Pa. Code 4300.118

This section establishes special funding limitations on units of service for county mental health programs, including a cap of 240 three-hour sessions (720 total hours) of partial hospitalization per patient in a 365-day period, and a 60-day benefit period for inpatient hospital care. It also addresses payment rules for psychiatrist hospital visits, drug reimbursement, client charges, and vocational rehabilitation service costs. Facility operators must ensure billing and service delivery comply with these unit and benefit-period limits and may not seek reimbursement from county program clients beyond what the title allows.

55 Pa. Code § 4300.118 - Special limitations on unit of service funding 

 State Regulations 

 Compare

(a)
 Costs of partial hospitalization services
 provided under this title shall be limited to 240 3-hour sessions (720 total
 hours) in a consecutive 365-day period per patient. Six hours of partial
 hospitalization equals 1 day of partial hospitalization.

(b)
 A benefit period begins with the first
 day of inpatient hospital care and includes a maximum of 60 days of care in one
 consecutive stay or in a number of lesser stays that add up to 60 days. If the
 Department pays for part of a day, the day shall be counted as a full day in
 the benefit period. A patient's benefit period ends after 60 consecutive days
 on which he is not hospitalized, regardless of the number of days of
 hospitalization he has had. After one benefit period ends, a new benefit period
 begins with the first day of hospitalization and is subject to appropriate
 utilization review standards.

(c)

 The payment for hospital visits by a psychiatrist, when the fee is not included
 in the inpatient rate, shall be allowed.

(d)
 The Department will participate in the
 cost of drugs according to Chapter 4220 (relating to reimbursement for
 medications).

(e)
 Charges to clients
 of the county program shall be in accordance with Chapter 4305 (relating to
 liability for community mental health and intellectual disability services). A
 facility may not seek reimbursement from a client of the county program above
 that provided for under this title.

(f)
 The Department of Labor and Industry,
 Office of Vocational Rehabilitation, establishes fees for selected vocational
 program services. The Department will financially participate in the costs of
 county programs purchasing these same services at the established
 fees.

Notes

55

 Pa. Code §
 
4300.118

The
 provisions of this § 4300.118 amended June 17, 2016, effective
 
6/18/2016
, 46 Pa.B.
 3177.

The provisions of this § 4300.118 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 §
 
4300.111
 (relating to
 applicability).

State regulations are updated quarterly; we currently have two versions available.
 Below is a 
comparison between our most recent version and the prior quarterly release.

 More comparison features will be added as we have more versions to compare.

 No prior version found.

 State Regulations Toolbox