§ 3170.84. Maximum levels of reimbursement.
(a) The maximum level of reimbursement in which the Department will participate when services are provided on a unit of service basis shall be the lesser of:
(1) That established by regulation, directive, or memorandum published by the Department.
(2) That charged another government agency which purchases the same service from the provider agency.
(3) That charged the general public as evidenced by a schedule of charges officially adopted by the provider.
(b) The county agency, the juvenile probation office, or the juvenile court shall determine the kind of service needed and together with the provider agency or facility determine the conditions under which the service shall be provided, except in the case where the child is diverted from final entry into the children and youth program. However, Departmental reimbursement will not be made for the specialized services to treat mental disabilities. Juvenile probation or other Commonwealth or Department sponsored programs shall not be allowed, nor costs of providing services which are the responsibility of a school district under the Right to Education consent agreement between the Department and the Department of Education.
(c) At least quarterly, the children and youth social service program shall require an invoice from the vendor agency or facility for delinquents to which children have been committed by the court, respective to the name—or type—of service provided, units of service provided, the rate per unit of service, and the total amount charged—that is, the rate times number of units provided.
(d) Unless specified in the agreement, the cost of client services shall not include costs for research, or other activities not essential to the provision of service to the client.
(e) The cost of services provided by vendor may include training for persons involved in the direct provision of the service being purchased.
Notes of Decisions General regulations for recordkeeping and regulatory monitoring through auditing do not authorize administrative agency to issue a bulletin for detailed cost reports by providers in order to receive Federal and State reimbursement. In addition, a regulation permitting administrative agency to set a maximum level of reimbursement by directive or memorandum does not authorize a specific cost-reporting process. Such cost-reporting process was a binding norm, not a generalized guideline, that had to be formally promulgated through the regulatory review process. Northwestern Youth Services., Inc. v. Com., Dep’t of Pub. Welfare, 66 A.3d 301 (Pa. 2013).
Cross References This section cited in 55 Pa. Code § 3170.11 (relating to purpose); 55 Pa. Code § 3170.22 (relating to direct provision of services); 55 Pa. Code § 3170.23 (relating to purchase of service); 55 Pa. Code § 3170.49 (relating to purchased personnel services); and 55 Pa. Code § 3170.83 (relating to establishing rates).
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