230.20 - BILLING OF PATIENT CHARGES -- COMPUTATION OF ACTUAL COSTS -- COST SETTLEMENT.
230.20 BILLING OF PATIENT CHARGES -- COMPUTATION OF
ACTUAL COSTS -- COST SETTLEMENT.
1. The superintendent of each mental health institute shall
compute by February 1 the average daily patient charges and other
service charges for which each county will be billed for services
provided to patients chargeable to the county during the fiscal year
beginning the following July 1. The department shall certify the
amount of the charges and notify the counties of the billing charges.
a. The superintendent shall separately compute by program the
average daily patient charge for a mental health institute for
services provided in the following fiscal year, in accordance with
generally accepted accounting procedures, by totaling the
expenditures of the program for the immediately preceding calendar
year, by adjusting the expenditures by a percentage not to exceed the
percentage increase in the consumer price index for all urban
consumers for the immediately preceding calendar year, and by
dividing the adjusted expenditures by the total inpatient days of
service provided in the program during the immediately preceding
calendar year. However, the superintendent shall not include the
following in the computation of the average daily patient charge:
(1) The costs of food, lodging, and other maintenance provided to
persons not patients of the hospital.
(2) The costs of certain direct medical services identified in
administrative rule, which may include but need not be limited to
X-ray, laboratory, and dental services.
(3) The costs of outpatient and state placement services.
(4) The costs of the psychiatric residency program.
(5) The costs of the chaplain intern program.
b. The department shall compute the direct medical services,
outpatient, and state placement services charges, in accordance with
generally accepted accounting procedures, on the basis of the actual
cost of the services provided during the immediately preceding
calendar year. The direct medical services, outpatient, and state
placement services shall be billed directly against the patient who
received the services.
2. a. The superintendent shall certify to the department the
billings to each county for services provided to patients chargeable
to the county during the preceding calendar quarter. The county
billings shall be based on the average daily patient charge and other
service charges computed pursuant to subsection 1, and the number of
inpatient days and other service units chargeable to the county.
However, a county billing shall be decreased by an amount equal to
reimbursement by a third party payor or estimation of such
reimbursement from a claim submitted by the superintendent to the
third party payor for the preceding calendar quarter. When the
actual third party payor reimbursement is greater or less than
estimated, the difference shall be reflected in the county billing in
the calendar quarter the actual third party payor reimbursement is
determined. For the purposes of this paragraph, "third party payor
reimbursement" does not include reimbursement provided under
chapter 249J.
b. The per diem costs billed to each county shall not exceed
the per diem costs billed to the county in the fiscal year beginning
July 1, 1996. However, the per diem costs billed to a county may be
adjusted annually to reflect increased costs to the extent of the
percentage increase in the total of county fixed budgets pursuant to
the allowed growth factor adjustment authorized by the general
assembly for the fiscal year in accordance with section 331.439.
3. The superintendent shall compute in January the actual
per-patient-per-day cost for each mental health institute for the
immediately preceding calendar year, in accordance with generally
accepted accounting procedures, by totaling the actual expenditures
of the mental health institute for the calendar year and by dividing
the total actual expenditures by the total inpatient days of service
provided during the calendar year.
4. The department shall certify to the counties by February 1 the
actual per-patient-per-day costs, as computed pursuant to subsection
3, and the actual costs owed by each county for the immediately
preceding calendar year for patients chargeable to the county. If
the actual costs owed by the county are greater than the charges
billed to the county pursuant to subsection 2, the department shall
bill the county for the difference with the billing for the quarter
ending June 30. If the actual costs owed by the county are less than
the charges billed to the county pursuant to subsection 2, the
department shall credit the county for the difference starting with
the billing for the quarter ending June 30.
5. An individual statement shall be prepared for a patient on or
before the fifteenth day of the month following the month in which
the patient leaves the mental health institute, and a general
statement shall be prepared at least quarterly for each county to
which charges are made under this section. Except as otherwise
required by sections 125.33 and 125.34 the general statement shall
list the name of each patient chargeable to that county who was
served by the mental health institute during the preceding month or
calendar quarter, the amount due on account of each patient, and the
specific dates for which any third party payor reimbursement received
by the state is applied to the statement and billing, and the county
shall be billed for eighty percent of the stated charge for each
patient specified in this subsection. For the purposes of this
subsection, "third party payor reimbursement" does not include
reimbursement provided under chapter 249J. The statement prepared
for each county shall be certified by the department and a duplicate
statement shall be mailed to the auditor of that county.
6. All or any reasonable portion of the charges incurred for
services provided to a patient, to the most recent date for which the
charges have been computed, may be paid at any time by the patient or
by any other person on the patient's behalf. Any payment made by the
patient or other person, and any federal financial assistance
received pursuant to Title XVIII or XIX of the federal Social
Security Act for services rendered to a patient, shall be credited
against the patient's account and, if the charges paid as described
in this subsection have previously been billed to a county, reflected
in the mental health institute's next general statement to that
county. However, any payment made under chapter 249J shall not be
reflected in the mental health institute's next general statement to
that county.
7. A superintendent of a mental health institute may request that
the director of human services enter into a contract with a person
for the mental health institute to provide consultation or treatment
services or for fulfilling other purposes which are consistent with
the purposes stated in section 226.1. The contract provisions shall
include charges which reflect the actual cost of providing the
services or fulfilling the other purposes. Any income from a
contract authorized under this subsection may be retained by the
mental health institute to defray the costs of providing the
services. Except for a contract voluntarily entered into by a county
under this subsection, the costs or income associated with a contract
authorized under this subsection shall not be considered in computing
charges and per diem costs in accordance with the provisions of
subsections 1 through 6 of this section.
8. The department shall provide a county with information, which
is not otherwise confidential under law, in the department's
possession concerning a patient whose cost of care is chargeable to
the county, including but not limited to the information specified in
section 229.24, subsection 3. Section History: Early Form
[R60, § 1487; C73, § 1428; C97, § 2292; S13, § 2292; C24, 27, 31,
35, 39, § 3600; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81,
S81, § 230.20; 81 Acts, ch 78, § 20, 38, 39] Section History: Recent Form
83 Acts, ch 96, § 157, 159; 86 Acts, ch 1169, § 2; 87 Acts, ch 37,
§ 1; 88 Acts, ch 1249, § 9; 88 Acts, ch 1276, § 39; 95 Acts, ch 82,
§5; 95 Acts, ch 120, §4; 96 Acts, ch 1183, § 25, 26; 98 Acts, ch
1155, §11; 2001 Acts, ch 155, §23--25; 2005 Acts, ch 167, §31, 32, 66
Referred to in § 218.78, 226.9C, 228.6, 230.21, 230.22, 904.201