§ 4310.4. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
Abatement—The reduction by the Department of an assessed liability amount to zero for a specified period.
Assets—Any resource available to the client to meet the cost of services, except real estate constituting the home residence of the client, his spouse or dependent children.
Benefit—A payment or other assistance given by an insurance company, mutual retirement fund, or public or private agency.
Benefit recipient—A client receiving income in the form of a benefit for which no services have been rendered.
Client—A patient/resident of a State mental hospital or State intellectual disability center.
Department—The Department of Human Services of this Commonwealth.
Head of household—The adult member of the household who is recognized by other family members as the primary household representative.
Home maintenance exemption—Documented and verified expenses currently being paid and necessary to maintain a home or rental residence, which includes mortgage or rental payments, utility bills and taxes on the home residence during the period of hospitalization.
Household—A group of persons living together, consisting of the head of household and all other household members for whom the head of household has a legal responsibility to provide support.
Household member—A person, including the head of household, for whom the head of household is liable.
IRS tax form—The forms filed by the household for Federal income tax purposes—most commonly Forms 1040 and 1040A.
Institutional collections officer—The Department’s employee responsible for applying for all resources available to meet the costs of services and establishing client and legally liable relative liability.
Intellectual disability professional—A case manager or an individual who is responsible for the clinical treatment program of the resident.
LLR—Legally liable relative—A parent or spouse responsible for the costs of service for a client in a State mental hospital or State intellectual disability center, or a client who is legally responsible for the support of his spouse or dependent children.
Liability—The portion of the cost of service for which the client or legally liable relative is required to pay.
Liable person—A person who has responsibility to pay the assessed liability. Liable persons are the client and the legally liable relative. In the event that assets, income, or benefits, or both, of the client or legally liable relative are controlled by a representative payee, a guardian of the estate, or trustee, these persons are responsible for assessments made against assets, income, or benefits, or both, belonging to the client or legally liable relative.
MAMIS—The Medical Assistance Management Information System responsible for reimbursement to facilities providing care to Medical Assistance eligible clients.
Maximum liability—The most which a liable person is required to pay toward the costs of service.
Mental health professional—An individual practicing in a generally recognized clinical discipline including, but not limited to, psychiatry, social work, psychology, nursing, rehabilitation or activity therapies, who has a graduate degree and clinical experience.
Modification—A reduction of an assessed liability, by the Department, to an amount greater than zero, but less than the original amount for a specified period.
Nonresident property—Real property is considered ‘‘nonresident’’ if the property:(i) Is not used as a home by the client.
(ii) Has been the home of the client or his spouse but has not been used for 6 consecutive months and there appears to be little likelihood that either will return to it.
Resident property—A client’s real property, used as the client’s primary residence, during the first 6 months of institutionalization.
Authority The provisions of this § 4310.4 amended under sections 201(2) and (8) and 202 of the Mental Health and Intellectual Disability Act of 1966 (50 P.S. § § 4201(2) and (8) and 4202).
Source The provisions of this § 4310.4 adopted December 3, 1982, effective December 4, 1982, 12 Pa.B. 4149; amended June 17, 2016, effective June 18, 2016, 46 Pa.B. 3177. Immediately preceding text appears at serial pages (251374) and (375697) to (375698).
Notes of Decisions Petitioner, who received psychiatric care after his discharge from a State hospital in a clinical abatement proceeding was not eligible for abatement because he was not a ‘‘client’’ as defined by the Department’s regulations, which requires the patient to be a resident of the State Hospital at the time of treatment. Weychert v. Department of Public Welfare, 551 A.2d 605 (Pa. Cmwlth. 1988).
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