reglab/statecodes huggingface dataset:
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4305 - LIABILITY FOR COMMUNITY MENTAL HEALTH AND INTELLECTUAL DISABILITY SERVICES › DETERMINATION OF LIABILITY › Section 4305.44 - Notice of liability

Current through Register Vol. 54, No. 28, July 13, 2024
At the time the liability is determined, a written notice
						of the liability shall be given to the liable person on a form prescribed by
						the Department.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4305 - LIABILITY FOR COMMUNITY MENTAL HEALTH AND INTELLECTUAL DISABILITY SERVICES › BILLING FOR LIABILITY › Section 4305.51 - Billing

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The county
					 administrator shall bill the liable person each month that community mental
					 health and intellectual disability services are received.
(b) If the liability exceeds the actual cost
					 of intellectual disability services or the net charge for mental health
					 services received for a month, the county administrator shall bill the liable
					 person for the actual cost of intellectual disability services or the net
					 charge for mental health services received.
The provisions of this §
													4305.51 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).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4305 - LIABILITY FOR COMMUNITY MENTAL HEALTH AND INTELLECTUAL DISABILITY SERVICES › BILLING FOR LIABILITY › Section 4305.52 - Insurance

Current through Register Vol. 54, No. 28, July 13, 2024
(a) If a client is
					 receiving or is expected to receive a community mental health or intellectual
					 disability service, or both, that is eligible for insurance, the county
					 administrator or the provider of service shall bill the insurance company for
					 the service prior to billing the liable person. The amount received from the
					 insurance company for services provided over a calendar month shall be deducted
					 from the liability for intellectual disability services or the client fee
					 schedule per unit times the number of units delivered that month for mental
					 health services. The liable person shall be billed the remainder up to the
					 liability.
(b) If insurance
					 benefits are not assignable, the provider shall bill the liable person for the
					 total amount of the liability or the amount the insurance company will pay,
					 whichever is greater, and shall assist the person in completing the insurance
					 forms if necessary or requested.
The provisions of this §
													4305.52 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).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4305 - LIABILITY FOR COMMUNITY MENTAL HEALTH AND INTELLECTUAL DISABILITY SERVICES › ADJUSTMENT OF LIABILITY › Section 4305.61 - Request for adjustment of liability

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The liable person has the right to
					 request adjustment of liability.
(b) Requests for adjustment of liability
					 shall be made within 30 calendar days of the time that conditions warranting
					 the adjustment occur.
(c) Requests
					 for adjustment of liability shall be made by the liable person, the client, or
					 the mental health or intellectual disability professional.
(d) Requests for adjustment of liability
					 shall be submitted to the county administrator on a form prescribed by the
					 Department.
The provisions of this §
													4305.61 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 §
													4305.15 (relating to delegation of
						  authority).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4305 - LIABILITY FOR COMMUNITY MENTAL HEALTH AND INTELLECTUAL DISABILITY SERVICES › ADJUSTMENT OF LIABILITY › Section 4305.62 - Review of requests for adjustment of liability

Current through Register Vol. 54, No. 28, July 13, 2024
The county administrator shall review requests for
						adjustment of liability.
This section cited in 55 Pa. Code §
													4305.15 (relating to delegation of
						  authority).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4305 - LIABILITY FOR COMMUNITY MENTAL HEALTH AND INTELLECTUAL DISABILITY SERVICES › ADJUSTMENT OF LIABILITY › Section 4305.63 - Reason for adjustment of liability-loss of benefits

Current through Register Vol. 54, No. 28, July 13, 2024
The county administrator shall have the power to reduce
						or eliminate the liability if the payment of the liability would make the
						client ineligible for benefits or payments.
This section cited in 55 Pa. Code §
													4305.15 (relating to delegation of
						  authority); and 55 Pa. Code §
													4305.67 (relating to decisions on
						  requests for adjustment of
						  liability).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4305 - LIABILITY FOR COMMUNITY MENTAL HEALTH AND INTELLECTUAL DISABILITY SERVICES › ADJUSTMENT OF LIABILITY › Section 4305.64 - Reason for adjustment of liability-substantial financial hardship

