Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart A - Statements of Policy › Chapter 4000 - FOSTER CARE › Subchapter C - ROOM AND BOARD PAYMENTS FOR MENTAL HEALTH ONLY CHILDREN IN RESIDENTIAL FACILITIES WHICH ARE NOT JCAHO ACCREDITED › Section 4000.251 - Payments for room and board charges

Current through Register Vol. 54, No. 28, July 13, 2024
The county mental health program will pay for room and
						board charges for a child eligible for Medical Assistance (MA) in a residential
						facility when the following standards are met.
(1) The Supplemental Security Income (SSI)
					 representative payee for the child signs a Standard Room and Board Contract
					 upon the child's admission to the residential facility. Signing the contract
					 obligates the representative payee to pay up to 72% of the monthly SSI payment
					 for the child's room and board.
(2)
					 If the child is not a recipient of SSI benefits, other sources of income
					 available to the child shall be considered as described in §
											6200.17 (relating to room and
					 board charges from other sources of income). In these instances, the term
					 "client," is defined as the child receiving services.
(3) When payment would represent a severe
					 financial hardship for the parents or the legal guardian of the child, they may
					 petititon the county mental health administrator for relief from the
					 requirements of this section. A petition shall be heard and a decision made
					 within 3 working days of filing by the parent or legal guardian. The county
					 mental health administrator shall notify the parent or legal guardian in
					 writing within 2 working days of a decision being made. The parent or legal
					 guardian is not responsible for payment for days elapsed during the appeal
					 described in this section and the notification period.
(4) The residential facility shall collect
					 payment from the SSI representative payee according to the terms of the
					 Standard Room and Board Contract or from the parent or legal guardian if
					 paragraph (2) applies. Any amount of the monthly charge for room and board
					 established by the Office of Medical Assistance Programs (OMAP), for which the
					 SSI representative payee or parent or legal guardian is not responsible to pay,
					 may be billed to the county mental health program. At the time the request for
					 county payment is made, the facility shall provide the county mental health
					 program with documentation-for example, the contract with the parent or the
					 waiver granted under paragraph (3)-that supports the amount of county payment
					 requested.
(5) Payment procedures
					 are as follows:
(i) The county mental health
					 program shall have a signed contract with the residential facility stipulating
					 billing and payment conditions.
(ii) At a minimum, the contract shall include
					 provisions that the residential facility submit the following information with
					 each bill to the county mental health program to obtain payment for room and
					 board charges incurred on a child's behalf:
(A) The name and MA client identification
					 number of the child for whom room and board was provided.
(B) A copy of the approved MA 97 authorizing
					 MA payment for the treatment services.
(C) A copy of the invoice submitted to OMAP
					 documenting the number of days of treatment in the billing period.
(D) The number of days of payment requested
					 from the county mental health program or children and youth program.
(E) The Department established fee for room
					 and board established for the residential facility.
(F) The amount received or expected from the
					 parent, legal guardian or representative payee.
(G) The total amount of reimbursement
					 requested. This total may not exceed the number of days times the Department
					 established rate minus the amount received or expected from the parent, legal
					 guardian or representative payee.