Reasonable Rate Documents
General State Trust Fund Documents
Policy
- Proof of Payment Policy memo (10/18/05 pdf)
- Examples of acceptable forms of proof of payment of costs (pdf)
- Clarify Codes 3.399, 8.100 and 12.010 (10/19/05 doc)
- Statute of Limitations on filing Eligibility Applications and Reimbursement Claims Memo (11/9/08 pdf)
- Remedial System Certification Policy (10/15/03 pdf)
Free Product Recovery Program
- Free Product Removal Program Preapproval/Claim Authorization Form (01/01/09 xls)
- List of Allowable Task Codes for Preliminary FP Evaluation (01/16/09 doc)
- List of Allowable Task Codes for Passive FP Recovery (doc)
Reasonable Rate Document Updates
- Current Electronic Pre-Approval Task Authorization
- Note: Do not use special characters in Electronic Pre-Approval Task Authorization file names (e.g. “#”, “/,” “$”, etc.). Hyphens are acceptable.
2024 Reasonable Rate Updates
- 2024 Claim Forms (xlsx) (11/15/2024 Revision)
- 2024 RRD Price List (xlsx) (11/15/2024 Revision)
- 2024 Reasonable & Necessary Task Scope of Work Document (11/15/2024 Revision)
- 2024 Claim Instructions (11/15/2024 Revision)
- 2024 Certification of Payment
- 2024 Certification of Costs
- 2024 Claim Preparation Checklist (11/15/2024 Revision)
Hard copies of the PATA form are no longer being accepted for manual processing. The current version of the ePATA form should be utilized for pre-approval requests.