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 › Appendix A

Current through Register Vol. 54, No. 28, July 13, 2024
Monthly Liability for Community Mental Health and
						Intellectual Disability Nonresidential Services
Adjusted Family Income
Number of Dependents
1
2
3
4
5
6
7
8
9
10
0- 499
0
0
0
0
0
0
0
0
0
0
500- 999
10
9
8
7
6
5
4
3
2
1
1000-1499
20
17
14
12
10
8
6
5
4
3
1500-1999
30
25
20
16
13
11
9
7
5
4
2000-2499
40
34
29
25
22
19
16
13
11
9
2500-2999
50
43
37
32
28
24
20
17
15
12
3000-3499
60
52
45
39
34
29
25
22
19
16
3500-3999
70
61
53
46
40
34
30
26
22
19
4000-4499
80
69
61
53
46
40
35
31
27
24
4500-4999
90
78
68
59
52
44
38
33
29
25
5000-5499
100
87
76
66
58
50
44
39
35
31
5500-5999
115
100
88
77
68
59
52
46
40
35
6000-6499
130
114
100
88
77
68
60
53
47
41
6500-6999
145
127
112
98
87
76
67
59
53
47
7000-7499
160
140
123
109
96
84
75
66
58
52
7500-7999
175
153
135
119
105
92
81
72
64
56
8000-8499
190
166
146
128
113
99
88
77
68
60
8500-8999
205
179
157
138
121
106
93
82
72
63
9000-9499
220
192
168
147
129
113
99
87
76
66
9500-9999
235
205
179
156
136
119
104
91
79
69
10000-10499
255
223
195
170
149
130
113
99
86
75
10500-10999
275
240
210
184
161
141
123
107
94
82
11000-11499
295
258
225
197
172
151
132
115
101
88
11500-11999
315
275
240
210
184
161
140
123
107
94
12000-12499
335
292
255
223
195
170
148
129
113
98
12500-12999
355
310
270
236
206
179
156
136
118
103
13000-13499
375
327
285
248
216
188
163
142
123
107
13500-13999
395
344
299
260
226
197
171
148
128
111
14000-14499
415
361
313
272
236
205
177
153
132
113
14500-14999
435
378
328
284
246
212
183
158
135
116
15000-15499
455
394
342
295
255
220
189
162
138
117
15500-15999
475
411
355
306
264
227
194
165
140
119
16000-16499
495
428
369
318
273
233
199
169
143
121
16500-16999
515
444
382
328
281
240
204
172
144
124
17000-17499
535
462
398
343
294
252
214
182
153
128
17500-17999
555
480
414
357
307
263
225
191
162
136
18000-18499
575
498
430
372
320
275
236
201
171
144
18500-18999
595
516
447
386
333
287
247
211
180
153
19000-19499
615
534
463
401
346
299
257
221
189
161
19500-19999
635
551
479
415
359
311
268
231
198
169
20000-20499
655
569
495
430
373
323
279
241
207
178
20500-20999
675
587
511
444
386
335
290
251
216
186
21000-21499
695
605
527
458
399
346
300
260
225
194
21500-21999
715
623
543
473
412
358
312
271
235
203
22000-22499
735
641
559
488
425
370
322
280
244
211
22500-22999
755
659
575
502
438
382
333
290
252
220
23000-23499
775
677
591
517
451
394
344
300
262
228
23500-23999
795
695
607
531
464
406
355
310
271
236
24000-24499
815
713
623
545
477
418
365
320
280
245
24500-24999
835
731
640
560
491
430
376
330
289
253
25000-25499
855
749
656
575
504
441
387
340
298
261
Formulae if Adjusted Family Income Exceeds
						$25,499
The liability for 1 dependent is adjusted family income
						times 0.0336
The liability for 2 dependents is adjusted family income
						times 0.0294
The liability for 3 dependents is adjusted family income
						times 0.0257
The liability for 4 dependents is adjusted family income
						times 0.0225
The liability for 5 dependents is adjusted family income
						times 0.0197
The liability for 6 dependents is adjusted family income
						times 0.0172
The liability for 7 dependents is adjusted family income
						times 0.0150
The liability for 8 dependents is adjusted family income
						times 0.0132
The liability for 9 dependents is adjusted family income
						times 0.0115
The liability for 10 dependents is adjusted family
						income times 0.0101
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 appendix cited in 55 Pa. Code §
													4305.41 (relating to liability);
						  55 Pa. Code §
													4305.42 (relating to more than one
						  client receiving service); and 55 Pa. Code §
													4305.43 (relating to client
						  receiving more than one service).