Pennsylvania Code
Title 28 - HEALTH AND SAFETY
Part I - General Health
Chapter 4 - HEAD INJURY PROGRAM
Appendix A - BUREAU OF FAMILY HEALTHDIVISION CHILD AND ADULT HEALTH SERVICES

Universal Citation: 28 PA Code ยง A
Current through Register Vol. 54, No. 44, November 2, 2024

PATIENT SHARE of COST (PSC) TABLE

PSC$0$0$50$250$400$550$700$850$1000$1150
% of Poverty0 to 100%[GREATER THAN]100 to 185%[GREATER THAN] 185 to 225%[GREATER THAN] 225 to 250%[GREATER THAN] 250 to 275%[GREATER THAN] 275 to 300%[GREATER THAN]300 to 325%[GREATER THAN] 325 to 350%[GREATER THAN] 350 to 375%[GREATER THAN] 375 to 400%
Size of Family Unit Income RangesUse these columns only for clients who were in DCAHS programs prior to 1/1/97 and have continuous participation without a lapse in eligibility.
1 0 8,591 15,893 19,329 21,476 23,624 25,771 27,919 30,066 32,214
8,590 15,892 19,328 21,475 23,623 25,770 27,918 30,065 32,213 34,360
2 0 11,611 21,480 26,124 29,026 31,929 34,831 37,734 40,636 43,539
11,610 21,479 26,123 29,025 31,928 34,830 37,733 40,635 43,538 46,440
3 0 14,631 27,067 32,919 36,576 40,234 43,891 47,549 51,206 54,864
14,630 27,066 32,918 36,575 40,233 43,890 47,548 51,205 54,863 58,520
4 0 17,651 32,654 39,714 44,126 48,539 52,951 57,364 61,776 66,189
17,650 32,653 39,713 44,125 48,538 52,950 57,363 61,775 66,188 70,600
5 0 20,671 38,241 46,509 51,676 56,844 62,011 67,179 72,346 77,514
20,670 38,240 46,508 51,675 56,843 62,010 67,178 72,345 77,513 82,680
6 0 23,691 43,828 53,304 59,226 65,149 71,071 76,994 82,916 88,839
23,690 43,827 53,303 59,225 65,148 71,070 76,993 82,915 88,838 94,760
7 0 26,711 49,415 60,099 66,776 73,454 80,131 86,809 93,486 100,164
26,710 49,414 60,098 66,775 73,453 80,130 86,808 93,485 100,163 106,840
8 0 29,731 55,002 66,894 74,326 81,759 89,191 96,624 104,056 111,489
29,730 55,001 66,893 74,325 81,758 89,190 96,623 104,055 111,488 118,920
9 0 32,751 60,589 73,689 81,876 90,064 98,251 106,439 114,626 122,814
32,750 60,588 73,688 81,875 90,063 98,250 106,438 114,625 122,813 131,000
10 0 35,771 66,176 80,484 89,426 98,369 107,311 116,254 125,196 134,139
35,770 66,175 80,483 89,425 98,368 107,310 116,253 125,195 134,138 143,080
11 0 38,791 71,763 87,279 96,976 106,674 116,371 126,069 135,766 145,464
38,790 71,762 87,278 96,975 106,673 116,370 126,068 135,765 145,463 155,160
12 0 41,811 77,350 94,074 104,526 114,979 125,431 135,884 146,336 156,789
41,810 77,349 94,073 104,525 114,978 125,430 135,883 146,335 156,788 167,240
13 0 44,831 82,937 100,869 112,076 123,284 134,491 145,699 156,906 168,114
44,830 82,936 100,868 112,075 123,283 134,490 145,698 156,905 168,113 179,320
14 0 47,851 88,524 107,664 119,626 131,589 143,551 155,514 167,476 179,439
47,850 88,523 107,663 119,625 131,588 143,550 155,513 167,475 179,438 191,400
15 0 50,871 94,111 114,459 127,176 139,894 152,611 165,329 178,046 190,764
50,870 94,110 114,458 127,175 139,893 152,610 165,328 178,045 190,763 203,480
16 0 53,891 99,698 121,254 134,726 148,199 161,671 175,144 188,616 202,089
53,890 99,697 121,253 134,725 148,198 161,670 175,143 188,615 202,088 215,560

This table is revised each year based on the release of HHS Federal Poverty Income Guidelines by the United States Department of Health and Human Services. The figures above were published in the Federal Register: February 16, 2001 (Volume 66, Number 33) Notices: (pages 10695-10697).

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