Ariz. Admin. Code § R6-6-1205 - Billing for the Cost of Care Portion

A. Each year, prior to July 1, the Division shall send a financial information form to each responsible party.
B. The responsible party shall return the financial information form to the Division within 30 days of the date of the request.
C. The responsible party shall provide the following information on the financial information form:
1. Client name;
2. Parent or responsible party name;
3. Parent or responsible party address;
4. Declaration of income from the prior year federal tax return;
5. Declaration of the assets of the client's estate, including any amount held in trust or in an annuity for the benefit of the client; and
6. Date and signature of the individual filling out the form.
D. The responsible party shall provide documentation that fully discloses the assets of the client's estate and a copy of the prior year federal tax return.
E. If the responsible party does not return the financial information form, the Division shall charge 100% of the cost of care. If a change occurs in financial circumstances or family size during any year, the responsible party shall contact the Division to amend the financial statement.
F. The Division shall determine the cost of care portion based on the cost of care and the financial information submitted by the responsible party.
G. Along with the monthly billing, the Division shall provide the responsible party with the information used to determine the cost of care for the client.
H. If the Division does not receive the required cost of care portion for two consecutive months, the Office of Accounts Receivable and Collections shall send a delinquent notice to the responsible party. If the responsible party fails to make the overdue payment within 30 days after the date of the delinquent notice, the Office of Accounts Receivable and Collections may take further action to collect, including requesting a change in the representative payee for benefits or referring the case to the Office of the Attorney General.
I. The Division reserves the right to terminate services to a client for nonpayment.

Notes

Ariz. Admin. Code § R6-6-1205
Adopted effective September 30, 1993, under an exemption from A.R.S. Title 41, Chapter 6 (Supp. 93-3). Former Section R6-6-1205 repealed, new Section renumbered from R6-6-1206 and amended under an exemption from A.R.S. Title 41, Chapter 6 effective December 1, 1996; filed in the Office of the Secretary of State November 22, 1996 (Supp. 96-4). Amended by exempt rulemaking at 10 A.A.R. 205, effective January 1, 2004 (Supp. 03-4).

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