NOTICES
DEPARTMENT OF
HUMAN SERVICES
Availability of the Proposed Rate Setting Methodology, Fee Schedule Rates and Department-Established Fees for Services Funded Through the Office of Developmental Programs' Consolidated, Community Living and Person/Family Directed Support Waivers and the Community Intellectual Disability Base-Funded Program and Availability of Proposed Amendments to the Community Living and Person/Family Directed Support Waivers
[54 Pa.B. 2182]
[Saturday, April 20, 2024]
The Department of Human Services (Department) is making available for public review and comment the rate setting methodology used to develop the proposed Fee Schedule Rates for services funded through the Consolidated, Community Living and Person/Family Directed Support (P/FDS) Waivers and the Community Intellectual Disability Base-Funded Program and the proposed Department-Established Fees for residential ineligible services. The rates will be effective July 1, 2024.
The Department is also making available for public review and comment the proposed increases to the maximum available annual funding per individual for services in the Community Living and P/FDS Waivers to ensure that proposed changes to the Fee Schedule Rates do not result in a reduction or loss of waiver services.
Background
The Department is required by 55 Pa. Code § 6100.571 (relating to fee schedule rates) to update the data used to establish the fee schedule rates for services funded through the Consolidated, Community Living and P/FDS waivers at least every 3 years. In addition, the Home and Community-Based Waiver Instructions, Technical Guide and Review Criteria requires the Department to ensure that rates are adequate to maintain an ample provider base and ensure quality of services at a minimum of every 5 years.
Rate-Setting Methodology for Fee Schedule Rates and Department-Established Fees:
The proposed Fee Schedule Rates and Department-Established Fees were developed using a market-based approach. The process for the development of the Fee Schedule Rates and Department-Established Fees included a review of the waiver service definitions and a determination of allowable cost components which reflected costs that are reasonable, necessary and related to the service, as defined in the Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Awards (OMB Circular Uniform Guidance, December 26, 2014). The Department established the Fee Schedule Rates and Department-Established Fees to fund services at a level sufficient to ensure access, encourage provider participation and promote provider choice, while at the same time ensuring cost effectiveness and fiscal accountability. The Fee Schedule Rates and Department-Established Fees represent the maximum rates that the Department will pay for each service.
In developing the proposed Fee Schedule Rates and Department-Established fees for each service, the Department evaluated and used various independent data sources, such as a Commonwealth-specific compensation study, to ensure the rates reflect the expected expenses for the delivery of the service under the Consolidated, Community Living and P/FDS waivers.
As required by 55 Pa. Code § 6100.571(b), to establish the Fee Schedule Rates the Department examined and used data relating to the following factors:
• The service needs of the individuals.
• Staff wages.
• Staff-related expenses.
• Productivity.
• Occupancy.
• Program and administration-related expenses.
• Geographic costs based on the location where the service is provided.
• Proposed service definitions in the Consolidated, Community Living and P/FDS waivers and determinations made about allowable cost components that reflect reasonable and necessary costs related to the delivery of each service.
• Cost of implementing applicable Federal and State statutes and regulations and local ordinances.
One Fee Schedule Rate was developed for each service. The Fee Schedule Rates are identified under the following categories: Community-Based Services, Agency with Choice/Financial Management Services (AWC/FMS), including benefit allowance and excluding benefit allowance and Residential Waiver Services. The AWC/FMS benefit allowance is provided as an option to include consideration for benefits such as disability insurance, life insurance, retirement savings and paid time off.
As required by 55 Pa. Code § 6100.711(c) (relating to fee for the ineligible portion of residential service), to establish the Department-Established Fees, the Department examined and used data relating to the following factors:
• Occupancy.
• Meals for staff persons.
• Custodial and maintenance expenses.
• Geographic costs based on the location where the service is provided.
Two Department-Established Fees were developed for each Residential Habilitation Ineligible service based on geographic costs based on the location where the service is provided.
The proposed Fee Schedule Rates and the proposed Department-Established Fees for each service are included in the following tables. The assumption logs used to develop the Fee Schedule Rates and Department-Established fees are available at https://www.dhs.pa.gov/providers/Providers/Pages/ODP-Proposed-Rate-Information.aspx.
A notice will be published announcing the final Fee Schedule Rates and Department-Established Fees after the public comment period.
FEE SCHEDULE RATES FOR COMMUNITY BASED SERVICES EFFECTIVE JULY 1, 2024
Rates in the table are per 15-minute unit unless otherwise noted.
