[46 Pa.B. 3177]
[Saturday, June 18, 2016]
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CHAPTER 4210. DESCRIPTION OF SERVICES AND SERVICE AREAS
GENERAL PROVISIONS § 4210.1. Purpose.
This chapter specifies the range of services that must be provided or arranged by the county Mental Health/Intellectual Disability (MH/ID) Program.
§ 4210.2. Applicability.
This chapter applies to county Mental Health/Intellectual Disability (MH/ID) Programs.
§ 4210.4. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
Act—The Mental Health and Intellectual Disability Act of 1966 (50 P.S. §§ 4101—4704).
Annual plan—The description, submitted to the Department, of the services to be provided through the county program, the facilities which will furnish services, and the terms under which services will be furnished.
Catchment area—A geographical territory of a city, county or combination of counties which has a minimum population of 75,000 and a maximum population of 200,000 and in which a full range of mental health and intellectual disability services is available.
Department—The Department of Human Services of the Commonwealth.
Mental health/intellectual disability (MH/ID) establishment—Premises or parts thereof, private or public, for the care of individuals who require care because of mental illness, an intellectual disability or inebriety. The term does not include the private home of a person who is rendering care to a relative.
§ 4210.5. General purpose and principles.
The purpose of the act is to make it possible for every person with a mental disability to receive the kind of treatment he needs, when and where he needs it. The act requires that a range of services be available to persons with a mental illness or an intellectual disability so that they will receive a comprehensive treatment program through a continuum of care in their own communities and, whenever possible, while they remain in their own homes.
§ 4210.6. Scope of the program.
(a) The minimum services to be made available by counties are specified in the act. These services may be provided outside the county program by the Department if a waiver has been granted under section 508 of the act (50 P.S. § 4508). These mental health and intellectual disability services must be available to persons of any age with a mental disability. Mental illness, mental impairment, intellectual disability or mental deficiency is a mental disability if it so lessens the capacity of a person to use customary self-control, judgment and discretion in the conduct of his affairs and social relations as to make it necessary or advisable for him to receive mental health or intellectual disability services.
* * * * * (e) For the program to be effective, not only are services to patients necessary; also essential are consultation to welfare, probation, court, health, school, and other agencies as well as specifically those organizations whose membership represents the low income consumer community to help them to:
(1) Identify their own clients who are in need of services because of serious mental disability.
(2) Strengthen their staffs' ability to help their clients solve their problems and thus prevent the development of seriously impaired psycho-social functioning.
(3) Differentiate their services from those of specialized mental health or intellectual disability facilities and to provide their agency services to persons with a mental disability as freely as to other members of the community.
(4) Be aware of the mental health and intellectual disability implications of their programs.
GENERAL REQUIREMENTS § 4210.11. Community mental health and intellectual disability centers.
For that portion of a county served by a community mental health or intellectual disability center, the local authorities shall contract with them for the services specified in the act, to be made available by counties, which the center can provide. If the local authorities do not wish to contract with an existing center on the grounds that its operations are inconsistent with the county program, the annual plan must substantiate the allegations in detail.
§ 4210.12. Court committed patients.
Regulations and programs pertaining to intake, transfer, leave of absence and discharge of patients are subject to specific court orders relating to individual court committed patients under the provisions of Article IV of the act (50 P.S. §§ 4401—4426). It is the responsibility of the administrator to designate appropriate mental health and intellectual disability facilities to which the court may commit patients. The designations may be made by way of prior blanket notification to the court or on an ad hoc basis.
BASE SERVICE UNIT § 4210.26. Methods of providing base service units.
(a) To the extent that a community mental health or intellectual disability center can staff a base service unit, the local authorities shall contract with it to carry out the responsibilities and provide the functions of the base service unit in the manner determined by the administrator under the same conditions as described for services in § 4210.11 (relating to community mental health and intellectual disability centers). To the extent that a center cannot fully staff a base service unit, the local authorities shall contract with the center for those services which it can furnish and, in the same contract, with other persons or facilities as necessary and appropriate to complete the staffing of a base service unit.
(b) The local authorities may staff base service units fully or partly by employing personnel directly on the staff of the administrator.
(c) The local authorities may contract for supplemental services required by base service units.
SHORT TERM INPATIENT SERVICES § 4210.32. Where services may be provided.
Short term inpatient services may be furnished by mental health/intellectual disability (MH/ID) establishments by the Department to give short term inpatient care, or by State general hospitals approved to furnish such services.
EMERGENCY SERVICES § 4210.42. Where services may be provided.
Emergency services shall be provided by a community mental health or intellectual disability center where feasible or by other licensed or approved facilities with whom the local authorities may contract to provide these services. Comprehensive community-wide 24 hour a day emergency services may be directly operated by the Administrator.
OUTPATIENT SERVICES § 4210.51. Description.
Outpatient services consist of the following: diagnosis, evaluation and treatment of persons with a mental disability who live outside of a mental health or intellectual disability institution while receiving services. This includes working with the patient, his family and significant other persons, utilizing such personnel and modalities as are appropriate to the needs of the patient. As one of the services in the continuum of care established by the county program, outpatient services may precede or follow inpatient care for some individuals and for others may continue while they receive rehabilitative services including sheltered workshop or training services.
§ 4210.52. Where services may be provided.
Outpatient services may be furnished under the county program by the base service unit, by community mental health and intellectual disability providers, by community clinics or by clinics conducted by hospitals or by institutions for persons with a mental disability. Facilities providing outpatient services must be licensed as mental health/intellectual disability (MH/ID) establishments to give outpatient services or, if operated by the State, meet the standards for these services.
PARTIAL HOSPITALIZATION § 4210.62. Where services may be provided.
Partial hospitalization services may be furnished by mental health/intellectual disability (MH/ID) establishments licensed by the Department to give partial hospitalization care, or by State general hospitals approved to furnish services.
REHABILITATIVE AND TRAINING SERVICES § 4210.71. Description.
(a) Rehabilitative and training services are ancillary to mental health and intellectual disability care provided on an inpatient or outpatient basis.
(b) These services consist of vocational evaluation, work adjustment training, job placement and group living experiences to assist an individual handicapped by mental disability, who may or may not have a physical disability, to reach his best level of social and vocational adaptation. According to the capacity of each individual, services may be successful if they result in competitive employment, transitional or indefinite employment in a sheltered workshop or work activity center, ability to maintain a home, or in enabling the client to achieve his maximum possible level or independent living.
