OAR 309-013-0030: Management of Trust Accounts and Patient Funds in State Institutions

(1) Purpose. This rule establishes standards and procedures to be observed by Superintendents and their employees in the management of trust accounts and patient funds in state institutions, as well as make applications on behalf of patients for Social Security or Veterans Administration benefits or be appointed representative payee for a patient’s Social Security or Veterans Administration benefit payments. (2) Statutory Authority and Procedure. This rule is authorized by ORS and carries out the provisions of ORS 179.510 to 179.530. (3) Definitions. As used in this rule: (a) “Agency trust account” means an account established in the name of a patient by the Superintendent of a state institution under ORS 179.510 to retain funds deposited with the Superintendent by or for the named patient; (b) “Division” means the Addictions and Mental Health Division of the Oregon Health Authority; (c) “Patient’s Designee” means a person designated by the patient in a state institution in writing to receive duplicate copies of documents sent to the patient relating to the patient’s funds; (d) “Representative or Indirect Payee Trust Account” means a trust account established in the name of a patient by the Superintendent of a state institution or other staff representative or indirect payee to retain the patient’s Social Security or Veterans benefits paid to the representative payee; (e) “State Institution” means Dammasch State Hospital in Wilsonville, Oregon State Hospital in Salem, Fairview Training Center in Salem, and Eastern Oregon Hospital and Training Center in Pendleton; (f) “Superintendent” means the executive head of the state institution as listed in subsection (3)(e) of this rule; (g) “Treatment Team” means the group whose membership consists of professional and direct care staff. (4) Admission to State Institution. Upon admission or readmission to a state institution, the patient, a guardian or conservator, and the patient’s designee, if any, shall be provided with written notices containing the following information: (a) The patient’s obligation under state law to reimburse the state for the actual cost of the patient’s care and maintenance, according to the patient’s ability to pay, whichever is less; (b) The patient’s option to place money in either an agency trust account or other suitable depository outside the state institution. The agency trust account withdrawal and deposit procedures and the Superintendent’s powers with respect to such accounts shall be explained therein; (c) In the event the patient requests the state institution to forward funds outside the state institution to other than a bank or secure financial institution and, in the clinical judgment of the Superintendent, the patient is not able to understand the implications of the patient’s request, the Superintendent shall provide notice that the patient’s funds have been placed in an agency trust account; and a proceeding to have a conservator appointed will be commenced within ten days from the date of the notice; (d) Copies of all relevant state laws and rules regarding handling of patient funds and institutional reimbursement shall be made available to the patient, a guardian or conservator, and the patient’s designee on request; (e) The patient, a guardian, or a conservator may designate another responsible person to be representative or indirect payee for benefits and/or to receive duplicate copies of all further documents detailing procedures, agency trust account transactions, applications by the Superintendent for patient benefits, or documents otherwise related to the institutional reimbursement process as it affects the patient. A form for designating one other person to receive such documents shall be provided upon request. (5) Agency Trust Account Transactions. A monthly statement indicating the deposits and withdrawals during the prior month of the agency trust account shall be delivered to the patient, a guardian or conservator, and the patient’s designee, if any. (6) Representative or Indirect Payee Trust Account Transactions. A monthly statement indicating the deposits and withdrawals during the prior month of the representative or indirect payee trust account shall be delivered to the patient, a guardian or conservator, and the patient’s designee, if any. (7) Determination of Patient’s Capability to Manage Funds: (a)(A) If an investigation indicates the patient is incapable of managing his or her funds, the relevant Social Security Administration or Veterans Administration form and recommendation shall be forwarded to the Superintendent’s office. Upon receiving the form, the Superintendent or the Superintendent’s designee shall cause notice of the proposed application to be sent as indicated in section (8) of this rule; (B) Inquiries may be made of attending doctors and other reliable persons who deal with the patient frequently. (b) When, after investigation, in the opinion of the Superintendent, a patient is or has become incompetent and/or incapable of making an informed consent or incapable of managing funds, and there is no person legally responsible for the patient (such as a guardian or conservator), the Superintendent may: (A) Apply to have a representative or indirect payee appointed under section (8) of this rule; and/or (B) Commence proceedings to establish a guardianship or conservatorship. (8) Application for Benefits or Notification of Incapacity to Manage Funds: (a) When, after investigation pursuant to section (7) of this rule, the Superintendent determines that such a step would be in the best interests of the patient, the Superintendent or the Superintendent’s designee may apply for Social Security or Veterans benefits on behalf of a patient. Before each application, the patient, a guardian or conservator, and the patient’s