| Service Name | Staffing Level | Procedure Code | Statewide Fee | Enhanced Communication Statewide Fee |
|---|
| 1:3 | W1724 | $3.51 | $4.75 |
| Companion | 1:2 | W1725 | $4.89 | $6.71 |
| 1:1 | W1726 | $9.55 | $11.97 |
| Homemaker/Chore | 1:1 | W7283 | $30.21
(hour) | N/A |
| 1:1 | W7282 | $30.21
(hour) | N/A |
| 1:3 | W7058 | $4.50 | $6.28 |
| 1:2 | W7059 | $6.33 | $8.97 |
| In-Home and Community Supports | 1:1 | W7060 | $12.22 | $16.23 |
| 1:1 enhanced | W7061 | $17.02 | $21.78 |
| 2:1 | W7068 | $23.11 | $31.58 |
| 2:1 enhanced | W7069 | $32.71 | $42.24 |
| Older Adult Daily Living Centers | 1:1 | W7094 | $4.09 | $4.94 |
| Community Participation Support | Community | 1:2 or 1:3 | W9351 | $7.68 | $8.98 |
| 2:3 | W9352 | $11.47 | $15.23 |
| 1:1 | W5996 | $14.09 | $16.77 |
| 1:1 enhanced | W5997 | $19.61 | $23.95 |
| 2:1 | W5993 | $27.08 | $32.56 |
| 2:1 enhanced | W5994 | $32.67 | $40.44 |
| Facility | 1:11 to 1:15 | W7222 | $3.26 | $3.66 |
| 1:7 to 1:10 | W7223 | $3.50 | $4.04 |
| 1:4 to 1:6 | W7226 | $5.75 | $6.73 |
| 1:2 to 1:3 | W7224 | $7.52 | $8.85 |
| 1:1 | W7244 | $13.64 | $16.24 |
| 1:1 enhanced | W9353 | $19.00 | $23.14 |
| 2:1 | W7269 | $26.15 | $31.32 |
| 2:1 enhanced | W9356 | $32.51 | $41.76 |
| Community Participation Support—Fading Support | N/A | W9400 | $1.80 | $1.99 |
| Community Participation Support Teleservices | 1:1 to 1:5 | W0065 | $5.43 | $6.36 |
| 1:6 and above | W0066 | $2.10 | $2.46 |
| 1:10 to 1:6 | W7237 | $2.53 | $3.12 |
| Small Group Employment | <1:6 to 1:3.5 | W7239 | $3.89 | $4.83 |
| <1:3.5 to >1:1 | W7241 | $7.66 | $9.51 |
| 1:1 | W7245 | $14.47 | $17.95 |
| Benefits Counseling | 1:1 | W1740 | $17.47 | $21.63 |
| Supported Employment | Job Finding and Development | 1:1 | H2023 | $20.60 | $24.66 |
| Job Coaching and Support | 1:1 | W9794 | $20.60 | $24.66 |
| 1:2 to 1:4 | H2025 | $12.33 | $14.43 |
| Career Assessment | 1:1 | W7235 | $20.60 | $24.66 |
| Advanced Supported Employment | Discovery Profile | 1:1 | W7235 | $4,410.16
(outcome) | $5,481.20
(outcome) |
| Job Acquisition | 1:1 | H2023 | $4,410.16
(outcome) | $5,481.20
(outcome) |
| Job Retention | 1:1 | H2025 | $10,584.38
(outcome) | $13,154.89
(outcome) |
| Shift Nursing—RN | 1:2 | T2025 | $10.89 | $13.71 |
| 1:1 | T2025 | $21.36 | $27.01 |
| Shift Nursing—LPN | 1:2 | T2025 | $7.98 | $10.03 |
| 1:1 | T2025 | $15.42 | $19.35 |
| Therapies—Physical | 1:1 | T2025 | $27.55 | $34.08 |
| Therapies—Occupational | 1:1 | T2025 | $26.15 | $32.33 |
| Therapies—Speech/Language | 1:1 | T2025 | $25.16 | $31.09 |
| Therapies—Orientation, Mobility, Vision | 1:1 | W7246 | $23.90 | $29.50 |
| Music Therapy | 1:1 | G0176 | $20.03 | $25.16 |
| 1:2 to 1:4 | $11.02 | $13.56 |
| Art Therapy | 1:1 | G0176 | $20.03 | $25.16 |
| 1:2 to 1:4 | $11.02 | $13.56 |
| Equine Therapy | 1:1 | S8940 | $13.94 | $17.42 |
| 1:2 to 1:4 | $7.67 | $9.11 |
| Behavioral Supports—Level 1 | 1:1 | W7095 | $24.73 | $30.35 |
| Behavioral Supports—Level 2 | 1:1 | W8996 | $26.50 | $33.49 |
| Communication Specialist | 1:1 | T1013 | $17.29 | $23.89 |
| Consultative Nutritional Services | 1:1 | S9470 | $15.64 | $19.95 |
| Family Caregiver Training and Support | 1:1 without participant present | 90846 | $16.10 | $21.02 |
| 1:1 with participant present | 90847 | $16.10 | $21.02 |
| 24 hour Respite—In-Home and Unlicensed Out-Of-Home | 1:4 | W9795 | $101.46
(per day) | $133.50
(per day) |
| 1:3 | W9796 | $133.40
(per day) | $176.13
(per day) |
| 1:2 | W9797 | $197.31
(per day) | $261.40
(per day) |
| 1:1 | W9798 | $355.94
