LAC 48:V.3703. Fee Adjustment Schedule

A.1. The fee adjustment schedule is designed to provide for proportional payment of each service based on the family's ability to pay. Three variable figures are utilized in calculating the schedule: a. United State Community Services Administration Poverty Guidelines as found in 45 CFR 1060.2; b. family size; and c. cost of service provided. 2. The client shall provide a statement of gross family size. B. Persons whose income adjusted for family size is at or below 100 percent poverty as is defined by the United State Community Services Administration poverty guidelines shall not be responsible for payment of services. Persons whose gross family income is set at or above 250 percent poverty as is defined by the United States Community Services Administration poverty guidelines shall be charged the full cost of services provided. Between these two levels, fees shall be adjusted in accordance with the formula used in the schedule of charges included in the following revised Fee Adjustment Schedule. Fee Adjustment Schedule % Poverty Income Family Size | I 100% or Less No Charge | II 101%-115% 10% of Cost | III 116%-103% 20% of Cost | IV 131%-145% 30% of Cost | V 146%-160% 40% of Cost 1 | 6620 | 6686 | 7679 | 8672 | 9665 2 | 8880 | 8969 | 10301 | 11633 | 12965 3 | 11140 | 11251 | 12922 | 14593 | 16264 4 | 13400 | 13534 | 15544 | 17554 | 19564 5 | 15660 | 15817 | 18166 | 20515 | 22864 6 | 17920 | 18099 | 20787 | 23475 | 26163 7 | 20180 | 20382 | 23409 | 26436 | 29463 8 | 22440 | 22664 | 26030 | 29396 | 32762 9 | 24700 | 24947 | 28652 | 35357 | 36032 10 | 26960 | 27230 | 31274 | 35318 | 39362 11 | 29220 | 29512 | 33895 | 38278 | 42661 12 | 31480 | 31795 | 36517 | 41239 | 45961 13 | 33740 | 34077 | 39138 | 44199 | 19260 14 | 36000 | 36360 | 41760 | 47160 | 52560 15 | 38260 | 38643 | 44382 | 50121 | 55860 16 | 40520 | 40925 | 47003 | 53081 | 59159 17 | 42780 | 43208 | 49625 | 56042 | 62459 VI 161%-175% 50% of Cost | VII 176%-190% 60% of Cost | VIII 191%-205% 70% of Cost | IX 205%-220% 80% of Cost | X 221%-235% 90% of Cost | XI 236%-250% 100% of Cost 10658 | 11651 | 12644 | 13637 | 14630 | 15623 14297 | 15629 | 16961 | 18293 | 19625 | 20957 21574 | 23584 | 25594 | 27604 | 29614 | 31624 25213 | 27562 | 29911 | 32260 | 34609 | 36958 28851 | 31539 | 34227 | 36915 | 39603 | 42291 32490 | 35517 | 38544 | 41571 | 44598 | 47625 36128 | 39494 | 42860 | 46226 | 49592 | 52958 39767 | 43472 | 47177 | 50882 | 54587 | 58292 43406 | 47450 | 51494 | 55538 | 59582 | 63626 47044 | 51427 | 55810 | 60193 | 64576 | 68959 50683 | 55405 | 60127 | 64849 | 69571 | 74293 54321 | 59382 | 64443 | 69504 | 74565 | 79626 57960 | 63360 | 68760 | 74160 | 79560 | 84960 61599 | 67338 | 73077 | 78816 | 84555 | 90294 65237 | 71315 | 77393 | 83471 | 89549 | 95627 68876 | 75293 | 8170 | 88127 | 94544 | 100961