55 Pa. Code § 4305.103 – Audit of the mental health client fee schedule.

Cost of service and client fee schedules based on these costs are subject to audit by the Commonwealth.

Cross References

This section cited in 55 Pa. Code § 4305.101 (relating to applicability).

APPENDIX A

Monthly Liability for Community Mental Health
and Intellectual Disability Nonresidential Services

Adjusted Family Income	Number of Dependents
	1	2	3	4	5	6	7	8	9	10
0- 499	0	0	0	0	0	0	0	0	0	0
500- 999	10	9	8	7	6	5	4	3	2	1
1000-1499	20	17	14	12	10	8	6	5	4	3
1500-1999	30	25	20	16	13	11	9	7	5	4
2000-2499	40	34	29	25	22	19	16	13	11	9
2500-2999	50	43	37	32	28	24	20	17	15	12
3000-3499	60	52	45	39	34	29	25	22	19	16
3500-3999	70	61	53	46	40	34	30	26	22	19
4000-4499	80	69	61	53	46	40	35	31	27	24
4500-4999	90	78	68	59	52	44	38	33	29	25
5000-5499	100	87	76	66	58	50	44	39	35	31
5500-5999	115	100	88	77	68	59	52	46	40	35
6000-6499	130	114	100	88	77	68	60	53	47	41
6500-6999	145	127	112	98	87	76	67	59	53	47
7000-7499	160	140	123	109	96	84	75	66	58	52
7500-7999	175	153	135	119	105	92	81	72	64	56
8000-8499	190	166	146	128	113	99	88	77	68	60
8500-8999	205	179	157	138	121	106	93	82	72	63
9000-9499	220	192	168	147	129	113	99	87	76	66
9500-9999	235	205	179	156	136	119	104	91	79	69
10000-10499	255	223	195	170	149	130	113	99	86	75
10500-10999	275	240	210	184	161	141	123	107	94	82
11000-11499	295	258	225	197	172	151	132	115	101	88
11500-11999	315	275	240	210	184	161	140	123	107	94
12000-12499	335	292	255	223	195	170	148	129	113	98
12500-12999	355	310	270	236	206	179	156	136	118	103
13000-13499	375	327	285	248	216	188	163	142	123	107
13500-13999	395	344	299	260	226	197	171	148	128	111
14000-14499	415	361	313	272	236	205	177	153	132	113
14500-14999	435	378	328	284	246	212	183	158	135	116
15000-15499	455	394	342	295	255	220	189	162	138	117
15500-15999	475	411	355	306	264	227	194	165	140	119
16000-16499	495	428	369	318	273	233	199	169	143	121
16500-16999	515	444	382	328	281	240	204	172	144	124
17000-17499	535	462	398	343	294	252	214	182	153	128
17500-17999	555	480	414	357	307	263	225	191	162	136
18000-18499	575	498	430	372	320	275	236	201	171	144
18500-18999	595	516	447	386	333	287	247	211	180	153
19000-19499	615	534	463	401	346	299	257	221	189	161
19500-19999	635	551	479	415	359	311	268	231	198	169
20000-20499	655	569	495	430	373	323	279	241	207	178
20500-20999	675	587	511	444	386	335	290	251	216	186
21000-21499	695	605	527	458	399	346	300	260	225	194
21500-21999	715	623	543	473	412	358	312	271	235	203
22000-22499	735	641	559	488	425	370	322	280	244	211
22500-22999	755	659	575	502	438	382	333	290	252	220
23000-23499	775	677	591	517	451	394	344	300	262	228
23500-23999	795	695	607	531	464	406	355	310	271	236
24000-24499	815	713	623	545	477	418	365	320	280	245
24500-24999	835	731	640	560	491	430	376	330	289	253
25000-25499	855	749	656	575	504	441	387	340	298	261

Formulae if Adjusted Family Income Exceeds $25,499
The liability for 1 dependent is adjusted family income times 0.0336 The liability for 2 dependents is adjusted family income times 0.0294 The liability for 3 dependents is adjusted family income times 0.0257 The liability for 4 dependents is adjusted family income times 0.0225 The liability for 5 dependents is adjusted family income times 0.0197 The liability for 6 dependents is adjusted family income times 0.0172 The liability for 7 dependents is adjusted family income times 0.0150 The liability for 8 dependents is adjusted family income times 0.0132 The liability for 9 dependents is adjusted family income times 0.0115 The liability for 10 dependents is adjusted family income times 0.0101

Authority

The provisions of this Appendix A amended under sections 201(2) and (8) and 202 of the Mental Health and Intellectual Disability Act of 1966 (50 P.S. § § 4201(2) and (8) and 4202).

Source

The provisions of this Appendix A amended June 17, 2016, effective June 18, 2016, 46 Pa.B. 3177. Immediately preceding text appears at serial pages (211853) to (211854).