(c) These services consist of group programs for teaching or improving self care, personal behavior and social adjustment for persons with a mental disability. Through group training, day care centers may prepare children with a mental disability to attend special classes in the public schools. For other children and for adults these services make continued community living possible by raising the level of social competency and by decreasing the necessity of constant supervision given by their families and others. The services shall include extended work activity programs in sheltered workshops or work activity centers.
INTERIM CARE OF INDIVIDUALS WITH AN INTELLECTUAL DISABILITY § 4210.91. Description.
(a) All of the patient services described previously shall be available to persons with an intellectual disability. In addition, interim care is exclusively for those persons with an intellectual disability.
(b) Inpatient care of persons with an intellectual disability is the responsibility of State operated institutions. The final determination as to whether a person is in need of inpatient care is the responsibility of the Department. When the Department determines that a person is eligible for care in a State operated facility, but that there is no room for him at the time of that determination, the Department will place the person on a waiting list. Interim care is intended for a person who, having been removed from his home, is on a waiting list.
§ 4210.92. Where interim care may be provided.
The Department will approve interim care placement in an appropriate licensed mental health/intellectual disability establishment. Placements may be made in institutions similarly licensed by neighboring states when the placement brings services closer to the person's home and when equally appropriate facilities are not available in this Commonwealth.
§ 4210.93. Application to State institution.
When the base service unit determines in a case that a person appears to be in need of inpatient care for individuals with an intellectual disability it shall forward a completed Preliminary Application, ID-71, to the appropriate State school and hospital.
INTAKE PROCEDURES § 4210.101. Services provided by a base service unit.
(a) All intake into the county program shall be through the base service unit. Within 15 days of the initial interview, if the client is found in need of services from the county program, the Intake and Proposed Service Plan, Form MH/ID 10, is completed and forwarded in two copies to the administrator.
(b) When recommending treatment, a base service unit develops a service plan best suited to the needs of the patient and the available service resources. The base service unit classifies the patient's mental disability to reflect the severity of his functional disorder and priority for intervention according to the Intervention Priority Scale in § 4210.191 (relating to description).
(c) If service is to be provided by the base service unit, the Intake and Proposed Service Plan, Form MH/ID 10, serves only to inform the administrator that intake has taken place and what is planned for the patient. No additional approval is necessary for the base service unit to proceed with its proposed service plan. In addition this form provides the basic information necessary for the patient service accountability system described in § 4210.121 (relating to patient service accountability system).
(d) If the recommendation of the base service unit on Form MH/ID 10 is for a service to be provided by a facility already under contract to the local authorities, the base service unit shall make arrangements directly with the facility to provide the services required by the patient.
(e) If the recommendation of the base service unit on Form MH/ID 10 is to arrange for supplemental services, the administrator uses Form MH/ID 10 as his basis for issuing an Authorization for Service, Form MH/ID 11. This authorization for service shall constitute a contract as described in § 4210.26(c) (relating to methods of providing base service units).
(f) In those instances where the patient is already under care by other than a base service unit and is referred for intake into the county program, arrangements should be made, whenever possible and indicated, for him to continue this treatment with the referring practitioner or facility to maintain continuity of care. The base service unit requests the administrator's authorization of this proposed service plan.
(g) If any portion of the cost of the patient's care under the proposed service plan is to be paid from funds of the county program, the administrator's decision is governed by the availability of funds and the requests for services to other patients. The administrator is guided in his decision by the base service unit's classification of the patient's mental disability according to the intervention priority scale. When the funds available do not permit the carrying out of the proposed service plan in relation to other demands, the administrator notes this on the Intake and Proposed Service Plan, Form MH/ID 10, and requests the base service unit to work out an alternate service plan if indicated and necessary.
LIABILITY § 4210.113. Client liability.
(a) When the patient is not eligible for payment of a portion of the cost of his care through a benefit, he and his legally responsible relatives are liable for payment of that portion of the cost of his care not covered by payment through a benefit. The extent of this liability shall be determined according to the procedure described in Chapter 4305 (relating to liability for community mental health and intellectual disability services).
(b) The extent of liability so determined is the total liability of the patient and his legally responsible relatives for all services rendered during the specified time and as such includes drugs.
RECORDS § 4210.123. Report of services provided.
(a) All services provided are reported on Service Rendered Report, Form MH/ID 13. Regardless of where services are provided, this form must be processed through the base service unit which serves the area in which the patient resides so that the base service unit can continue to monitor the services provided. Where the service is on a continuing basis, the service rendered report may be a monthly summary. If the base service unit certifies Form MH/ID 13 indicating that the report is in keeping with the proposed service plan, Form MH/ID 13 shall be forwarded to the administrator for payment.
(b) At all times, there must be due respect for confidentiality. Service rendered reports should include only basic data concerning the course of service to the patient and his progress in general, and must not contain therapy notes or information communicated by the patient which could be considered confidential.
CONSULTATION AND EDUCATION SERVICES § 4210.141. General requirements.
For the county program to be effective, consultation and education services are essential. The administrator shall arrange for the consultation and education services as are necessary to carry out the functions described in § 4210.6 (relating to scope of the program), by developing a county-wide program for these services. This program shall reflect:
(1) The requests received by the administrator from community agencies and groups for consultation and education services.
(2) Consultation and education services which the administrator plans to provide.
(3) Consultation and education services which the administrator has arranged to be provided by community mental health or intellectual disability centers, by other facilities serving persons with a mental disability and by individual practitioners in the fields of mental health and intellectual disability.
§ 4210.142. Consultation service.
Consultation service is an organized method by which professional advice is given by a practitioner in the mental health or intellectual disability fields to a practitioner of another discipline or field regarding the mental health or intellectual disability aspects of a problem and the most effective way of dealing with these aspects. The problem may be that of an individual, a specific group or a community. Consultation service by extending the expertise of a mental health or intellectual disability practitioner enables the consultee to become a more effective care-giving person thus making possible a greater use of mental health and intellectual disability professionals as well as identifying those persons who are a high risk. In addition to dealing with individual care-giving persons, mental health and intellectual disability consultation service can also be of great benefit in helping a variety of agencies and groups to be aware of the mental health and intellectual disability implications of their programs and to develop more appropriate and effective services.
§ 4210.143. Education service.
