POLICY/PURPOSE: Burrell Behavioral Health (BBH) Payment Policy ("Policy") is intended to accomplish the following:
- Ensure access to necessary behavioral health care;
- Assist uninsured clients by providing financial assistance until such time as clients are able to obtain insurance coverage;
- Provide financial assistance to members of the community in need of healthcare services but who cannot afford to pay for those services; and address the billing and collection practices for uninsured clients and clients with demonstrated financial need, as well as clients with public or private insurance.
SCOPE: This Policy is specifically designed to address client access, utilization, billing, and collection practices for uninsured clients and clients with demonstrated financial need, as well as clients with public or private insurance who receive care at BBH. BBH seeks to ensure that clients are made aware of the financial assistance available to them at the earliest point in consumer care possible and that all clients pay a fair and reasonable amount for the services rendered by BBH.
A. Types of Financial Assistance Available
- Purchase of Service (POS)
- Available for Comprehensive Substance Treatment and Rehabilitation (C-STAR) program
- Available for Community Psychosocial Rehab (CPR) program
- Not available to cover Housing, Assertive Community Treatment (ACT) or Assertive Community Treatment–Transitional Age Youth (ACT-TAY), Medication
- Financial Aid
- Available for Outpatient individual therapy services only
- Medication Assistance
- Available through some Pharmaceutical Companies
B. In order to qualify for any type of Financial Assistance, clients or the parents or legal guardians of clients are responsible for providing financial information when completing the Missouri Standards Means Test for the delivery of services.
C. Adjustments to charges will not be routine and will not be made without a good faith determination of financial need as described herein.
D. All clients are responsible for the amounts set forth in this Policy at the time of service (unless collection of co-pay is prohibited, i.e. Medicaid) as well as any previous balance due.
E. Assistance with the application process for Financial Assistance will be made available as part of the initial intake process.
F. If approved, the client will be eligible for financial assistance under this Policy for six (6) months for services occurring in that timeframe, or less if there is a change impacting the client's ability to pay for services. Discharge planning will begin at month five (5) if Medicaid or another funding source has not been approved.
G. BBH will not advertise the availability of financial aid to clients in any way to induce prospective clients to choose receiving services from BBH and all financial aid shall be given only in relation to the criteria specified in this policy.
H. Spend Down
- At admission to BBH, clients with Spend Down (a Missouri HealthNet Program) or any similar successor program, through the Missouri Department of Social Services will be given a Missouri Health Automatic Spend Down Withdrawal form. If the client choses to complete the form, BBH will submit the paperwork to the State.
- If the client does not chose to complete the Missouri Health Automatic Spend Down Withdrawal form, then he/she will be expected to pay for the services in full up until the time that the spend down has been met.
I. The financial assistance Policy will not apply to:
- Clients who refuse to provide BBH with appropriate documentation, including documentation of insurance
- Court ordered evaluations
J. The maximum charge billed to a client who is eligible for financial assistance under this Policy will be a fair and consistent amount based on the criteria for financial assistance included in this Policy.
A. To be eligible for financial assistance under the Policy, a client must complete the Missouri Standard Means Test, provide the form to BBH, and provide proof that he or she is a resident of Missouri.
III. Types of Financial Assistance
A. Purchase of Services (POS) Funds
- POS funds will be used for services if the client does not have Medicaid or another pay source. The Community Support Specialist (CSS) will help the client apply for Medicaid. If Medicaid is not approved, POS funds will continue to be used for CSTAR services.
- POS will be used for individuals who are referred to CPR services through an Initial Assessment/Eligibility Determination and may be eligible for Medicaid
- The application for Medicaid may have been started at point of access. If not, at the first meeting with the CSS, the CSS will assist the client in applying for Medicaid
- No services, after the second visit with the CSS will be provided without proof that the client has applied for Medicaid
- Once the Medicaid Application has been submitted, unlimited CPR services will be provided through POS for six (6) months, excluding housing and psychiatry
v CSS will verify monthly where the client is in the Medicaid process
v Discharge planning will begin at month five (5) if Medicaid hasn’t been approved
v Plan 1 – Reinstate Medicaid –When a lapse in Medicaid is discovered, Managed Care will be notified.
v Plan 2 – Client is no longer eligible for Medicaid or chooses not to reapply for Medicaid
B. Burrell’s Sliding Fee Scale Based on a Percentage of Cost of Services
C. Financial Aid (Only applies to Outpatient Therapy services)
- If a client qualifies for the lowest rate on the Sliding Scale but expresses an inability to pay that rate the client can complete a Financial Aid and Agreement Form.
- By completing this form the client agrees to the following terms:
- During this time the client will agree to apply for Medicaid coverage
- Client will receive six (6) sessions per rolling year at no cost. Services will be discontinued if a client no shows an appointment. (See No Show/Cancellation Policy) If the client attends all six (6) appointments and there is medical necessity for additional appointments, three (3) additional appointments will be offered at no cost.
- After a maximum of nine (9) sessions the client will be discharged if they have not obtained Medicaid or Insurance coverage, or they may choose to begin to pay the qualified Sliding Scale rate.
- Clients may apply for Financial Aid intermittently but will not exceed nine (9) no cost sessions per rolling year.
- Example: A client, who qualifies for the lowest Sliding Scale Rate, may request Financial Aid during their course of treatment but not to exceed nine (9) no cost sessions per rolling year.
D. Full Pay
- Full fee (self-pay) clients will be eligible to receive a 20% discount from billed services if the pay at the time of service
E. Medication Assistance
- Available through some Pharmaceutical Companies. BBH’s Pharmacy staff will provide information to the client concerning the financial assistance provided by Pharmaceutical Companies.
IV. Eligibility Determination
A. Prior to seeking financial assistance under this Policy, the client will pursue all possible forms of third party payment, including public benefit programs.
B. The client will be required to cooperate with BBH in applying for benefits from State, federal, or other charitable programs, including Medicaid.
C. BBH reserves the right to investigate and verify any third party payment sources, including but not limited to Medicare, worker's compensation, Veteran's Administration benefits, no-fault automobile insurance, and pending litigation.
D. Eligibility determined based on data included in the application form.
V. Uniformity Guidance
A. All charges will be recorded in accordance with the normal procedure used for all clients. Charges will not be withheld.
B. Services will not be "down coded" to a lower fee.
C. Payment for services will be required at the time of service. If the client does not provide the payment at the time of service, the appointment will be rescheduled.
D. BBH will not discriminate on the basis of race, color, national origin, sex, religion, age,
disability, political beliefs, sexual orientation, and marital or family status.
VI. Appeals Process
Individuals who are denied financial assistance under the provisions of this Policy may request a review of that decision by an appeals committee.