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The county
					 administrator shall have the power to reduce or eliminate the liability if the
					 payment of the liability would cause substantial financial hardship on the
					 client, a person owing a legal duty to support the person or the family of
					 either.
(b) The following debt
					 payments may not be considered when deciding if there is a substantial
					 financial hardship.
(1) Mortgage or rent on
					 principal residence.
(2) Utility
					 payments.
(3) Automobile
					 payments.
(4) Medical expenses
					 already deducted under §
												4305.36(5)
					 (relating to deductions).
(5)
					 Insurance premiums.
(6) A debt
					 payment for which the liable person has not incurred a legal obligation to
					 pay.
(7) Retail charge purchases
					 for personal items, food and commodities.
(8) Debts incurred after treatment has begun
					 if services are provided for less than 365-consecutive days.
(9) Debts not paid on a regularly scheduled
					 basis.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4305 - LIABILITY FOR COMMUNITY MENTAL HEALTH AND INTELLECTUAL DISABILITY SERVICES › ADJUSTMENT OF LIABILITY › Section 4305.65 - Reason for adjustment of liability-financial burden upon Commonwealth

Current through Register Vol. 54, No. 28, July 13, 2024
The county administrator shall have the power to reduce
						or eliminate the liability if the payment of the liability would result in
						greater financial burden upon the Commonwealth.
This section cited in 55 Pa. Code §
													4305.15 (relating to delegation of
						  authority); and 55 Pa. Code §
													4305.67 (relating to decisions on
						  requests for adjustment of
						  liability).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4305 - LIABILITY FOR COMMUNITY MENTAL HEALTH AND INTELLECTUAL DISABILITY SERVICES › ADJUSTMENT OF LIABILITY › Section 4305.66 - Reason for adjustment of liability- nullify result of care

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The county
					 administrator shall have the power to reduce or eliminate the liability if the
					 imposition of the liability would create a financial burden upon the client as
					 to nullify the results of care, treatment, service or other benefits.
(b) Requests for an adjustment of the
					 liability due to nullification of the result of care shall include
					 documentation by a mental health/intellectual disability professional
					 justifying the clinical reasons for the request and how the client's welfare
					 would be seriously harmed if the liability is not adjusted.
The provisions of this §
													4305.66 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 §
													4305.15 (relating to delegation of
						  authority); and 55 Pa. Code §
													4305.67 (relating to decision on
						  requests for adjustment of
						  liability).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4305 - LIABILITY FOR COMMUNITY MENTAL HEALTH AND INTELLECTUAL DISABILITY SERVICES › ADJUSTMENT OF LIABILITY › Section 4305.67 - Decisions on requests for adjustment of liability

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The county administrator shall make a
					 decision on a request for adjustment of the liability within 30 calendar days
					 of receipt of the request.
(b) The
					 county administrator shall make a decision on requests for adjustment of the
					 liability based upon the requirements specified in §§
					 4305.63-4305.66.
This section cited in 55 Pa. Code §
													4305.15 (relating to delegation of
						  authority).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4305 - LIABILITY FOR COMMUNITY MENTAL HEALTH AND INTELLECTUAL DISABILITY SERVICES › ADJUSTMENT OF LIABILITY › Section 4305.68 - Notification of adjustment decision

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The county administrator shall notify the
					 liable person of the adjustment decision in writing within 30 calendar days of
					 receipt of the request.
(b) The
					 written notice of the adjustment decision shall include the decision, the
					 reasons for decision, the new liability if applicable, the length of time the
					 new liability will be in effect not to exceed 12 months, a copy of the
					 prescribed appeal form and the appeal rights and procedures in accordance with
					 §
											4305.69 (relating to
					 appeals).
This section cited in 55 Pa. Code §
													4305.15 (relating to delegation of
						  authority).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4305 - LIABILITY FOR COMMUNITY MENTAL HEALTH AND INTELLECTUAL DISABILITY SERVICES › ADJUSTMENT OF LIABILITY › Section 4305.69 - Appeals

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The liable
					 person has the right to file a written appeal for a fair hearing to review the
					 county administrator's adjustment decision within 30 calendar days of the date
					 the decision is mailed.
(b) The
					 written request for appeal and reasons for the appeal shall be submitted
					 directly to the Office of Hearings and Appeals, Department of Human Services,
					 Post Office Box 2675, Harrisburg, Pennsylvania 17105, on a form prescribed by
					 the Department.
(c) The county
					 administrator shall participate in any fair hearings conducted by the Office of
					 Hearings and Appeals.
This section cited in 55 Pa. Code §
													4305.15 (relating to delegation of
						  authority); and 55 Pa. Code §
													4305.68 (relating to notification
						  of adjustment decision).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4305 - LIABILITY FOR COMMUNITY MENTAL HEALTH AND INTELLECTUAL DISABILITY SERVICES › COLLECTION OF PAST DUE ACCOUNTS › Section 4305.81 - Payment plans

