Charges for Mental Health (MH) and Intellectual and Developmental Disabilities (IDD) Community Services
1. How the Center Charges for Services
The Center will not turn you away from services just because you cannot pay for them. The amount that the center charges for services is based on your ability to pay. The way we decide your ability-to-pay is fair and is the same for everyone. We will show you the way we did it and answer your questions.
2. What We Need From You?
To decide if you are able to pay for service, Center staff will ask you for the following information:
- To provide proof of your household income
- To provide proof of any extraordinary expenses (major medical expenses, childcare expenses, major property loss or damage)
- the number of people in your household
3. What You Will Pay?
Your income (minus any extraordinary expenses) and the number of people in your family will be applied to a fee schedule to get your maximum monthly fee. Center staff will tell you the amount of your maximum monthly fee and give you the fee schedule we used. Center Staff will give you the form used to decide your maximum monthly fee. If your maximum monthly fee is more than zero, then you will receive a bill for services. You may pay more than your maximum monthly fee if you want.
4. If You Have Medicare or Medicaid Benefits
Medicaid-covered services will be billed directly to Medicaid. You will not receive a bill for any services paid by Medicaid. If you have Medicare you are responsible for co-insurance and/or deductibles, up to your maximum monthly fee. If your services are not covered by Medicaid or Medicare, then you may be charged up to your maximum monthly fee.
Consumers who are eligible for benefits and refuse to apply for benefits may be charged the full standard fee for services. (Texas Administrative Code)
5. If You Have Private Health Insurance
If you have private health insurance and complete an assignment of benefits, the Center will bill your insurance company directly for covered services. You are responsible for charges that insurance company does not pay for. If you have insurance and do not complete an assignment of benefits, then the Center may charge you the full standard rate for services. If the Center is not a provider for your insurance plan, we will assist you in locating a provider who accepts your insurance.
6. Financial Hardship
If it is difficult to pay all charges owed, the center may be able to arrange for you to temporarily pay a lesser amount each month. If you have private health insurance and financial hardship prevents you from paying your full co-insurance, co-pays, or deductible, we will make arrangements with you to pay no more than your maximum monthly fee (or $5.00 a month, if your maximum monthly fee is zero).
7. Reduction or Termination of Services for Non-Payment
When it has been determined through a financial assessment that an individual has the ability to pay, whether through determination of a maximum monthly fee (MMF) or third party, the Center will make every reasonable effort to collect on past due accounts. Each account is properly assessed and if needed, the Center will conduct a follow up financial assessment in evaluating ability to pay. If it is determined that non-payment is not related to the person’s mental health crisis and despite reasonable efforts to secure payment, the responsible party refuses to pay, then the Center may propose to involuntarily reduce or terminate the services to a person for non-payment by the person (or parent).
You have the right to appeal any decision. You may request that the appeal decision be reviewed by the Office of Consumer Services and Rights Protection-Ombudsman, 1-800-252-8154.
Note: if we do not accept your private health insurance and refer you to another provider to receive services, you may appeal this decision as a denial of services. Instructions for appeal are in the written notification of denial or termination.