PURPOSE: This rule establishes procedures for the State Cancer Center to utilize payments by third-party sources and responsible parties to offset the cost of care.

1. (1) The Stats Cancer Center, through its director or his/her designee, such as the patient accounts manager, shall apply toward the costs incurred for providing the patient’s services payments received on behalf of the patient from third-party sources, including public and private health insurance, to the extent and limits of the coverage of the patient by the third-party sources.
2. (A) If a federal program requires the hospital to accept federal reimbursement as full payment as a condition of participation in the program, the hospital shall not charge the patient any additional fee or amount for the services or care except for any permitted deductible or coinsurance.
3. (B) The hospital shall charge the patient or responsible party for any deductible or coinsurance permitted by the third-party source.
4. (C) If payment by a parent or spouse under this rule would result in a reduction of government benefits to the patient, then the parent or spouse shall not be charged unless required by the third-party source.
5. (2) The following are jointly liable for payment for the services rendered by the Stats Cancer center:
6. (A) The patient;
7. (B) The patient’s estate;
8. (C) The patient’s spouse;
9. (D) The parents of a” emancipated patient under the we of eiehteen-08) “ears or the stepparent oFan u”&“cip&ed patient under the ageofeightesn (18) years who residesin the home of the stepparent;
10. (E) The parents of a patient age eighteen

11. (18) years or over who is not a resident of this state and who is insolvent or incapacitated; 6 CSR 250-7-DEPARTMENT OF HIGHER EDUCATION

    1. (F) Any fiduciary, such as a trustee, only to the extent of the assets the fiduciary is holding on behalf of or for the patient and which are assets that may be used according to law; and
    2. (G) Any representative of the patient to the extent of the benefits and assets under the law governing and permitting payment of benefits and assets for the patients. Auth: sections 192.005.2. and 200.030, RSMo (196’6). This rule was preuiously filed as 19 CSR 80-1.020. original rule (il& May 15, 1990, effectme Sept. 28,

6CSR250-7.030StandardMeansTestfor Missouri Residents Who Are Patients of the State Cancer Center PURPOSE: This rule establishes a standard for fair and consistent determination of the ability of patients who are Missouri residents to pay for seruices provided at the State Cancer Center.

1. (1) A determination of whether the patient is a resident of Missouri shall be made in accordance&h thedefinitionin6CSR250.7.010(g).
2. (2) The gross income of the Missouri resident patient, of all family members and of any other responsible party shall be made in accordance with the definition contained in 6 CSR 250. 7.010(4).
3. (3) The State Cancer Center reserves the right to require documentation as to the amount of gross income of the patient! of all family members and of any responsible party. This documentation shall include, but not exclusively, payroll records, bank statements, income tax returns or any other applicable or appropriate documentation.
4. (4) As a condition for treatment or admissio?, the patient or his/her family or other responslble party shall assign all payments from thirdparty sources to the State Cancer Center.
5. (5) Thenumberofdependents ofthepatient, of his/her family and of any responsible party shall be determined in accordance with the definition in 6 CSR 250.7.010(7).
6. (6) If the patient has been determined to be a Missouri resident and, if the patient, his/her family members and any other responsible party have cooperated with the State Cancer Center by supplying necessary documentation of gross income; and, if the patient, his/her family and any responsible party have assigned to the State Cancer Center payments of third-party sources, the patient, his/her family and any responsible party shall have Original rule filed May 15,1990, effective the benefit of the application of the Standard Sept. Z&1990. Means Test in the Table to Determine Ability to Pay Based on Income and Family Size (following this rule) to determine the amount, if any, to be paid for care at the State Cancer Center.
7. (7) The director of the State Cancer Center or his/her designee, such as the patient accounts manager, shall charge the patient or the patient’s family or any other responsible parties who are Missouri residents and who have assigned payment from all third-party sources for payment of the charges for medical or health care at the State Cancer Center, the balances due on their respective charges not satisfied by third-party sources, as indicated in the Standard Means Test. The maximum liability for State Cancer Center services per year for a household is based on income and the number of persons in the household. In each case, the maximum liability is indicated in the table in terms of percentage of annual income.
8. (8) If the patient, patient’s family or other responsible party experiences a significant improvement in income or overall financial condition, then the patient or family members or other responsible party shall report the improvements in financial condition within ten (10) days of the cause of the improvement in financial condition to the director of the State Cancer Center or his/her designee, such as the program accounts manager, for purposes of reapplying the Standard Means Test. Failure ta make the report required by this section shall mean that the patient or patient’s family or other responsible party shall become liable for all net charges as provided in 6 CSR 250-7.040.
9. (9) If the patient, patient’s family or other responsible party experiences a significant decline in financial condition, the patient or the patient’s family or other responsible party may request the State Cancer Center’s director or his/her designee, such as the patient accounts manager, to reapply the Standard Means Test for possible adjustment ofliability for charges for services.

10. (10) All patients or patients’ families or other responsible parties shall be reevaluated annually on or about the anniversary date of their initial acceptance to determine the following twelve (12) months’ liability for charges.

    Auth: sections 192.005.2., 200.030 and 200.101, RSMo (1986). This rule was preuiously filed as 19 CSR 80.1.030.

    semtarg Of state

    ^: 6 CSR 250-7 , m

    fscrsw Of state

m 6 CSR 250-7--DEPARTMENT OF HIGHER EDUCATION