Current through Register Vol. 54, No. 28, July 13, 2024
The county administrator shall attempt to establish a
						payment plan for a liable person who is unable to pay the bill immediately upon
						receipt of the bill.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4305 - LIABILITY FOR COMMUNITY MENTAL HEALTH AND INTELLECTUAL DISABILITY SERVICES › COLLECTION OF PAST DUE ACCOUNTS › Section 4305.82 - Identification of past due account

Current through Register Vol. 54, No. 28, July 13, 2024
An account is considered past due if the following exist:
(1) A bill was sent and payment was
					 not received within 90 calendar days.
(2) Request for adjustment of liability has
					 not been received or no payment plan has been agreed to and followed.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4305 - LIABILITY FOR COMMUNITY MENTAL HEALTH AND INTELLECTUAL DISABILITY SERVICES › COLLECTION OF PAST DUE ACCOUNTS › Section 4305.83 - Cost of service

Current through Register Vol. 54, No. 28, July 13, 2024
If there is a past due account for a client, the
						Department will not participate in the cost of future service for that
						client.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4305 - LIABILITY FOR COMMUNITY MENTAL HEALTH AND INTELLECTUAL DISABILITY SERVICES › COLLECTION OF PAST DUE ACCOUNTS › Section 4305.84 - Collection process

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The
					 county administrator shall attempt to collect a past due account by mailing
					 three successive dunning statements notifying the liable person that the
					 account is past due and requesting payment. The statements shall be mailed at
					 10 day intervals. During a period not to exceed 45 calendar days after mailing
					 the first dunning statement, effort shall be made by telephone or personal
					 contact with the liable person concerning the past due account.
(b) If the requirements in subsection (a)
					 have been completed and the past due account exceeds $150, the past due account
					 shall be referred to a private collection agency familiar with the collection
					 of debts arising from medical or social services for collection.
(c) If the requirements in subsection (a)
					 have been completed and the past due account amount is $150 or less, the past
					 due account may be written off.
This section cited in 55 Pa. Code §
													4305.91 (relating to write-off
						  conditions).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4305 - LIABILITY FOR COMMUNITY MENTAL HEALTH AND INTELLECTUAL DISABILITY SERVICES › WRITE-OFF OF PAST DUE ACCOUNT › Section 4305.91 - Write-off conditions

Current through Register Vol. 54, No. 28, July 13, 2024
The past due account may be considered for write-off if
						the following conditions are met:
(1)
					 The requirements of §
											4305.84 (relating to collection
					 process) have been met.
(2) An
					 account balance continues to exist.
(3) No payment plan has been agreed to or the
					 agreed-to payment plan is not being followed.
This section cited in 55 Pa. Code §
													4305.15 (relating to delegation of
						  authority).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4305 - LIABILITY FOR COMMUNITY MENTAL HEALTH AND INTELLECTUAL DISABILITY SERVICES › WRITE-OFF OF PAST DUE ACCOUNT › Section 4305.92 - Justification of write-offs

Current through Register Vol. 54, No. 28, July 13, 2024
The write-off of a past due account shall be justified by
						at least one of the following considerations:
(1) There is an adverse court decision under
					 similar factual situations or an adverse legal opinion prepared by the county
					 solicitor or a designee.
(2) There
					 is doubt as to collectibility.
This section cited in 55 Pa. Code §
													4305.15 (relating to delegation of
						  authority).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4305 - LIABILITY FOR COMMUNITY MENTAL HEALTH AND INTELLECTUAL DISABILITY SERVICES › WRITE-OFF OF PAST DUE ACCOUNT › Section 4305.93 - Approval of write-offs

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The
					 county administrator is responsible for approving write-offs. By approving a
					 write-off, the county administrator is certifying that the requirements in this
					 chapter have been met and the account is deemed uncollectible.
(b) The county administrator shall respond in
					 writing to a request for a write-off within 15 days of receipt of the
					 request.
(c) Documentation
					 supporting the county administrator's decision to approve or deny a write-off
					 shall be kept. This shall include a record of the collection effort and
					 relevant comments and recommendations.
This section cited in 55 Pa. Code §
													4305.15 (relating to delegation of
						  authority).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4305 - LIABILITY FOR COMMUNITY MENTAL HEALTH AND INTELLECTUAL DISABILITY SERVICES › WRITE-OFF OF PAST DUE ACCOUNT › Section 4305.94 - Write-off of past due account

