TITLE 29

State Government

Departments of Government

CHAPTER 79. DEPARTMENT OF HEALTH AND SOCIAL SERVICES

Subchapter III. Payment for Services


(a) Any person committed to or accepting the services of any hospital, home, clinic or other facility of the Department and that person's spouse or parents in the order named, except for persons committed to a prison or correctional institution, shall at all times be jointly and severally liable for the full cost of the care, treatment or both provided such person, except as may be specifically set forth in this section. Notwithstanding any other provision of the Delaware Code, parents and spouses of a patient shall not be required to pay all or part of any of the cost of care of any patient if:

(1) With respect to parental liability, the patient shall have attained the age of 18 years; or

(2) With respect to spousal liability, the patient shall have attained the age of 18 years and shall have been a patient in 1 or more of the institutions served by the Department for a period of 5 years.

(b) The "cost of care, treatment or both" per diem for an inpatient facility such as, but not limited to, a hospital or home shall be deemed to mean the total disbursements made by or on behalf of such facility during a fiscal year, divided by the number of patient-days during such fiscal year. Such cost shall be computed based on the experience of the previous fiscal year and the revised rate shall be charged beginning on the first day of the fourth month following the end of said fiscal year. In the event the inpatient facility has not been operational during the previous fiscal year, the "cost of care, treatment or both" shall be the amount determined by the Department within the guideline of available appropriations and anticipated patient-days. In the event an inpatient facility provides various services that have substantially different costs, and such different costs may be reasonably identified, the Department may determine the "cost of care, treatment or both" based upon the particular service provided. In the case of outpatient or clinic services, the "cost of care, treatment or both" shall be determined by the Department based upon the most recent available experience of actual cost.

(c) The Department is authorized and empowered to accept partial payments from any person committed to, or accepting the services of, any hospital, home clinic or other facility of the Department, or from any other person liable for the cost of care of such person, in an amount less than the full cost of care, treatment or both based upon the financial ability of such person or persons as determined by the Department. In determining financial ability to pay, the Department shall take into account the assets, liabilities, income, expenses, number of dependents of the entire family and any other relevant factors. The Department shall also promulgate such rules and regulations under subsection (i) of this section as may be necessary to insure that the enforcement of this obligation shall be as uniform as possible; provided, however, that such rules and regulations limit the financial liability of a spouse or parents to no more than 10 percent of their annual disposable income in any 12-month period of care or treatment.

(d) Except in cases committed by order of the courts of this State, the Department may require, before or after the patient is admitted or treated, the written agreement of those persons receiving or to receive care, treatment or both from the Department, and of those other persons who are liable under this section, concerning the payments required by this section. Such agreements may be reviewed from time to time at the request of the Department or the person liable and in any event shall be automatically reviewed at least once every 2 years and may be amended if the cost of care, treatment or both has changed or if the ability to pay of the person liable has changed in the judgment of the Department. The Department may require the person receiving or to receive care, treatment or both or from persons liable for the cost of care, treatment or both under this section such evidence of ability to pay as copies of federal income tax returns, tax withholding forms and statements of bank accounts and property holdings. Failure to provide such evidence may be grounds to refuse or terminate such care, treatment or both. Except in the case of the Delaware Hospital for the Chronically Ill, such evidence of ability to pay shall not be required of liable persons if they agree to pay the full cost of care, treatment or both and so long as such payments are timely rendered.

(e) Any court of this State committing a person to the jurisdiction of the Department, may, at its discretion, order said person, and such other persons liable for the payment of costs under this section over which the court has jurisdiction, to pay for the costs of care, treatment or both in such amounts as may be fixed by the Department under this subchapter.

(f) The Department, after full investigation of collectibility and/or reasons for nonpayment, shall proceed for the recovery of the moneys owed for such care, treatment or both in an action to be brought in any court of the State in the name of the Department, where such action is deemed justified. The Department of Justice of the State shall represent the Department in such cases and any costs to the State arising from such action shall be paid by the State Treasurer from moneys in the General Fund not otherwise appropriated.

