Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 276 - CONTRACTING TO PROVIDE ASSISTED LIVING AND RESIDENTIAL CARE SERVICES
Subchapter C - PROVIDER REQUIREMENTS
Section 276.37 - Copayment and Room and Board
Universal Citation: 26 TX Admin Code § 276.37
Current through Reg. 50, No. 13; March 28, 2025
(a) Amount. The facility must collect the copayment and room and board amounts indicated on the Texas Department of Human Services' (DHS's) Notification of Community Care Services form or DHS's Notification of Community Based Alternatives (CBA) Services form. This subsection does not apply to clients who receive Community Care for Aged and Disabled emergency care service.
(b) Due date.
(1) The facility must designate a due date
for copayment and room and board in writing. The due date must be during the
same month the copayment and room and board is applied.
(2) The facility must collect the entire
copayment and room and board on or before the due date. If the due date falls
on a weekend or a holiday, the facility must collect the entire copayment and
room and board on or before the first working day thereafter.
(3) If the client or the client's
representative fails to pay the entire copayment and room and board by the due
date, the facility must notify the client or the client's representative and
the case manager in writing no later than the first working day after the due
date.
(c) Credit balances.
(1) A credit balance is an amount
due to the client or the client's representative when there is an overpayment
by the client or the client's representative.
(2) The facility must handle credit balances
as follows:
(A) The facility must provide
written notice of a credit balance (client notice) to the client or the
client's representative within 35 days of receipt of the payment resulting in a
credit balance. The client notice may be the first monthly statement following
the receipt of the payment resulting in a credit balance, if the monthly
statement specifies the credit balance.
(B) The facility must offer the client or the
client's representative the following options in the client notice:
(i) the client or the client's representative
may choose to provide the corrected payment, and the facility will return the
original amount paid;
(ii) the
facility will provide the client or the client's representative with a refund
of the credit balance; or
(iii) the
client or the client's representative may choose to have the credit balance
applied to the following month's payment. The client may choose to spread the
credit balance over several months.
(C) If the client or the client's
representative fails to contact the facility within 35 days of the date of the
client notice, the facility must, on the 35th day:
(i) provide the client or the client's
representative with a refund of the credit balance or apply the credit balance
to the following month's payment; and
(ii) provide written notice of the facility's
choice of action to the client or the client's representative. The written
notice of the facility's choice of action may be a monthly statement if the
monthly statement specifies the facility's choice of action.
(d) Copayment and room and board receipts.
(1)
The facility must provide receipts for all copayment and room and board
payments received from or on behalf of clients at the time the payment is
received.
(2) The facility must
keep a copy of all copayment and room and board receipts.
(3) Copayment and room and board receipts
must contain the following elements if the elements are not contained in the
copayment and room and board ledger described in subsection (e) of this
section:
(A) the name of the
client;
(B) the month, day, and
year the payment was received;
(C)
the total amount collected;
(D) the
specific amounts of copayment and room and board collected; and
(E) the month and year of the coverage period
for the payment received.
(4) Copayment receipts may be in any
format.
(e) Copayment and room and board ledger. The facility must maintain a copayment and room and board ledger system in any format for each client.
(1) The facility may keep the copayment and
room and board ledger systems as separate ledgers, or the facility may combine
both ledgers into a single ledger system. If the facility chooses to keep a
single ledger system, a separate entry must be made for each copayment and room
and board entry.
(2) The copayment
and room and board ledger system must reflect the following:
(A) all charges for copayment and room and
board by client;
(B) all payments
for copayment and room and board made by or on behalf of a client;
(C) all credits for copayment and room and
board by client, including the:
(i) specific
amount credited;
(ii) month and
year of the coverage period of the credit;
(iii) type of payment credited; and
(iv) reason for the credit; and
(D) a running balance by
client.
(3) The facility
must record all activities on the copayment and room and board ledger system
within 35 days or by the next billing cycle, whichever is sooner.
(4) The copayment and room and board ledger
must be maintained in accordance with generally accepted accounting principles
(GAAP).
(f) Refunds upon discharge. The facility must refund the client's copayment and room and board for the remaining days of the month following the date of discharge or death. The refund must be made within ten working days of awareness that the client will be discharged or is deceased. The facility must document the date of awareness of the client's discharge from the facility.
Disclaimer: These regulations may not be the most recent version. Texas 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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