55 Pa. Code 4305 app A

Current through Register Vol. 54, No. 19, May 11, 2024

Appendix A

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

55 Pa. Code 4305 app A

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

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).