Current through Register Vol. 54, No. 28, July 13, 2024
The write-off of a past due account does not absolve the
						liable person from payment of a past due account.
This section cited in 55 Pa. Code §
													4305.15 (relating to delegation of
						  authority).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4305 - LIABILITY FOR COMMUNITY MENTAL HEALTH AND INTELLECTUAL DISABILITY SERVICES › MENTAL HEALTH CLIENT FEE SCHEDULES › Section 4305.101 - Applicability

Current through Register Vol. 54, No. 28, July 13, 2024
The requirements specified in §§
											4305.102 and
						4305.103 (relating to content of
						the mental health client fee schedule; and audit of the mental health client
						fee schedule) are applicable only for clients receiving community mental health
						services.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4305 - LIABILITY FOR COMMUNITY MENTAL HEALTH AND INTELLECTUAL DISABILITY SERVICES › MENTAL HEALTH CLIENT FEE SCHEDULES › Section 4305.102 - Content of the mental health client fee schedule

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A provider of service and a county mental
					 health program providing services to county mental health program clients shall
					 establish a fee schedule of charges known as "client fee schedule". This client
					 fee schedule shall state a rate per unit of service and shall reflect as
					 accurately as possible the cost of service. The cost of providing service is
					 expected to vary from provider to provider depending on the nature of the
					 services provided, the combination of personnel who provide these services and
					 the client target group being served.
(b) The client fee schedule may not be higher
					 than the fee schedule used by the provider for its private clients.
(c) The client fee schedule rate may exceed
					 the county program rate of reimbursement.
This section cited in 55 Pa. Code §
													4305.101 (relating to
						  applicability).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4305 - LIABILITY FOR COMMUNITY MENTAL HEALTH AND INTELLECTUAL DISABILITY SERVICES › MENTAL HEALTH CLIENT FEE SCHEDULES › Section 4305.103 - Audit of the mental health client fee schedule

Current through Register Vol. 54, No. 28, July 13, 2024
Cost of service and client fee schedules based on these
						costs are subject to audit by the Commonwealth.
The provisions of this Appendix A 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 §
													4305.101 (relating to
						  applicability).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4310 - CLIENT LIABILITY-STATE MH/ID FACILITIES › GENERAL PROVISIONS › Section 4310.1 - Legal base

Current through Register Vol. 54, No. 28, July 13, 2024
The legal base for this chapter is sections 201(2) and
						504(d) of the Mental Health and Intellectual Disability Act of 1966
						(50
						P.S. §§
												4201(2)
						and 4504(d)).
The provisions of this §
													4310.1 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).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4310 - CLIENT LIABILITY-STATE MH/ID FACILITIES › GENERAL PROVISIONS › Section 4310.2 - Purpose

Current through Register Vol. 54, No. 28, July 13, 2024
This chapter establishes a sequential order of payors or
						persons liable and responsible for costs of service or both, and the maximum
						liability for those services.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4310 - CLIENT LIABILITY-STATE MH/ID FACILITIES › GENERAL PROVISIONS › Section 4310.3 - Applicability

Current through Register Vol. 54, No. 28, July 13, 2024
This chapter applies to State mental hospitals and State
						intellectual disability centers. Liability for services received at these
						facilities is determined according to this chapter.
The provisions of this §
													4310.3 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).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4310 - CLIENT LIABILITY-STATE MH/ID FACILITIES › PAYORS RESPONSIBLE FOR THE COSTS OF SERVICE › Section 4310.5 - Sequential order of payors and persons liable for costs of service

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The sequential
					 order of payors responsible for the costs of service is:
(1) Medicare.
(2) Third-party insurance.
(3) Client/LLR.
(4) MA.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4310 - CLIENT LIABILITY-STATE MH/ID FACILITIES › MAXIMUM LIABILITY FOR SERVICES PROVIDED › Section 4310.6 - Maximum liability-payors/liable persons

