations may not be the most recent version. Massachusetts 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.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.