designee, if any, shall be mailed notice of the proposed application. Notice shall include the following: (A) A statement of the intention to apply for such benefits; (B) A copy of the proposed application, indicating the reason for the application and the evidence relied upon in determining that an application is warranted; (C) If the applicant seeks to be selected as representative or indirect payee, a statement that this will mean that the representative of the federal agency concerned will determine whether it is in the best interests of the patient that a payee be appointed; (D) A statement that the patient, a guardian or conservator, or the patient’s designee, if any, may submit to the Superintendent a written statement including written evidence why the application should not be made. This statement and evidence must be submitted not more than 12 days from the date of the notice; and (E) A statement that any such written statement submitted on behalf of the patient and received within the time specified shall be considered by the Superintendent or other official in the decision to submit the proposed application. (b) After such notice has been given, and either: (A) Twelve days have elapsed without response from the patient, a guardian or conservator, or the patient’s designee, if any; or (B) The statement or written evidence submitted pursuant to paragraph (8)(a)(D) of this rule has been received, the Superintendent or the Superintendent’s designee shall consider all the evidence submitted and decide whether an application would be in the patient’s best interest. If it is decided that the application should be made, the patient, a guardian or conservator, and the patient’s designee, if any, shall receive copies of the application and any supporting materials thereof. (c) The response of the Social Security Administration or Veterans Administration to the application shall likewise be forwarded, along with information concerning the rights of patients and other interested persons regarding Social Security or Veterans Administration benefits, to the patient, a guardian or conservator, and the patient’s designee, if any. (9) Deposit of Social Security Administration and Veterans Administration Checks: (a) Checks for which the patient is the payee must be deposited directly into the patient’s agency trust account if the patient has elected to have such an account. In the event the patient has elected a suitable depository outside the state institution, arrangements for forwarding the patient’s funds to that depository are the responsibility of the patient, a guardian or conservator, or the patient’s designee, if any. Notification of receipt of the check and the deposit thereof in the agency trust account shall be made in the next monthly statement to the patient, a guardian or conservator, and the patient’s designee, if any. When such Social Security or Veterans funds are deposited in the agency trust account, the funds shall be clearly designated as Social Security Administration or Veterans Administration benefit money; (b) Social Security or Veterans funds in the agency trust account may be taken to pay the patient’s bill for care and maintenance at the state institution only when the patient (if not judicially or factually incompetent) or the patient’s guardian or conservator has executed a written consent for that particular transaction. “Blanket” or continuing consents will not be honored insofar as they affect Social Security or Veterans benefits; (c) Checks payable to the Superintendent or the Superintendent’s designee as indirect or representative payee may be deposited directly into the patient’s representative or indirect payee trust account. Notification of receipt of the check and the deposit thereof in the representative or indirect payee trust account shall be made in the next quarterly statement to the patient, a guardian or conservator, and the patient’s designee, if any. (10) Discharge from State Institution. At or before discharge from a state institution, each patient, a guardian or conservator, and the patient’s designee, if any, shall be provided with a statement containing the following information: (a) The patient’s continuing obligation under state law to reimburse the state for the actual cost of the patient’s care and maintenance, according to the patient’s ability to pay; (b) The patient may contest payments made to the State of Oregon for charges for institutional care and maintenance during the period of recent hospitalization; (c) Copies of the relevant state laws and administrative rules regarding the patient’s post-discharge right to contest payments made to the State of Oregon for charges for institutional care and maintenance will be made available to the patient or other interested party on request; (d) Copies of monthly statements of transactions concerning the activity in the patient’s agency trust account and quarterly statement of representative or indirect payee trust account may be made available to the patient, legal representative, or other designated person not otherwise prohibited from seeing them upon request. (11) Incapacity to Perform: (a) The patient’s treatment team at the state institution may certify in writing that a patient’s mental illness or mental retardation has rendered the patient incapable of even minimal understanding of any of the notices provided for in this rule. Notwithstanding any other provision of this rule, should such certification occur, the Division or state institution is not required to provide the patient with the various forms of notice otherwise required by this rule; (b) Certification that a patient’s mental illness or mental retardation renders the patient incapable of understanding the notice provided by this rule shall be reviewed and redetermined annually by the Superintendent as part of the patient’s annual plan of care.