Education service is an organized method by which a practitioner in the field of mental health or intellectual disability furnishes professional groups, community agencies and the general public with information about mental health and intellectual disability. By disseminating mental health and intellectual disability information, education service facilities both primary and secondary prevention by the early identification of those members of the population who are at risk. When possible, provisions should be made by the administrator through base service units or other contractual facilities for sufficient out-reaching personnel with the objective of bringing persons so identified into the care-taking network. In the field of tertiary prevention, education is important in helping the public accept persons with a mental disability, provide employment and in other ways enhance their returning to and remaining in the community in useful roles.
§ 4210.144. How services may be provided.
(a) The administrator may provide for consultation and education services through the following:
(1) Utilizing his own staff.
(2) Contracting with community mental health and intellectual disability centers and with other facilities serving persons with a mental disability.
(3) Payment of a fee to individual practitioners in the fields of mental health and intellectual disability.
(b) Although consultation and education services are provided as a specific element of the county program, both the administrator and the providers of these services shall conduct a continuing investigation of sources available for funding consultation and education services, and assist the prospective recipients in their effort to secure funding.
TRAINING OF PERSONNEL § 4210.151. Description.
Training of personnel may include:
(1) In-service instruction regarding objectives, regulations, procedures and other matters specific to the county program.
(2) Staff development through attendance at State, regional and National meetings in the fields of mental health and intellectual disability.
§ 4210.153. Staff development.
Expenses for staff development may be authorized by the local authorities for the administrator, the program personnel of his staff and the program personnel of services provided under contract with the local authorities to attend State, regional and National meetings in the fields of mental health and intellectual disability.
PROGRAM AND SERVICES EVALUATION § 4210.182. Responsibility for the program and services evaluation.
(a) Under the act, the evaluation is a joint responsibility of the administrator and the Board.
(b) The responsibility of the administrator for the evaluation shall be to:
(1) Review and evaluate facilities, and to cooperate with the Department in the maintenance of established standards.
(2) Analyze and evaluate mental health and intellectual disability needs and services in the county.
(3) Recommend improvements to the Board and local authorities.
(c) The Board shall have the following responsibility for the evaluation:
(1) To recommend a system of program evaluation.
(2) To appoint a utilization review committee composed of at least one member of the Board and a multidiscipline group selected from the base service units and nearby State facilities to assist the administrator in his evaluation.
(3) Based on the analysis prepared by the administrator, to review and evaluate the county's mental health and intellectual disability needs, services, facilities and special problems in relation to the local health and welfare needs, services and programs.
(4) To make recommendations to the local authorities regarding the program and other matters relating to mental health and intellectual disability services in the county.
INTERVENTION PRIORITY SCALE § 4210.191. Description.
The base service unit classifies the patient's mental disability to reflect the severity of his functional disorders and priority for intervention. This is noted on I, II, III or IV on Intake and Proposed Service Plan, Form MH/ID 10, under the following Intervention Priority Scale:
* * * * *
CHAPTER 4215. ANNUAL PLAN AND ESTIMATE OF EXPENDITURES
GENERAL PROVISIONS § 4215.1. Purpose.
The purpose of this chapter is to specify the requirements for submission of an annual plan and estimate of expenditures by County Mental Health and Intellectual Disability (MH/ID) Programs to the Department.
§ 4215.2. Applicability.
This chapter applies to county mental health/intellectual disability (MH/ID) programs.
§ 4215.3. Legal base.
The legal authority for this chapter is section 201(2) of the Mental Health and Intellectual Disability Act of 1966 (50 P.S. § 4201(2)).
§ 4215.4. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
Approve—Acceptance based upon formal compliance with this chapter. The term does not imply the Department's agreement with the content of county mental health/intellectual disability (MH/ID) annual plan and estimate of expenditures regarding budget priorities.
Board—A group of persons appointed by the local authorities of a county, or two or more counties participating in concert in a county mental health and intellectual disability program, to review and evaluate the county's MH/ID needs, services, facilities and special problems in relation to local health and welfare needs, services and programs.
County administrator—The administrator of the county mental health and intellectual disability program, or the administrator's designee.
Department—The Department of Human Services of the Commonwealth.
Local authorities—The county commissioners or county executives of a county, or the city councils and the mayors of first class cities, or two or more of these acting in concert.
Secretary—The Secretary of the Department of Human Services.
GENERAL REQUIREMENTS § 4215.21. Preparation of annual plan and estimate of expenditures.
The county mental health/intellectual disability (MH/ID) administrator and the Board shall prepare an annual plan and estimate of expenditures in accordance with written instructions specified by the Department, including, but not limited to, instructions on budget estimates, needs assessments, and goal statements. The annual plan and estimate of expenditure shall describe how the services specified in Chapter 4210 (relating to description of services and service areas) are to be made available and shall estimate the anticipated expenditures for the services.
§ 4215.22. Public hearing.
(a) The county mental health/intellectual disability (MH/ID) administrator and the Board shall hold a public hearing to consider the annual plan and estimate of expenditures, prior to submission of the annual plan and estimate of expenditures to the Department.
(b) The county MH/ID administrator shall give adequate notice of the date, time and location of the public hearing to persons affected by the annual plan and estimate of expenditures.
(c) The county MH/ID administrator shall provide notification of the public hearing through a widely distributed local newspaper, prior to the public hearing.
§ 4215.23. Report of the public hearing.
(a) The county mental health/intellectual disability (MH/ID) administrator shall prepare and maintain a summary report of the public hearing, including a list of people who testified and written comments received.
(b) The county MH/ID administrator shall provide copies of the summary report of the public hearing to the Department upon request.
§ 4215.24. Review and approval by local authorities.
(a) The county mental health/intellectual disability (MH/ID) administrator and the Board shall submit the annual plan and estimate of expenditures to the local authorities for review and approval.
(b) Local authorities shall indicate their approval by signing and dating the annual plan and estimate of expenditures.
§ 4215.25. Submission of the notice of public hearing and the annual plan and estimate of expenditures to the Department.
After approval by the local authorities, the county mental health/intellectual disability (MH/ID) administrator and the Board shall submit to the Department the notice of public hearing and the annual plan and estimate of expenditures.
§ 4215.26. Review of the annual plan and estimate of expenditures by the Department.
(a) The Department will review and approve the annual plan and estimate of expenditures against predetermined criteria.
(b) The Department will notify the county mental health/intellectual disability (MH/ID) administrator of the result of the review against predetermined criteria.
CHAPTER 4220. REIMBURSEMENT FOR MEDICATIONS
GENERAL PROVISIONS § 4220.1. Purpose.
This chapter specifies requirements pertaining to reimbursement by the county mental health and intellectual disability program for the cost of drugs.
