§ 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.
Authority 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).
Source The provisions of this § 4300.117 amended June 17, 2016, effective June 18, 2016, 46 Pa.B. 3177. Immediately preceding text appears at serial pages (359890) to (359891) and (213213).
Cross References 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).
No part of the information on this site may be reproduced for profit or sold for profit.
This material has been drawn directly from the official Pennsylvania Code full text database. Due to the limitations of HTML or differences in display capabilities of different browsers, this version may differ slightly from the official printed version.
