Section 4000.251. Payments for room and board charges

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.

The provisions of this § 4000.251 adopted March 31, 1995, effective immediately and apply retroactively to July 1, 1994, 25 Pa.B. 1170.