PURPOSE: This rule establishes a standard for fair and consistent determination of the ability of patients who are Missouri residents to pay for services provided at the State Cancer Center.

1. (1) A determination of whether the patient is a resident of Missouri shall be made in accordance with the definition in 6 CSR 250- 7.010(9).
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 admission, the patient or his/her family or other responsible party shall assign all payments from third-party sources to the State Cancer Center.
5. (5) The number of dependents of the patient, 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 the benefit of the application of the Standard 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 to 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 of liability 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.

AUTHORITY: sections 192.005.2., 200.030 and 200.101, RSMo 1986.* This rule was previously filed as 19 CSR 80-1.030. Original rule filed May 15, 1990, effective Sept. 28, 1990. *Original authority: 192.005, RSMo 1985.