Current through Register Vol. 54, No. 44, November 2, 2024
(a) The Department will participate in the
cost of reimbursement to unit of service providers when computed according to
the following procedure.
(b) The
potential reimbursement by the county is computed as follows:
(1) Multiply each unit of service provided
during a given month to a client by one of the following:
(i) The county program rate of reimbursement
for that service if the provider's client fee schedule rate-as defined in
§
4305.3 (relating to
definitions)-for that service is equal to or exceeds the county program rate of
reimbursement.
(ii) The provider's
client fee schedule rate for that service, if the provider's client fee
schedule rate is less than the county program rate of reimbursement for the
same service.
(2) Total
the products found under paragraph (1). This sum is the potential reimbursement
by the county.
(3) If the sum of
the net charge to the liable person-as defined in §
4305.3 -and the net charge to a
third party-as defined in § 4305.3-is less than the potential
reimbursement by the county, the Department will participate in reimbursing the
provider for the difference between the potential reimbursement by the county
and the sum of the net charge to the liable person and the net charge to a
third party.
(4) If the sum of the
net charge to the liable person and the net charge to a third party is greater
than or equal to the potential reimbursement by the county, the Department will
not participate in reimbursement to the provider.
(5) If collection has been pursued according
to Chapter 4305 (relating to liability for community mental health and
intellectual disability services), the Department will participate in
reimbursement to a provider of the uncollectable net charge to the liable
person or the uncollectable net charge to a third party up to the potential
reimbursement by the county.
The provisions of this §4300.117 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).
This section cited in 55 Pa. Code §
4300.111 (relating to
applicability); 55 Pa. Code §
4300.114 (relating to agency
schedule of charges); 55 Pa. Code §
4300.115 (relating to Department
established fees); and 55 Pa. Code §
4300.116 (relating to county
negotiated fees).