§ 4220.2. Applicability.
This chapter applies to county mental health and intellectual disability programs.
§ 4220.3. Legal base.
The legal authority for this chapter is section 201(2) of the Mental Health and Intellectual Disability Act of 1966 (50 P.S. § 4201(2)).
GENERAL REQUIREMENTS § 4220.11. Purchase of drugs.
(a) For the cost of a drug to be reimbursed by the county mental health and intellectual disability program it must be prescribed by a practitioner licensed by statute to prescribe the drugs and must be specifically for the mental disorder under treatment. Client liability and third party revenues must be exhausted before county mental health and intellectual disability funds are used.
(b) For a pharmacy to receive reimbursement from the county mental health and intellectual disability program it must be licensed by the State Board of Pharmacy.
§ 4220.12. Limitations.
(a) Drugs in the following general categories may be reimbursed by the county mental health and intellectual disability program.
(1) Major tranquilizers. Includes:
(i) Phenothiazines.
(ii) Butyrophenones.
(iii) Thioxanthenes.
(iv) Rauwolfia Alkaloids.
(v) Dibenzoxazepines.
(vi) Molindones.
(2) Minor tranquilizers. Includes:
(i) Propanediole.
(ii) Benzodiazepines.
(iii) Diphenylmethane Derivatives.
(3) Hypnotics and sedatives. Includes:
(i) Barbiturates.
(ii) Nonbarbiturates.
(4) Antidepressants. Includes:
(i) Tricyclics.
(ii) Monomine Oxidase Inhibiters.
(iii) Lithium.
(5) Central nervous system stimulants.
(6) Anticonvulsant agents.
(7) Antiparkinsonian agents.
(8) Various geriatric psychotropic agents.
(b) The county mental health and intellectual disability program may also reimburse for an item not falling in the general categories listed in subsection (a)(1)—(8) if, in the licensed practitioner's professional opinion, it is essential for the present treatment of the patient's mental disorder. The county mental health and intellectual disability program may require, as a condition of reimbursement for these items, that prior approval be given by the County MH/ID Program. Where prior approval is required, it is the responsibility of the county administrator to ensure that proper notification of approval be given to the pharmacy at the time the prescription is presented to be filled.
(c) An initial prescription is limited to a 45-day supply and a maximum of one refill may be requested on an initial prescription. The quantity dispensed on the refill prescription cannot exceed the quantity prescribed on the initial prescription.
(d) The County MH/ID Program's maximum rate of reimbursement for drugs is the pharmacy's usual and customary charges to the general public for psychotropic drugs. Discounts given to special groups such as senior citizens must also be given to County MH/ID clients who are members of those specialized groups.
§ 4220.13. Procedures.
(a) The prescription must be made on Prescription and Pharmacist's Invoice, Form MH/ID 12. The number of refills permitted—not to exceed one—should be indicated on the MH/ID 12. It is the responsibility of the physician to ensure that the patient's drug costs are eligible for reimbursement by the County MH/ID Program and have been authorized for payment by the county administrator before using an MH/ID 12 prescription form.
(b) The pharmacy submits the MH/ID 12 on a monthly basis to the county MH/ID administrator for reimbursement. Refills of prescriptions should be reported to the county program on a monthly basis on a form of the county program's choosing.
(c) The county administrator is responsible for providing authorization for purchase of medication. The county administrator is also responsible for ensuring that the invoice is correctly priced and is for eligible drugs. The county administrator makes payment to the pharmacy for invoices submitted under subsection (b). It is the responsibility of the county administrator to ensure that patient liability and third party revenues are exhausted before County Mental Health/Intellectual Disability (MH/ID) funds are used. This responsibility may be delegated; however, the county administrator shall make every effort to ensure that pharmacies are reimbursed in a timely fashion. The goal should be reimbursement within 30 days of receipt of the claim.
§ 4220.14. Cost and quality control measures.
* * * * * (d) The following cost control measures are available to county programs when taken in consultation with a county PTRC. These measures should only be used when limited resources cause expenditure on medication to impact adversely on other service areas. Caution should be exercised in the use of these measures. The goal of the PTRC program should be to ensure cost benefit and sound practice in the county drug program, while at the same time permitting flexibility, easy access by clients, and encouraging the private model of human service delivery and of the dispensing of drugs.
(1) The county program may establish a formulary of drugs for which it will reimburse and may exclude from that formulary specific drugs or classes of drugs even though they fall in the general categories in § 4220.12(a) (relating to limitations). A county drug formulary must be published at least annually in a newspaper or papers having side circulation in the county program service area.
(2) The county program may establish limits on the total allocation or dollar amount for which it will reimburse.
(3) The county program may require prior approval or post-review by the PTRC for reimbursement to occur. Post-review procedures are to be preferred to prior approval procedures and should be used where possible.
(4) The county program may limit the number of refills to less than one refill, or limit the number of days to fewer than 45 days. The maximum limits under § 4220.12(c) may not be exceeded.
(5) The county program PTRC may conduct a review or audit of pharmacies participating in the Mental Health/Intellectual Disability (MH/ID) drug program to ensure that charges made by the pharmacy to the county program are the usual and customary charges of the pharmacy to the general public.
(6) Where any of the cost control measures under this subsection are enacted, the county administrator must make provision for appeals by prescribers, pharmacies or providers on a ''special case'' basis.
(7) Cost control measures enacted by county programs under this subsection are subject to review and approval by the Department.
CHAPTER 4230. WAIVER OF SERVICE
GENERAL PROVISIONS § 4230.1. Purpose.
This chapter defines the process for requesting a waiver of the duty to provide mental health and intellectual disability mandated services. Section 301(d) of the Mental Health and Intellectual Disability Act of 1966 (50 P.S. § 4301(d)) requires county mental health and intellectual disability programs to provide the following nine mandated services:
(1) Short-term inpatient services.
(2) Outpatient services.
(3) Partial hospitalization services.
(4) Emergency services.
(5) Consultation and education.
(6) Aftercare services.
(7) Rehabilitative and training services.
(8) Interim care of individuals with an intellectual disability.
(9) Unified intake.
§ 4230.2. Applicability.
This chapter applies to county mental health and intellectual disability programs.
§ 4230.3. Legal base.
The legal authority for this chapter is sections 201(2) and 508 of the Mental Health and Intellectual Disability Act of 1966 (50 P.S. §§ 4201(2) and 4508).
WAIVER OF SERVICE § 4230.11. Requesting waivers.