Current through Register Vol. 54, No. 28, July 13, 2024
The maximum liability for services provided is
						established by the institutional collections officer for both payors and liable
						persons within the following:
(1)
Maximum charge to Medicare.
(i) The maximum monthly charge to Medicare
					 shall be the product of the per diem rate multiplied by the number of client
					 days.
(ii) Medicare reimbursement
					 includes only covered charges and shall be accepted by the facility as payment
					 in full for the number of Medicare-eligible days billed, excluding deductibles
					 and coinsurances.
(iii) If Medicare
					 deductibles and coinsurances have been deducted from the Medicare
					 reimbursement, the deductibles and coinsurances shall be billed to MAMIS if the
					 client is Medical Assistance eligible.
(iv) If the client is not Medical Assistance
					 eligible, deductibles and coinsurances are the responsibility of the client or
					 LLR up to his maximum liability.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4310 - CLIENT LIABILITY-STATE MH/ID FACILITIES › DETERMINING LIABILITY AND ASSESSMENTS › Section 4310.7 - Determining client monthly liability

Current through Register Vol. 54, No. 28, July 13, 2024
The extent of a client's liability for costs of services
						provided over and above that paid by third-party payors, other agencies, or
						LLR's is determined as follows:
(1)
					 During the first six months of care, clients have their liability determined in
					 the following manner:
(i) The client's
					 liability is all income less $60 per month personal use monies, except when the
					 client is maintaining a home to which he plans to return on discharge from the
					 facility. A liability exemption to maintain a home is allowable six months from
					 the date service began.
(A) The home could be
					 owned by the client or rented from a landlord. If rented, the client must
					 continue to pay the rent, utilities, and other expenses associated with
					 maintaining a property or rental property. The roomer or roomer/boarder
					 situation would also be included if the client continues to pay the landlord to
					 hold the room during the period of hospitalization, not to exceed 6
					 months.
(B) If the home maintenance
					 exemption is applied, the client's liability is all income less the home
					 maintenance exemption and $60 a month personal use monies.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4310 - CLIENT LIABILITY-STATE MH/ID FACILITIES › DETERMINING LIABILITY AND ASSESSMENTS › Section 4310.8 - Benefits

Current through Register Vol. 54, No. 28, July 13, 2024
When a client receives institutional services and is the
						recipient of benefits such as Social Security, veteran's benefits, retirement
						pensions, and the like, the first $60 is disregarded for the client's personal
						needs. All income, including interest earned, over $60 is assessed for services
						provided. Personal use funds may be conserved for his use up to a maximum of
						$1,500. When the conserved fund maximum is reached, the full amount of the
						benefit is assessed, less $25 per month personal use monies. If, after the
						assessment, the conserved fund level still exceeds the maximum of $1,500, the
						excess income over $1,500 is assessed. If the conserved fund account falls
						below $1,500, the assessment returns to all income over $60 until it again
						reaches $1,500.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4310 - CLIENT LIABILITY-STATE MH/ID FACILITIES › DETERMINING LIABILITY AND ASSESSMENTS › Section 4310.9 - Working client income

Current through Register Vol. 54, No. 28, July 13, 2024
When a client residing in a State mental hospital or
						State intellectual disability center receives income for services rendered at
						sheltered workshops or other employment, 50% of all income over $65 per month
						is assessed for his cost of service provided. Any amount less than $65 per
						month is exempted as personal use monies. Personal use monies may be conserved
						for his use up to a maximum of $1,500. When the conserved fund maximum is
						reached, the full amount of income is assessed less $25 per month personal use
						monies. If, after the assessment, the conserved fund level still exceeds the
						maximum of $1,500, the excess income over $1,500 is assessed. If the conserved
						fund account falls below $1,500, the assessment returns to 50% of all income
						over $65 until funds again reach $1,500.
The provisions of this §
													4310.9 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).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4310 - CLIENT LIABILITY-STATE MH/ID FACILITIES › DETERMINING LIABILITY AND ASSESSMENTS › Section 4310.10 - Multiple income sources

