55 Pa. Code 4305 app B

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

Appendix B

Monthly Liability for Community Mental Health and Intellectual Disability Residential and Short-Term Inpatient Services

Adjusted Family Income	Number of Dependents
Adjusted Family Income	1	2	3	4	5	6	7	8	9	10
500- 999	13	11	10	9	8	6	5	4	3	2
1000-1499	25	21	18	15	13	10	8	6	5	4
1500-1999	38	31	25	20	16	14	11	9	6	5
2000-2499	50	43	36	31	28	24	20	16	14	11
2500-2999	63	54	46	40	35	30	25	21	19	15
3000-3499	75	65	56	49	43	36	31	28	24	20
3500-3999	88	76	66	58	50	43	38	33	28	24
4000-4499	100	86	76	66	58	50	44	39	34	30
4500-4999	113	98	85	74	65	55	48	41	36	31
5000-5499	125	109	95	83	73	63	55	49	44	39
5500-5999	144	125	110	96	85	74	65	58	50	44
6000-6499	163	143	125	110	96	85	75	66	59	51
6500-6999	181	159	140	125	109	95	84	74	66	59
7000-7499	200	175	154	136	120	105	94	83	73	65
7500-7999	219	191	169	149	131	115	101	90	80	70
8000-8499	238	208	183	160	141	124	110	96	85	75
8500-8999	256	224	196	173	151	133	116	103	90	79
9000-9499	275	240	210	184	161	141	124	109	95	83
9500-9999	294	256	224	195	170	149	130	114	99	86
10000-10499	319	279	244	213	186	163	141	124	108	94
10500-10999	344	300	265	230	201	176	154	134	118	103
11000-11499	369	323	281	246	215	189	165	144	126	110
11500-11999	394	343	300	263	230	201	175	154	134	118
12000-12499	419	365	319	279	244	213	185	161	141	123
12500-12999	444	388	338	295	258	224	195	170	148	129
13000-13499	469	409	356	310	270	235	204	178	154	134
13500-13999	494	430	374	325	283	246	214	185	160	139
14000-14499	519	451	391	340	295	256	221	191	165	141
14500-14999	544	473	410	355	308	265	229	198	169	145
15000-15499	569	493	428	369	319	275	236	203	173	146
15500-15999	594	514	444	383	330	284	243	206	175	149
16000-16499	619	535	461	398	341	291	249	211	179	151
16500-16999	644	555	478	410	351	300	255	215	180	155
17000-17499	669	578	498	429	368	315	268	228	191	160
17500-17999	694	600	518	446	384	329	281	239	203	170
18000-18499	719	623	538	465	400	344	295	251	214	180
18500-18999	744	645	559	483	416	359	309	264	225	191
19000-19499	769	668	579	501	433	374	321	276	236	201
19500-19999	794	689	599	519	449	389	335	289	248	211
20000-20499	819	711	619	538	466	404	349	301	259	223
20500-20999	844	734	639	555	483	419	363	313	270	233
21000-21499	869	756	659	573	499	433	375	325	281	243
21500-21999	894	779	679	591	515	448	390	339	294	254
22000-22499	919	801	699	610	531	463	403	350	305	264
22500-22999	944	824	719	628	548	478	416	363	315	275
23000-23499	969	846	739	646	564	493	430	375	328	285
23500-23999	994	869	759	664	580	508	444	388	339	295
24000-24499	1019	891	779	681	596	523	456	400	350	306
24500-24999	1044	914	800	700	614	538	470	413	361	316
25000-25499	1069	936	820	719	630	551	484	425	373	326

Formulae if Adjusted Family Income Exceeds $25,499

The liability for 1 dependent is adjusted family income times 0.0420

The liability for 2 dependents is adjusted family income times 0.0368

The liability for 3 dependents is adjusted family income times 0.0321

The liability for 4 dependents is adjusted family income times 0.0281

The liability for 5 dependents is adjusted family income times 0.0246

The liability for 6 dependents is adjusted family income times 0.0215

The liability for 7 dependents is adjusted family income times 0.0188

The liability for 8 dependents is adjusted family income times 0.0165

The liability for 9 dependents is adjusted family income times 0.0144

The liability for 10 dependents is adjusted family income times 0.0126

The liability for 11 dependents is adjusted family income times 0.0110

55 Pa. Code 4305 app B

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

The provisions of this Appendix B 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).