(a) A county mental health and intellectual disability program is permitted to request a waiver of one or more of the nine mandated services if the service is not available or if the county mental health and intellectual disability program shows that it is economically unsound to provide the service.
(b) A request for waiver shall be to waive the provision of an entire service. Waivers may not be requested for a reduction in the level of service.
(c) Waivers shall be requested for a period of one fiscal year or less.
(d) A request for waiver for the next fiscal year shall be submitted to the Department between April 15 and May 15 of the current fiscal year.
(e) Waivers may not be requested for the current fiscal year.
§ 4230.12. Documentation.
(a) The county mental health and intellectual disability program shall submit a written request for waiver to the Secretary of the Department of Human Services, with a copy of the request for waiver to the Deputy Secretary, Office of Developmental Programs and the Deputy Secretary, Office of Mental Health and Substance Abuse Services.
(b) A request for waiver shall include the following:
(1) The service for which the waiver is requested.
(2) The fiscal year for which the waiver is requested.
(3) Justification for the waiver.
(4) The total expenditure by the county mental health and intellectual disability program for the service in the previous and current fiscal years.
(5) Clients and units of service for the previous and current fiscal years.
§ 4230.14. Hearing.
(a) The Department will hold a hearing in the county requesting the waiver by June 15 of the year in which the waiver request was made.
(b) The county mental health and intellectual disability program shall arrange a location for the hearing.
(c) The county mental health and intellectual disability program shall inform the public of the date, time, location and purpose of the hearing.
(d) The county mental health and intellectual disability program shall present the request for waiver and justification for the waiver at the hearing.
§ 4230.15. Waiver decision.
The Department will provide a written waiver decision to the county mental health and intellectual disability program by June 30 of the year in which the waiver request was made.
§ 4230.16. Provision for mandated service.
(a) If the waiver is granted, the county mental health and intellectual disability program is not required to provide the mandated service for the fiscal year for which the waiver was granted.
(b) If a waiver is granted and the Department decides to provide the service according to section 508(b) of the Mental Health and Intellectual Disability Act of 1966 (50 P.S. § 4508(b)), the county mental health and intellectual disability program is liable for the total county share for the service waived, under section 508(c) of the Mental Health and Intellectual Disability Act of 1966. The county's mental health and intellectual disability allocation shall be reduced by the total State amount expended in the fiscal year immediately preceding the fiscal year of the waiver, for the service waived. The actual amount reduced from the county's mental health and intellectual disability allocation is deducted in the year of the waiver.
(c) If a waiver is granted, and the Department decides not to provide the service according to section 508(b) of the Mental Health and Intellectual Disability Act of 1966, the county mental health and intellectual disability allocation shall be reduced by the total State amount expended in the fiscal year immediately preceding the fiscal year of the waiver, for the service waived. The actual amount reduced from the county's mental health and intellectual disability allocation is deducted in the year of the waiver.
(d) If the waiver is denied, the county mental health and intellectual disability program shall provide the service for which the waiver was requested.
§ 4230.17. Right to appeal.
The county mental health and intellectual disability program has the right to appeal the Department's decision under 2 Pa.C.S. §§ 501—508 and 701—704 (relating to Administrative Agency Law). Appeals shall be submitted within 15 days of receipt of the Department's waiver decision to the Department's Hearing and Appeals Unit, according to the appeal procedures in 1 Pa. Code Part II (relating to General Rules of Administratative Practice and Procedure).
CHAPTER 4300. COUNTY MENTAL HEALTH AND INTELLECTUAL DISABILITY FISCAL MANUAL
GENERAL PROVISIONS § 4300.1. Purpose.
This chapter specifies the fiscal requirements for county mental health and intellectual disability programs.
§ 4300.2. Applicability.
This chapter applies to county mental health and intellectual disability programs. County mental health and intellectual disability programs shall use this chapter to reimburse providers of service.
§ 4300.3. Legal base.
The legal authority for this chapter is section 201(2) of the Mental Health and Intellectual Disability Act of 1966 (50 P.S. § 4201(2)).
§ 4300.4. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
Act—The Mental Health and Intellectual Disability Act of 1966 (50 P.S. §§ 4101—4704).
County—A county or a first class city.
County authority—The county official responsible for certain functions related to the administration of the county program. The responsibility and authority may be established by statute or the delegation of duties by the county commissioners, county executive, county councils or the city councils of first class cities, or two or more of these acting in concert.
County program—A mental health and intellectual disability program established by a county, or two or more counties acting in concert. The term includes a program which contains a variety of services and provides a continuum of care in the community for individuals with a mental disability.
Department—The Department of Human Services of the Commonwealth.
Direct costs—Costs that can be identified and immediately charged to a specific cost or service category.
Expensing—Payment for an item in full at the time of acquisition or within the fiscal period in which it was acquired.
Facility—An establishment, hospital, clinic, institution, center, day care center or other organizational unit, or part thereof, which is devoted primarily to the diagnosis and treatment of individuals with a mental disability.
Fixed assets—Major items, excluding real estate, which can be expected to have a useful life of more than 1 year, or which can be used repeatedly without materially changing or impairing their physical condition by normal repair, maintenance or replacement of components with a purchase price of $500 or more.
Indirect costs—Costs incurred for a common or joint purpose and not readily assignable to a specific cost or service category.
Joinder—Two or more counties acting in concert to establish a county program.
Modified Classification Review (MCR)—A personnel classification system whereby the county authority has the authority to crosswalk positions in contracted agencies into a structure of categorical position definitions developed by the Department.
Mortgaged real estate—A conveyance of real property subject to certain financial conditions or obligations which are satisfied by payment according to stipulated terms. The conveyance of real property through bonded indebtedness shall be considered as mortgaged real estate.
New program—A program initiated and approved by the Department that is not a mandated service identified in section 301 of the act (50 P.S. § 4301).
Personnel Action Plan (PAP)—A personnel classification system whereby the county authority has the authority to crosswalk positions in contracted agencies into a structure of categorical positions developed by the county within a broad structure developed by the Department.
Prevailing county practice for agencies funded by multiple counties—Policies agreed upon by the involved county programs, when two or more county programs fund an agency.
Prevailing county practice for joinders—A policy agreed upon by the counties in the joinder.
Related party—A party who meets the tests of common ownership or control.
Secretary—The Secretary of the Department.
DEPARTMENT GRANTS AND PAYMENTS § 4300.21. Departmental powers.