Current through Register Vol. 54, No. 28, July 13, 2024
(a) If
					 a client has multiple income sources, such as more than one benefit, or earned
					 interest, or both, all sources of income shall be aggregated and assessed as
					 income except as detailed in subsection (c).
(b) If a client has more than one source of
					 income, the $60 exemption is applied only once. Multiple exemptions are not
					 permitted, and a combination of these benefits cannot equal more than $1,500 in
					 combined conserved funds, except as detailed in subsection (c).
(c) If a client is a working resident and
					 also has other income in form of benefits, interest, and the like-for
					 rehabilitative purposes and recognizing the need for work expenses-working
					 clients are permitted a $60 deduction in personal use monies from benefit or
					 other income or both plus the $65 deduction and 50% additional earning working
					 client income. Conserved fund levels exceed $1,500, however, from the
					 combination of benefit or other income or both and working client income
					 accounts.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4310 - CLIENT LIABILITY-STATE MH/ID FACILITIES › DETERMINING LIABILITY AND ASSESSMENTS › Section 4310.11 - Capital assets

Current through Register Vol. 54, No. 28, July 13, 2024
For the purpose of obtaining Medical Assistance
						eligibility, charges shall be made against assets of the client following 6
						months of continuous inpatient hospitalization at the State facility and
						physician's certification of continued need of care for an additional one year.
						These resources, exclusive of the real estate which constitutes the home
						residence of the client, shall be considered a resource for the client to meet
						the cost of service at the State facility. Charges against capital assets are
						billed at the full per diem rate until only $1,500 in combined funds remains.
						When the allowable conserved fund amount is reached, the client's liability is
						reassessed based on his income.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4310 - CLIENT LIABILITY-STATE MH/ID FACILITIES › DETERMINING LIABILITY AND ASSESSMENTS › Section 4310.12 - Irrevocable/court-ordered burial accounts and restricted trust accounts

Current through Register Vol. 54, No. 28, July 13, 2024
If a client has a burial or trust account, the status of
						the account shall be determined and documented. The only burial reserve or
						trust account that is not considered a resource to the client is an irrevocable
						or court-ordered burial account or restricted trust account.
(1)
Irrevocable/court-ordered burial
					 accounts.
Those accounts that can only be released to a funeral
					 director or legal representative upon the client's death. Documentation is
					 required in all cases to verify irrevocability.
(2)
Restricted trust
					 accounts.
Those trusts that have been established in the client's name
					 that are legally restricted from invasion of the principal amount for care and
					 maintenance. Income only may be assessed from such trusts. Documentation is
					 required in all cases to verify the status of the trust.
(3)
Clients with legally liable
					 relatives and with income or assets restricted to their own use.
(i) Clients with income or assets restricted
					 to their own use are assessed liability against income or assets or
					 both.
(ii) Liability of the
					 client's LLR is based on the monthly liability scale. Charges are first
					 assessed on the client's income or assets or both and then on the LLR's
					 income.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4310 - CLIENT LIABILITY-STATE MH/ID FACILITIES › BILLING AND COLLECTION › Section 4310.14 - Billing legally liable relatives/clients and other liable persons

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Client/LLR's
					 and other liable persons must be billed at the end of each calendar month for
					 the amount of the maximum liability or outstanding charges or both.
(b) LLR's/clients/liable persons who refuse
					 to provide sufficient financial information or other information for
					 determining monthly liability must be billed at the full per diem rate for the
					 facility.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4310 - CLIENT LIABILITY-STATE MH/ID FACILITIES › BILLING AND COLLECTION › Section 4310.15 - Collections

Current through Register Vol. 54, No. 28, July 13, 2024
If a third-party payment is received, the LLR/client is
						liable for that portion of the charges not covered by the payment up to their
						maximum liability. When a third-party payor makes direct payment to a
						LLR/client, the amount paid by the insurance company is payable to the provider
						in full in addition to the liability assessment against the client/LLR except
						when the imposition of client/LLR liability would exceed the monthly per diem
						rate for the facility.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4310 - CLIENT LIABILITY-STATE MH/ID FACILITIES › BILLING AND COLLECTION › Section 4310.16 - Frequency of redetermination

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
					 Liability must be redetermined at least once per year for non-Medical
					 Assistance clients.
(b) Liability
					 and income/resource redetermination must be completed every 6 months for MA
					 clients or as often as a County Assistance Office requests.
(c) The liable person/client is responsible
					 for reporting all changes in income to institutional collections. If the
					 liability is redetermined prior to a redetermination period, the liable
					 person/client is liable for the amount of the assessment made on
					 redetermination.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4310 - CLIENT LIABILITY-STATE MH/ID FACILITIES › BILLING AND COLLECTION › Section 4310.17 - Abatement or modification of liability