(g) The Department may partially or totally waive liability for persons receiving services from a facility such as, but not limited to, a clinic when the Department determines that the cost of computing ability to pay and making collection would exceed the sums to be collected or when the Department determines that such liability would jeopardize the health of the community.

(h) In the event any person, juvenile or adult is committed to a prison or correctional institution, and in the event a court of this State has not ordered payment of the full cost of care, the Department may require such payments from such juvenile or adult while on a work release or similar program as it may deem appropriate provided that the total payment shall not exceed the actual cost of care while on the work release program.

(i) The Delaware Hospital for the Chronically Ill and any similar facility of the Department may continue, as heretofore, to refuse admission to persons adjudged to have adequate resources, either personally or from others legally liable for them, to secure such services from private facilities.

(j) The Secretary of the Department shall have the power to promulgate any rules and regulations not contrary to the laws of the State which the secretary deems necessary to carry out this section and such rules and regulations shall have the full force and effect of law.

(k) If it appears to the satisfaction of the Department that a person receiving or to receive care, treatment or both will be institutionalized for a long period of time and that the expected income of such person from all sources (including any portion of the cost of care to be paid by legally liable relatives) will be insufficient to pay for the full cost of care, treatment or both, the Department may require that all or part of the assets of such person be transferred and conveyed to the State to be applied to the cost of care as the same shall come due, any balance thereof to be returned to such person or such person's estate upon such person's discharge or death. In carrying out this provision, the Department may bring suit in any court having jurisdiction to require the transfer of such assets and may also apply for the appointment of a guardian or trustee of such person. The court, after giving appropriate notice and after hearing the evidence, shall enter such order as it deems appropriate.

(l) Nothing herein contained shall be construed to prevent the Department from refusing to admit or from discharging any patient who, for reasons other than nonpayment of cost of care, treatment or both, in the opinion of the Department, does not qualify for admission under the law or who will not benefit from the care, treatment or both available, or whose presence in any such institution will be detrimental to others.

(m) In the event that any person is aggrieved by any decision of the Department with respect to the payment of fees, refusal of admission or discharge for other than medical reasons, the person may appeal to a Special Appeals Committee consisting of the Chairpersons of the respective advisory Councils to the Division of Developmental Disabilities Services and on Substance Abuse and Mental Health and Delaware Home and Hospital and Physical Health by petition in writing stating the substance of the decision appealed from, the facts in support of the appeal and the relief sought. The Department shall reply to the petition within 10 days. The Committee shall hold a hearing within 60 days and shall render its decision promptly. The Committee's decision shall be final and binding. The Committee may establish its own rules of evidence not inconsistent with this subchapter.

29 Del. C. 1953, § 7940; 58 Del. Laws, c. 217; 59 Del. Laws, c. 48, § 6; 60 Del. Laws, c. 207, § 1; 64 Del. Laws, c. 166, § 1; 64 Del. Laws, c. 467, § 6; 68 Del. Laws, c. 418, §§ 1-3; 70 Del. Laws, c. 186, § 1; 73 Del. Laws, c. 41, § 1; 78 Del. Laws, c. 179, § 318.;

Notwithstanding § 1241 [repealed] of Title 30, the Secretary of Finance shall, upon the written request of the Secretary of the Department of Health and Social Services, provide the Secretary with the gross and net income, as defined in Chapter 11 of Title 30, and all other available financial data concerning those persons who are liable under this subchapter for payments for the care, treatment or both of any persons in facilities operated by the Department of Health and Social Services and who are not paying the full cost of such care, treatment or both monthly. The Secretary shall certify that information so received shall be used only for the purpose of collecting sums due the State and any employee of the Department found guilty of disclosing such information for any other purpose shall be subject to the same penalties as provided in § 1241 [repealed] of Title 30.

29 Del. C. 1953, § 7941; 58 Del. Laws, c. 217.;