§ 4300.115. Department established fees.
(a) Rates or fees per unit of service may be published as a Departmental bulletin by the Department for selected services. These published fees are considered to be a reasonable cost for the services covered by the fee schedules. They represent the maximum amount in which the Department will participate for the identified services. When payment is based on established fees, the county/joinder and provider are not required to negotiate or determine unit costs based on the allowable cost standards in § § 4300.82—4300.108.
(b) The Medical Assistance program fee schedule and Chapter 1150 (relating to Medical Assistance program payment policies), identify psychiatric services and fees reimbursed by the medical assistance program. This fee schedule shall establish the maximum level of reimbursement by the Department to county programs for the following services: Outpatient psychiatric clinic services, psychiatric outpatient partial hospitalization services and hospital visits by a psychiatrist.
(c) The maximum level of reimbursement by the Department to county programs for short-term psychiatric inpatient services is the audited Blue Cross rate for the facility. Counties/joinders may negotiate lower rates based on the actual cost of providing psychiatric inpatient services. If there is no Blue Cross rate for a facility, the maximum rate of reimbursement shall be the medical assistance interim payment rate.
(d) The Department will participate in the cost of reimbursement to unit of service providers under this section subject to § § 4300.117 and 4300.158(b) (relating to computation of reimbursement; and revenue).
Source The provisions of this § 4300.115 amended September 30, 1988, effective October 1, 1988, 18 Pa.B. 4418. Immediately preceding text appears at serial page (114674).
Cross References This section cited in 55 Pa. Code § 4300.111 (relating to applicability).
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