The Department has the power to make grants, pay subsidies, purchase service and provide reimbursement for mental health and intellectual disability services under the act.
§ 4300.22. Departmental financial participation.
A service shall qualify for Departmental financial participation if it is authorized by the act and is specifically provided for in this chapter or approved by the Department in advance of its incorporation in the county plan as training, research, or another service or program designed to prevent mental disability or the necessity of admitting or committing the individual with a mental disability to a facility.
§ 4300.23. Percentage of expenditures reimbursable.
(a) Subject to the appropriation of funds and under the act and this chapter, the Department will participate at 100% of the approved expenditures for the following:
(1) Diagnosis, evaluation and care in Commonwealth-operated facilities, or in a facility with which the Commonwealth may contract.
(2) Payments for inpatient care and partial hospitalization for persons financially ineligible for care under public assistance law.
(3) Licensed community residential programs for individuals with an intellectual disability.
(4) Other obligations that may arise under a new program established by the Department.
(b) The Department will participate at 90% of the approved expenditures for other services or activities qualifying for financial support under the county program. The remaining 10% is the county obligation or the local match of the county program.
§ 4300.25. Direct provision of services.
Direct provision of services is the provision of mental health and intellectual disability services by county employees under the supervision of the county authority. Costs associated with the direct provision of services, subject to the limitations contained in this chapter, are eligible for Departmental participation.
§ 4300.26. Unit of service funding.
Unit of service funding is the procedure used to fund facilities based on a charge per unit of service. Unit of service funding applies to facilities which are administered separately from the county or county joinder and which receive reimbursement by a contracted per diem or fee rate. Funding is based on a charge per service.
(1) The following services shall be purchased only by the unit of service:
(i) Inpatient care.
(ii) Partial hospitalization.
(iii) Laboratory services.
(iv) Drugs.
(v) Respite care.
(vi) Interim care.
(vii) Services where the provision of the service is not limited to individuals with a mental disability, such as a workshop service or day care.
(2) An exception to paragraph (1) will be allowed when a regional mental health official authorizes, in writing, the initiation of a new partial hospitalization program and determines that it is necessary to expend funds to staff and equip the program prior to providing services to clients. The Department will then authorize program-funding of this particular partial hospitalization program for a period not to exceed 1 year from the initial date of funding.
(3) Domiciliary care placement agencies shall be funded only by unit of service funding after the initial year of operation. During the initial full year of operation, domiciliary care may be purchased by unit of service funding or program-funding.
(4) During the first year, the county or county joinder may program-fund a share of the cost of operating the domiciliary care placement agency. After the first year, these services shall be purchased on a unit of service basis. Payment may be made either by cash or inkind contribution.
COUNTY AND COUNTY JOINDER ALLOWABLE COST STANDARDS § 4300.45. Staff development.
(a) Staff development includes the training of personnel through inservice instruction and recognized professional education programs, or through attendance at State, regional and National meetings, seminars or conferences.
(b) The Department will participate in the cost of training of staff to the extent that the training is related to the objectives of the county program or is essential for the continuation or improvement of the program.
(c) Training for staff shall be in or directly related to the fields of mental health and intellectual disability, or the administration of these programs.
(d) Expenses for staff development shall be approved by the appropriate county authority or a designee.
§ 4300.46. Purchased personnel services.
(a) Purchased personnel services are allowable expenses for justifiable programmatic or administrative reasons. A written agreement shall state the services to be provided, the rate of compensation and the method of payment. Consultant fees shall be determined in accordance with prevailing county practice. Participation in the cost for fees and expenses of professional practitioners and consultants, who are board members, directors, commissioners, county elected officials or regular employees requires the prior approval of the Department.
(b) County employees may not receive remuneration for acting as consultants or in another capacity to facilities with which the county/joinder contracts for mental health and intellectual disability services, or with Commonwealth agencies.
§ 4300.48. Occupancy.
* * * * * (d) Mortgaged real estate which is owned and utilized by a county/joinder may be charged to the Department, except that no charge may be made for the refinancing of buildings unless a lower interest rate is available. The original amortization period may not be extended. Departmental participation is limited to the mortgaged cost associated with acquisition or renovation/improvement/repair/maintenance, or both, of property. The amount of these charges shall be the lesser of the fair rental value of the space and use, or the actual cost of the principal and interest incurred in the mortgage amortization, including any amortized minor or major renovation/improvement/repair/maintenance costs. The amount charged shall be prorated in relation to the percentage of space used by the program.
(1) The Department will participate in closing costs and downpayments required by lending institutions for the acquisition of real estate to be used for the county mental health and intellectual disability program. The Department will participate in a downpayment not to exceed 25% of the property value. Real estate purchased with a downpayment reimbursed by the Department shall be used in the county program for at least 5 years.
* * * * * § 4300.56. Library expenses.
The Department will participate in the purchase of books, documents and subscriptions to journals pertaining to mental health, intellectual disability and other relevant topics.
§ 4300.63. Commitment procedures.
(a) The Department will participate in costs incurred by counties for the commitment of individuals under the Mental Health Procedures Act (50 P.S. §§ 7101—7503) and intellectual disability commitments under the act.
(b) The following costs are allowable:
(1) Mental health review officer time and related costs.
(2) Attorney for the county mental health and intellectual disability program or the facility.
(3) Examination and expert medical testimony by the examining physician.
(4) Cost of client transportation to or from hearing.
(5) Client's expert witness as provided under section 304(d) of the Mental Health Procedures Act (50 P.S. § 7304(d)).
(6) Commitment delegate expenses.
(c) The following costs are not allowable:
(1) Court costs or fees.
(2) Court clerical costs.
(3) Transcription costs.
(4) Client's attorney.
(5) Court reporter.
(6) Attorney for the petitioner when the petitioner is not the county administrator.
(7) Fees for testimony by witnesses other than expert medical and client's expert witnesses.
§ 4300.68. Title to fixed assets.
(a) Title to fixed assets, excluding real estate, acquired with mental health and intellectual disability funds shall remain with the county/joinder.
(b) Income received by the county program when disposing of fixed assets obtained with mental health and intellectual disability funds shall be used to reduce gross expenditures submitted by the county program for Departmental participation. The county may reimburse the Department in direct proportion to the Department's participation in the purchase of the fixed assets—either 90% or 100%.