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Only in extraordinary circumstances will
					 consideration be given to abatement or modification of liability in accordance
					 with the following criteria under section 504(a) of the Mental Health and
					 Intellectual Disability Act of 1966 (50 P.S. §
												4504(a)). The imposition of
					 such liability would:
(1) "result in the loss
					 of financial payments or other benefits from any public or private source which
					 the mentally disabled person would receive, would be eligible to receive or
					 which would be expended on his behalf except for such liability";
(2) "result in a substantial hardship upon
					 the mentally disabled person, a person owing a legal duty to support such
					 person or the family of either";
(3) "result in a greater financial burden
					 upon the people of the Commonwealth"; or
(4) "create such a financial burden upon such
					 mentally disabled person as to nullify the results of care and treatment,
					 service or other benefits afforded to such person under any of this
					 act."
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4310 - CLIENT LIABILITY-STATE MH/ID FACILITIES › BILLING AND COLLECTION › Section 4310.18 - Debt payments not included when considering liability abatement/modification requests

Current through Register Vol. 54, No. 28, July 13, 2024
The following is a list of debt payments not included
						when considering liability abatement/modification requests:
(1) Mortgage or rent on principal
					 residence.
(2) Utility
					 payments.
(3) Payments on first
					 automobile.
(4) Medical expenses
					 already deducted under §
											4310.13(2)(i)(B) or
					 (D) (relating to determining legally liable
					 relative monthly liability).
(5)
					 Debts incurred after treatment has begun.
(6) Any other debt or payment for which the
					 client has not incurred a legal obligation to pay.
(7) Retail charge purchases for personal use
					 items, food and commodities.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4310 - CLIENT LIABILITY-STATE MH/ID FACILITIES › BILLING AND COLLECTION › Section 4310.19 - Criteria for abatement or modification in hardship cases

Current through Register Vol. 54, No. 28, July 13, 2024
The following is a list of criteria for abatement or
						modification in hardship cases:
(1) If
					 the ratio of debt payments to income exceeds or is equal to .8, abate the
					 liability.
(2) If the ratio is less
					 than .8, but greater than or equal to .7, modify the liability to 25% of the
					 assessed amount.
(3) If the ratio
					 is less than .7, but greater than or equal to .6, modify the liability to 50%
					 of the assessed amount.
(4) If the
					 ratio is less than .6, but greater than or equal to .5, modify the liability to
					 75% of the assessed amount.
(5) If
					 the ratio is less than .5, liability shall be neither abated nor
					 modified.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4310 - CLIENT LIABILITY-STATE MH/ID FACILITIES › BILLING AND COLLECTION › Section 4310.20 - Clinical abatement or modification of liability

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The Department may make a clinical
					 abatement or modification of liability if the imposition of liability would
					 result in a greater financial burden upon the people of this Commonwealth or
					 would create such a financial burden upon such mentally disabled person as to
					 nullify the result of care and treatment, service, or other benefits afforded
					 to the person under the Mental Health and Intellectual Disability Act of 1966
					 (50
					 P.S. §§
												4101-4704). Clinical
					 abatements will be granted only if:
(1) The
					 imposition of liability would be likely to negate the effectiveness of
					 treatment, or prohibit the client's entry into treatment.
(2) The failure to provide the treatment
					 would result in serious harm to the client's welfare or in greater cost to this
					 Commonwealth due to the deterioration of the client's
					 condition.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4310 - CLIENT LIABILITY-STATE MH/ID FACILITIES › BILLING AND COLLECTION › Section 4310.21 - Departmental review procedure

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The request for review of the
					 determination of the assessment or for an abatement or modification of
					 liability is considered by the Secretary's designee.
(b) Following this consideration, a reply is
					 prepared for the Secretary's or his authorized designee's signature. In
					 addition, the notice of decision informs the client or his LLR or both that he
					 has the right to appeal the decision within 30 days, if he is dissatisfied with
					 it, by submitting a written request for a fair hearing to the Office of
					 Hearings and Appeals. An explanation of the appellant's rights and fair hearing
					 law are included with the notice.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4310 - CLIENT LIABILITY-STATE MH/ID FACILITIES › BILLING AND COLLECTION › Section 4310.22 - Appeals