Cross References

This appendix cited in 55 Pa. Code § 4305.41 (relating to liability); 55 Pa. Code § 4305.42 (relating to more than one client receiving service); and 55 Pa. Code § 4305.43 (relating to client receiving more than one service).

APPENDIX B

Monthly Liability for Community Mental Health and Intellectual Disability
Residential and Short-Term Inpatient Services

Adjusted Family Income	Number of Dependents
	1	2	3	4	5	6	7	8	9	10
500- 999	13	11	10	9	8	6	5	4	3	2
1000-1499	25	21	18	15	13	10	8	6	5	4
1500-1999	38	31	25	20	16	14	11	9	6	5
2000-2499	50	43	36	31	28	24	20	16	14	11
2500-2999	63	54	46	40	35	30	25	21	19	15
3000-3499	75	65	56	49	43	36	31	28	24	20
3500-3999	88	76	66	58	50	43	38	33	28	24
4000-4499	100	86	76	66	58	50	44	39	34	30
4500-4999	113	98	85	74	65	55	48	41	36	31
5000-5499	125	109	95	83	73	63	55	49	44	39
5500-5999	144	125	110	96	85	74	65	58	50	44
6000-6499	163	143	125	110	96	85	75	66	59	51
6500-6999	181	159	140	125	109	95	84	74	66	59
7000-7499	200	175	154	136	120	105	94	83	73	65
7500-7999	219	191	169	149	131	115	101	90	80	70
8000-8499	238	208	183	160	141	124	110	96	85	75
8500-8999	256	224	196	173	151	133	116	103	90	79
9000-9499	275	240	210	184	161	141	124	109	95	83
9500-9999	294	256	224	195	170	149	130	114	99	86
10000-10499	319	279	244	213	186	163	141	124	108	94
10500-10999	344	300	265	230	201	176	154	134	118	103
11000-11499	369	323	281	246	215	189	165	144	126	110
11500-11999	394	343	300	263	230	201	175	154	134	118
12000-12499	419	365	319	279	244	213	185	161	141	123
12500-12999	444	388	338	295	258	224	195	170	148	129
13000-13499	469	409	356	310	270	235	204	178	154	134
13500-13999	494	430	374	325	283	246	214	185	160	139
14000-14499	519	451	391	340	295	256	221	191	165	141
14500-14999	544	473	410	355	308	265	229	198	169	145
15000-15499	569	493	428	369	319	275	236	203	173	146
15500-15999	594	514	444	383	330	284	243	206	175	149
16000-16499	619	535	461	398	341	291	249	211	179	151
16500-16999	644	555	478	410	351	300	255	215	180	155
17000-17499	669	578	498	429	368	315	268	228	191	160
17500-17999	694	600	518	446	384	329	281	239	203	170
18000-18499	719	623	538	465	400	344	295	251	214	180
18500-18999	744	645	559	483	416	359	309	264	225	191
19000-19499	769	668	579	501	433	374	321	276	236	201
19500-19999	794	689	599	519	449	389	335	289	248	211
20000-20499	819	711	619	538	466	404	349	301	259	223
20500-20999	844	734	639	555	483	419	363	313	270	233
21000-21499	869	756	659	573	499	433	375	325	281	243
21500-21999	894	779	679	591	515	448	390	339	294	254
22000-22499	919	801	699	610	531	463	403	350	305	264
22500-22999	944	824	719	628	548	478	416	363	315	275
23000-23499	969	846	739	646	564	493	430	375	328	285
23500-23999	994	869	759	664	580	508	444	388	339	295
24000-24499	1019	891	779	681	596	523	456	400	350	306
24500-24999	1044	914	800	700	614	538	470	413	361	316
25000-25499	1069	936	820	719	630	551	484	425	373	326

Formulae if Adjusted Family Income Exceeds $25,499
The liability for 1 dependent is adjusted family income times 0.0420 The liability for 2 dependents is adjusted family income times 0.0368 The liability for 3 dependents is adjusted family income times 0.0321 The liability for 4 dependents is adjusted family income times 0.0281 The liability for 5 dependents is adjusted family income times 0.0246 The liability for 6 dependents is adjusted family income times 0.0215 The liability for 7 dependents is adjusted family income times 0.0188 The liability for 8 dependents is adjusted family income times 0.0165 The liability for 9 dependents is adjusted family income times 0.0144 The liability for 10 dependents is adjusted family income times 0.0126 The liability for 11 dependents is adjusted family income times 0.0110

Authority

The provisions of this Appendix B amended under sections 201(2) and (8) and 202 of the Mental Health and Intellectual Disability Act of 1966 (50 P.S. § § 4201(2) and (8) and 4202).

Source

The provisions of this Appendix B amended June 17, 2016, effective June 18, 2016, 46 Pa.B. 3177. Immediately preceding text appears at serial pages (211855) to (211856).