(c) Fixed assets acquired with mental health and intellectual disability funds shall be solely for the benefit of the mental health and intellectual disability program. If fixed assets are transferred from the mental health and intellectual disability program, the county/joinder shall reimburse the Department for its percentage of the remaining value of the equipment based on an independent appraisal of the value of the fixed assets. The county program may not transfer fixed assets purchased with categorical funding to another component of the county program without the prior written approval of the appropriate program deputy secretary.
CONTRACTED AGENCY ALLOWABLE COST STANDARDS § 4300.83. Compensation.
* * * * * (c) The Department will participate in the costs of compensation for employees of agencies funded on a unit of service basis. The Department will participate in compensation for the chief executive officers of these agencies up to the combined salaries and benefits approved for these positions. A chief executive officer reimbursement grid methodology will be used to determine eligible salaries. It classifies agencies according to total expenditures, and as multiple or single service providers. Multiple service providers are those providers for which counties reported expenditures of at least $100,000 in at least two cost centers. Single service providers are those providers for which counties reported expenditures of at least $100,000 in a single cost center. Total provider expenditures and expenditures by cost center will be based on annual county program income and expenditure reports submitted by counties under § 4300.133 (relating to financial reporting requirements) and the cost reports submitted to the Department by intermediate care facilities for individuals with an intellectual disability. The Department will entertain waiver requests submitted under § 4300.11 (relating to waivers) to include other expenditures, not normally reported to the Department, for classifying agencies.
* * * * * § 4300.86. Staff development.
(a) The Department will participate in the cost of training of staff to the extent that the training is essential for the continuation or improvement of the program.
(b) Training for staff shall be in or directly related to the fields of mental health and intellectual disability, or the administration of these programs.
§ 4300.94. Agency indirect costs.
* * * * * (g) To be allowable for Departmental participation, indirect costs shall meet the following criteria:
(1) Be necessary and reasonable for the proper and efficient operation and administration of the contract.
(2) Be authorized under statutes and regulations.
(3) Conform to limitations, exclusions or allowable cost standards for items of expenditure as included in this chapter if more than 50% of the agency's indirect costs are allocated to mental health or intellectual disability programs, or both, funded by a county/joinder or a combination of Commonwealth counties/joinders.
(4) Be accorded consistent treatment as either a direct or indirect cost.
§ 4300.95. Library expenses.
The Department will participate in the purchase of books, documents and subscriptions to journals pertaining to mental health, intellectual disability and other relevant topics.
§ 4300.106. Title to fixed assets.
(a) Title to fixed assets which are depreciated under § 4300.105 (relating to depreciation allowances) shall remain with the contracted agency.
(b) Title to fixed assets which are expensed or loans amortized using county mental health and mental retardation funds shall remain with the county/joinder or the provider.
(c) If title remains with the county/joinder, contracted agencies may not sell, leave, donate or dispose of county fixed assets without written permission from the appropriate county authority. Upon termination or cancellation of the contract and within a fixed period determined in that contract, the county shall at its discretion:
(1) Retain possession for county use or permit the use of fixed assets by another provider of services.
(2) Dispose of fixed assets purchased with mental health and intellectual disability funds upon obtaining an independent appraisal of the fixed assets.
(3) Allow the contracted agency to purchase the fixed assets upon obtaining an independent appraisal of the fixed assets.
(d) If title remains with the provider under subsection (b), the fixed asset shall be made available by the provider for use in the county program for its useful life. If the provider holds title to the asset, the provider may pledge the asset as collateral for loans necessary to the agency.
(e) Income received when disposing of fixed assets, or received by the county in refunds from agencies, shall be used to reduce gross eligible expenditures in determining the amount eligible for Departmental participation.
UNIT OF SERVICE FUNDING § 4300.117. Computation of reimbursement.
(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.
§ 4300.118. Special limitations on unit of service funding.
(a) Costs of partial hospitalization services provided under this title shall be limited to 240 3-hour sessions (720 total hours) in a consecutive 365-day period per patient. Six hours of partial hospitalization equals 1 day of partial hospitalization.
(b) A benefit period begins with the first day of inpatient hospital care and includes a maximum of 60 days of care in one consecutive stay or in a number of lesser stays that add up to 60 days. If the Department pays for part of a day, the day shall be counted as a full day in the benefit period. A patient's benefit period ends after 60 consecutive days on which he is not hospitalized, regardless of the number of days of hospitalization he has had. After one benefit period ends, a new benefit period begins with the first day of hospitalization and is subject to appropriate utilization review standards.
(c) The payment for hospital visits by a psychiatrist, when the fee is not included in the inpatient rate, shall be allowed.
(d) The Department will participate in the cost of drugs according to Chapter 4220 (relating to reimbursement for medications).
(e) Charges to clients of the county program shall be in accordance with Chapter 4305 (relating to liability for community mental health and intellectual disability services). A facility may not seek reimbursement from a client of the county program above that provided for under this title.
(f) The Department of Labor and Industry, Office of Vocational Rehabilitation, establishes fees for selected vocational program services. The Department will financially participate in the costs of county programs purchasing these same services at the established fees.
FISCAL MANAGEMENT OF THE COUNTY PROGRAM § 4300.132. Accountability for expenditures of mental health and intellectual disability funds for clients.
(a) The appropriate county authority is responsible for the accounting of funds expended through the county program, and the authorization of expenditures consistent with this chapter. Service provided without proper authorization or accountability, or both, may not be considered as reimbursable. Services purchased on a fee per unit of service basis shall have prior authorization of the administrator or designee.
(b) The county program and providers with whom the county contracts for services shall maintain books, records, documents and other evidence according to standard accounting procedures and practices, sufficient to reflect properly direct and indirect costs claimed to have been incurred and anticipated to be incurred for funds supported by the act and for which reimbursement is claimed. Records shall be kept for a minimum of 4 years after the close of the fiscal year.
(c) Time and attendance and payroll distribution records shall be maintained for each employee. Any method of keeping the records is acceptable as long as it is complete and accurate.
§ 4300.134. Apportionment of administrator's office costs.
The costs of the administrator's office as defined in this chapter are funded from both mental health and intellectual disability allocations. Two alternatives are available for apportioning these costs. The costs of the administrator's office may be apportioned according to the actual cost incurred for the administration of each program or as a proportion of program costs. Documentation supporting the apportionment of these costs shall be retained by the county program.
§ 4300.135. Actual costs.
The intention of this method is to determine and assign the actual costs related to the provision of mental health or intellectual disability services. Once a county program has developed and implemented a methodology for apportionment based on actual costs, it may not assign costs according to a proportion of program costs methodology. Costs shall be assigned as follows:
(1) Costs which can be readily identified as mental health or intellectual disability shall be appropriately assigned.
