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INVOLUNTARY COMMITMENT COSTS. SHOULD MY COUNTY PAY?. Governing law Idaho Code § 66-327(a) In Re Daniel W., 145 Idaho 677 (2008), holding that “those substantive portions of chapter 35…should be incorporated as they evolve from time to time.” Idaho Code § 31-3506(2) – obligated county
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INVOLUNTARY COMMITMENT COSTS SHOULD MY COUNTY PAY?
Governing law • Idaho Code § 66-327(a) • In Re Daniel W., 145 Idaho 677 (2008), holding that “those substantive portions of chapter 35…should be incorporated as they evolve from time to time.” • Idaho Code § 31-3506(2) – obligated county • Idaho Code § 31-3502 (25) – resources
When you receive an Order Fixing Costs on your county: • Is this the first you learn of this involuntary case? • Did you get the Order from the Court? • Do you have prior holds for this patient? • Do you have prior medical indigency applications regarding this patient?
Required findings Residency – misnomer, as the costs are to be fixed on the obligated county under Idaho Code § 31-3506(2) • Six months or longer in the past five (5) years • At least thirty (30) days immediately preceding the occurrence • County where the patient last resided prior to receiving medical services
Required findings Indigency – Idaho Code § 31-3502(17) See also Idaho Code § 31-3502(25) What is the evidence of the patient’s ability to pay the hospitalization costs? • Medicaid/Medicare • Private insurance • Other resources, e.g., employment, VA benefits
Evidence sources • Hold paperwork, including application for commitment, DE certificates • Minutes of court hearing with testimony • Declaration of Residency and Resources • Affidavit provided to the court with facts, not merely conclusions
Evidence sourcesThe court found the “best evidence” concerning a patient’s residency was information provided by the patient to the Designated Examiner “The proposed patient lives at the following address: Client is currently homeless and has been for about 1 month. Prior to last month, client was living in Idaho City for about 9 months.”
Evidence sources Affidavit provided to the court: • Based upon my investigation, I found and verily I believe that the residence of the person is as follows I.C. Title 31, Chapter 35: • It appears that the patient is a resident of Ada County for the purposes of medical indigency. • Patient resides at _____________ , Garden City. • It appears Ada County is the obligated county for this patient for this date of service.
Evidence sources Affidavit provided to the court: • Based upon my investigation, I found and verily I believe that the residence of the person is as follows I.C. Title 31, Chapter 35: • The person is a resident of Ada County for the purposes of medical indigency. • Patient’s physical addresses are as follows: • Patient currently lives at ___________, Idaho Falls as of September 25, 2018 • Patient has lived at 525 So. Americana Blvd. Boise, Idaho, January 9, through September 24, 2018. • Ada County is the obligated county for this patient for this date of service (October 15, 2018).
Payment is directed pursuant to: • Order of Commitment and fixing costs • Order to Dismiss and fixing costs • Stipulation/Abeyance* Order and fixing costs • Amended Order fixing costs pursuant to a stipulation of the parties • Order granting a Motion to Reconsider the Order fixing costs * If the patient is unsuccessful on an abeyance, an affidavit is filed reinstituting the hold. Do not pay the days patient is on an abeyance (voluntary).
Challenging an Order fixing costs • When costs were fixed on the wrong county • When costs were fixed on the patient, who was thought to have insurance but didn’t, or when the insurance termed, or when insurance doesn’t cover mental health or costs related to court proceedings • When costs were fixed on a county, but the facility notifies county that patient has insurance
Will the County you believe to be obligated agree to an amended order? • Prepare a stipulation to amend the order fixing costs • Have your prosecutor file a Motion to Reconsider within the time prescribed by the court rules of civil procedure • Within 14 days of the date of the order, unless you received the Order fixing costs later, from the facility or when the patient or PD calls to inquire about payment
Payment • Idaho Code § 66-327(a) provides for payment of all the costs associated with the commitment proceedings, including fees of designated examiners, transportation costs and all medical, psychiatric and hospital costs… • Dates of service (DOS) begin with the date of the instigation of the hold, not the filing date • DOS end with date of commitment or date of filing of the negative Designated Examiner’s certificate, not the date of dismissal
What of an Order Fixing only the costs of the DE on the County? Is the patient indigent for the cost of the DE? Does the patient have resources sufficient to pay the costs over five years, pursuant to Idaho Code § 31-3502(24)?
Medicaid will not pay a “freestanding psychiatric hospital” • Federal law defines an “institution for mental disease” as a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in the diagnosis and treatment or care of persons with mental disease • Under 42 C.F.R § 441.13(a)(2), Medicaid “is not available in expenditures for services for any individual who is under age 65 and in an institution for mental diseases [excepting individuals under 22]