Current through Register Vol. 54, No. 28, July 13, 2024
The fair hearing will be conducted by the Department's
						Office of Hearings and Appeals in conformance with the Department's Office of
						Hearings and Appeals' procedures. The institutional collections officer
						completing the liability assessment shall participate in the hearing to explain
						how the assessment was completed. The Department staff member responsible for
						reviewing the request for abatement or modification or both shall participate
						in the hearing process.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4310 - CLIENT LIABILITY-STATE MH/ID FACILITIES › BILLING AND COLLECTION › Section 4310.23 - Delinquent accounts

Current through Register Vol. 54, No. 28, July 13, 2024
(a) An
					 account is considered delinquent if three successive billings during a 90-day
					 period have not been paid.
(b) When
					 a client/LLR refuses to make the payment for services, the institutional
					 collections officer shall take all necessary action to pursue the collection of
					 charges up to the 90-day limit. If all collection attempts fail, the
					 institutional collections officer shall prepare the delinquent account for
					 collection and forward it to the Office of the Attorney General for further
					 action.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4310 - CLIENT LIABILITY-STATE MH/ID FACILITIES › BILLING AND COLLECTION › Section 4310.24 - Write-off requests

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
					 Write-off is the termination of all collection activity with regard to a
					 specific amount.
(b) In the event
					 that all collection efforts fail or there is documented evidence that the
					 account cannot be collected, or both, the outstanding balance shall be
					 submitted to the Division of Institutional Collections for review and forwarded
					 to the Office of the Attorney General for final approval for
					 write-off.
(c) Write-off does not
					 exonerate the client/LLR from paying the account. It is authorization to remove
					 the account from active accounts receivable. These charges shall be billed at a
					 later date if the client/LLR becomes financially able to pay.
(d) The write-off of any account shall be
					 justified by at least one of the following considerations:
(1) There is doubt as to liability, when a
					 bona fide dispute exists, either as a question of fact or of law. This doubt
					 may be the result of:
(i) Adverse court
					 decisions under similar factual situations.
(ii) Adverse legal opinions prepared by the
					 Office of Legal Counsel.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VII - Mental Health Manual › Subpart C - Administration and Fiscal Management › Chapter 5100 - MENTAL HEALTH PROCEDURES › GENERAL PROVISIONS › Section 5100.1 - Legal base

Current through Register Vol. 54, No. 28, July 13, 2024
The legal base for this chapter is section 112 of the
						Mental Health Procedures Act (50 P. S. §
												7112), section 201 of the Mental Health and
						Mental Retardation Act of 1966 (50 P. S. §
												4201), and section 1021 of the Public Welfare
						Code (62 P. S. §
												1021).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VII - Mental Health Manual › Subpart C - Administration and Fiscal Management › Chapter 5100 - MENTAL HEALTH PROCEDURES › GENERAL PROVISIONS › Section 5100.3 - Statement of policy

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The
					 act establishes procedures for the treatment of mentally ill persons. The
					 procedures are to be applied consistently with the principles of due process to
					 make voluntary and involuntary treatment available where the need is great and
					 where the absence of treatment could result in serious harm to the mentally ill
					 person or to others. The act and the Mental Health and Mental Retardation Act
					 of 1966, set forth the Commonwealth's policy and procedures regarding the
					 provision of mental health services. This chapter implements and supplements
					 the act and the Mental Health and Mental Retardation Act of 1966, and are to be
					 read together with the applicable provisions of the act and the Mental Health
					 and Mental Retardation Act of 1966.
(b) It is the policy of the Commonwealth to
					 seek to assure that adequate treatment is available with the least restrictions
					 necessary to meet each client's needs. While this policy remains a shared
					 responsibility between State, county, and facility personnel, the
					 accountability for recommending the transfer to the least restrictive
					 alternatives available remains a responsibility of those directing treatment.
					 Adequate treatment provided in an individual's own community or as close as
					 possible to his own home shall be preferred.
(c) Persons who are mentally retarded,
					 senile, alcoholic or drug dependent shall be afforded mental health examination
					 or treatment if they are also diagnosed as mentally ill, or if there is a
					 reasonable probability that upon examination such diagnosis will be
					 established.
(d) Persons in
					 treatment under the act shall be afforded necessary diagnostic or treatment
					 procedures as defined in their treatment plan for conditions of mental
					 retardation, senility, alcohol, or drug abuse when it is determined that the
					 absence of such procedures will be detrimental to the progress of the person
					 accomplishing the goals of treatment.