(2) Time records or a random time study shall be used to apportion individual staff salaries, benefits, and operating and fixed asset expenses related to staff. Time which cannot be assigned, not to exceed 25% of available time, can be ignored in developing an apportionment ratio.
(3) Other costs shall be apportioned based on the overall ratio resulting from the assignment of costs in paragraphs (1) and (2).
§ 4300.136. Proportion of program costs.
The Department's grants to county programs include base allocations, categorical allocations and allocations of Federal funds. The ratios of the mental health and intellectual disability allocations to the total allocation received from the Department shall be used to assign the costs of the administrator's office when using this method.
§ 4300.137. County joinder contracts.
When a mental health and intellectual disability program is administered by two or more counties, the local authorities acting in concert shall enter into a contract to establish the policies of that program.
(1) The contract shall provide for proportionate costs of the program to be borne by each participating county.
(2) A separate bank account shall be established into which funds received from the Department and from the participating counties for the purposes of the program shall be paid and out of which payments for the program shall be made.
(3) The contract shall designate the person authorized to sign checks, indicate services and facility operation to be administered jointly and address other matters necessary or proper for the accomplishment of program objectives.
(4) The contract shall include a description of policies agreed to by the counties as prevailing county practice for the mental health and intellectual disability program. These include the policies of leave, travel, recruitment and consultant fees.
(5) Contracts shall be reviewed at least once every 10 years.
§ 4300.139. Contracting requirements.
* * * * * (c) A signed contract becomes the authorization for the expenditure of funds for services identified by the agreement. County mental health and intellectual disability funds cannot be expended for provider expenses until a contract exists. For licensed inpatient and authorized partial hospital providers, an authorization for service form may be used, in lieu of a contract, to purchase services.
(d) Counties shall establish a procedure to provide contract agencies with an opportunity to be heard by the county mental health and intellectual disability board, or a committee thereof, regarding contract disputes arising under this chapter. The purpose shall be for the board to hear the issues and arguments involved in the dispute and develop recommendations to the appropriate county authority.
* * * * * § 4300.148. Uncollected revenue.
Income referred to as accounts receivable may be adjusted for uncollected revenues when a request for abatement or write-off has been approved under Chapter 4305 (relating to liability for community mental health and intellectual disability services).
§ 4300.155. Categorical funding.
(a) Categorical funding is the identification of a certain dollar amount in a county mental health and intellectual disability allocation to be used for a specific component of the county program. The funding may occur as the result of an authorization by the Secretary. The funds shall be considered restricted and available for the stated purpose only. This also applies to the base program allocation as a whole.
(b) Unexpended categorical funds may not be used to offset a deficit incurred in the base program or another categorical program unless approved by the Secretary.
(c) Unexpended categorical funds are carried over into the next fiscal year and considered by the Department in the computation of the allocation for the next fiscal year.
§ 4300.158. Revenue.
(a) Allocations from the Department are to defray part of the cost of county programs authorized by the act and approved by the Department. Income from the amounts paid for the same purpose from a public or private source directly to participating counties, facilities or individuals shall be deducted from approved expenditures to determine the amount eligible for Departmental participation.
(b) The Department will not participate in costs for a mentally disabled person until the person, who has been admitted or committed, or is receiving services or benefits under the act, has exhausted his eligibility and receipt of benefits under other private, public, local, Commonwealth or Federal programs.
(c) Unrestricted donations and gifts shall be considered as income to reduce gross eligible expenditures in arriving at expenditures eligible for Departmental participation. Since donations and gifts are a revenue of the county or contracted agency, they are available for use by the county or contracted agency to increase the level of eligible expenditures.
(d) Donations and gifts may be used for paying expenses which are eligible or ineligible for Departmental participation if given or restricted by the donor for that purpose. This includes income from fund-raising activities which publicly identify the purpose for which contributions are solicited and their restricted use.
(e) Donations and gifts from fund-raising organizations may be used for paying expenses which are eligible or ineligible for Departmental participation if given or restricted by the fund-raising organization for that purpose. A fund-raising organization shall be separate from the contract agency in that it is not involved in the delivery of service and is not funded directly or indirectly by Department grants.
(f) Interest earned on Departmental funds shall be considered as other income to reduce total expenditures in arriving at eligible expenditures for Departmental participation. Since interest is considered a legitimate revenue of the county program, it is available for use by the program to increase the level of service provided. Interest may not be used to offset the county's 10% matching share, to fund nonmental health/intellectual disability services, or to fund general county expenses not properly apportioned to the mental health/intellectual disability program.
§ 4300.159. Restricted receipt account.
The funds for the county mental health/intellectual disability program shall be used for this specific purpose and accounted for separately from other monies. This may be accomplished by maintaining separate bank accounts or by fund accounting. Monies may be combined if the following exist:
(1) Clear audit trails are established.
(2) Earnings for each account are individually computed, credited and recorded.
(3) Receipts, disbursements and transfers are processed through separate accounts.
(4) The general principles of fund accounting are observed.
§ 4300.161. Contracted agency audits.
(a) The audits performed on contracted agencies shall contribute to the county audit. The county may require the agency to retain an independent certified/registered public accountant to perform the audit, contract for an independent certified/registered public accountant directly to perform the audit, perform the audit using qualified county auditors who meet the independence requirements and professional standards in the ''Standards for Audit of Governmental Organizations, Programs, Activities and Functions'' promulgated by the Comptroller General of the United States, General Accounting Office. Under generally accepted auditing standards, contracted agency audits will be evaluated for the rendering of an opinion on total county funding.
(b) The purpose of the provider audit is to ensure that reimbursement is based on the reasonable costs of contracted services, to provide verified financial information for making a final determination of allowable costs, and to develop other information as counties/joinders may need to fulfill their responsibilities. It shall include an examination of financial transactions, accounts and reports, an evaluation of the adequacy of accounting and administrative controls and an evaluation of compliance with provisions of the contract, including applicable statutes and regulations. It shall be of sufficient depth and detail for the auditor to render an opinion that invoicing is based upon the terms and conditions negotiated by the county/joinder and provider in developing the contract budget or unit costs, or both.
(c) This chapter may not be construed to limit the authority of the Department, the Department's Comptroller's Office, the Auditor General, Federal auditors or other authorized agencies to perform audits of contracted agencies. The county or its agents shall have access to and the right to examine records of contracted agencies involving transactions related to mental health and intellectual disability funding.
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