Section 388-855-0065 - Determination of liability(1) In determining the ability of the estate of the patient and responsible relative to pay hospitalization charges, first priority shall be given to any third party benefits which might be available. The availability of third party benefits, such as medical insurance, health insurance, medicare, medicaid, CHAMPUS, CHAMPVA, shall be considered as an available asset of the estate and shall justify a finding for actual costs of hospitalization during such period as the coverage is in effect.(2) In the absence of third party benefits, charges shall be based upon the available assets of the estate giving consideration to any unusual and exceptional circumstances and other pertinent factors. No financial determination of the ability of the estate to pay hospitalization charges shall conflict with the eligibility requirements for medicaid for those patients who are eligible or potentially eligible for such benefits.(3) The ability of the estate to pay adjusted charges will be determined by applying the following formula: X | = | (Z-E)F |
Where Z | = | (A-Y-N-R)/D |
Z | = | available income per family member |
X | = | adjusted charges (daily) |
A | = | gross income |
Y | = | mandatory deductions |
N | = | allowance for unusual and exceptional circumstances |
R | = | allowance for other pertinent factors |
D | = | number of dependents |
E | = | exempt income |
F | = | a factor which converts the monthly figures to a daily rate (.0328767). |
All calculations are expressed in monthly terms except the final adjusted charge which is converted to a daily rate. All final figures are rounded out to the nearest cent.
(4) The adjusted gross income (A-Y) is determined by first developing the gross income of the estate of the patient and the responsible relative. Gross income (A) includes not only gross wages for services rendered, and/or net earnings from self-employment, but all other available assets which have been divided by twelve months to convert them to a monthly cash equivalent figure. All mandatory deductions (Y), such as income tax and social security, are deducted from the gross income to arrive at the adjusted gross income.(5) Approved allowances for unusual and exceptional circumstances (N) and for other pertinent factors (R) are then subtracted from the adjusted gross income.(6) The available income (A-Y-N-R) is then divided by the number of dependents in the household of the patient (D) to determine the available income per family member.(7) Exempt income (E) as defined in WAC 388-855-0045 is then subtracted from the available income per family member to arrive at the monthly adjusted charges.(8) The monthly adjusted charges are multiplied by the factor of .0328767 which converts the monthly figure to a daily rate.Wash. Admin. Code § 388-855-0065
Statutory Authority: RCW 43.20B.335, 43.20B.325, 72.01.090. 01-01-007, amended and recodified as § 388-855-0065, filed 12/6/00, effective 1/6/01. Statutory Authority: RCW 81.02.412 [71.02.412]. 81-08-020 (Order 1627), § 275-16-065, filed 3/25/81.