(per day) | $473.58
(per day) |
| 1:1 enhanced | W9799 | $550.92
(per day) | $697.83
(per day) |
| 2:1 | W9800 | $706.70
(per day) | $941.99
(per day) |
| 2:1 enhanced | W9801 | $1,079.73
(per day) | $1,387.10
(per day) |
| 15-Minute Respite (In-Home Respite and Unlicensed Out-Of-Home Respite) | 1:4 | W8096 | $2.53 | $3.34 |
| 1:3 | W9860 | $3.34 | $4.40 |
| 1:2 | W9861 | $4.93 | $6.53 |
| 1:1 | W9862 | $8.90 | $11.84 |
| 1:1 enhanced | W9863 | $13.78 | $17.45 |
| 2:1 | W9864 | $17.66 | $23.55 |
| 2:1 enhanced | W8095 | $26.99 | $34.68 |
| Supports Broker | 1:1 | W7096 | $20.35 | $24.95 |
| Supports Coordination | 1:1 | W7210 | $30.46 | N/A |
| Targeted Supports Management | 1:1 | T1017 | $30.46 | N/A |
| Housing Transition and Tenancy Sustaining Services | 1:1 | H0043 | $22.67 | $27.35 |
| Family Medical Support Assistance | 1:1 | W0064 | $20.62 | $23.71 |
| Transportation Trip (for providers that do not have a cost-based rate) | Zone 1 | W7274 | $35.32 | N/A |
| Zone 2 | W7275 | $63.96 | N/A |
| Zone 3 | W7276 | $72.65 | N/A |
AGENCY WITH CHOICE FINANCIAL MANAGEMENT SERVICES, INCLUDING BENEFIT ALLOWANCE
EFFECTIVE JULY 1, 2024
Rates in the table are per 15-minute unit unless otherwise noted.
| Service Name | Staffing Level | Procedure
Code | Statewide Fee | Enhanced Communication Statewide Fee
(U1 modifier) |
|---|
| In-Home and Community Supports | 1:1 | W7060 | $8.46 | $10.55 |
| 2:1 | W7068 | $16.90 | $21.11 |
| In-Home and Community Supports—Enhanced | 1:1
(Enhanced) | W7061 | $10.82 | $13.61 |
2:1
(Enhanced) | W7069 | $15.90 | $19.81 |
| Companion Services | 1:1 | W1726 | $6.80 | $8.42 |
In-Home Respite and Unlicensed Out-of-Home
Respite Services | 1:1 | W9862 | $5.80 | $7.12 |
| 2:1 | W9864 | $11.59 | $14.25 |
| 1:1 | W9798 | $440.26
(per day) | $541.32
(per day) |
| 2:1 | W9800 | $727.78
(per day) | $885.62
(per day) |
In-home Respite and Unlicensed Out-of-Home
Respite Services—Enhanced
| 1:1 | W9863 | $11.29 | $14.21 |
| 2:1 | W8095 | $17.09 | $21.34 |
| 1:1 | W9799 | $792.70
(per day) | $995.97
(per day) |
| 2:1 | W9801 | $1,156.59
(per day) | $1,438.77
(per day) |
| Supported Employment—Career Assessment | 1:1 | W7235 | $9.55 | $11.97 |
| Supported Employment—Job Finding and Development | 1:1 | H2023 | $9.55 | $11.97 |
| Supported Employment—Job Coaching and Support | 1:1 | W9794 | $9.55 | $11.97 |
| Supports Broker | 1:1 | W7096 | $8.01 | $9.98 |
| Homemaker | 1:1 | W7283 | $18.74
(per hour) | N/A |
| Chore | 1:1 | W7282 | $18.74
(per hour) | N/A |
| AWC FMS Monthly Administrative Fee | Per Person
Per Month
| W7319 | $349.08 | N/A |
AGENCY WITH CHOICE FINANCIAL MANAGEMENT SERVICES, EXCLUDING BENEFIT ALLOWANCE
EFFECTIVE JULY 1, 2024
Rates in the table are per 15-minute unit unless otherwise noted.
| Service Name | Staffing Level | Procedure
Code | Statewide Fee | Enhanced Communication Statewide Fee
(U1 Modifier) |
|---|
| In-Home and Community Supports | 1:1 | W7060 | $7.60 | $9.70 |
| 2:1 | W7068 | $15.20 | $19.40 |
| In-Home and Community Supports—Enhanced | 1:1
(Enhanced) | W7061 | $9.97 | $12.75 |
2:1
(Enhanced) | W7069 | $14.19 | $18.10 |
| Companion Services | 1:1 | W1726 | $5.94 | $7.56 |
In-Home Respite and Unlicensed Out-of-Home
Respite Services
| 1:1 | W9862 | $4.94 | $6.26 |
| 2:1 | W9864 | $9.88 | $12.53 |
| 1:1 | W9798 | $375.19
(per day) | $476.26
(per day) |
| 2:1 | W9800 | $597.64
(per day) | $755.47
(per day) |
In-home Respite and Unlicensed Out-of-Home
Respite Services—Enhanced
| 1:1 | W9863 | $10.44 | $13.36 |
| 2:1 | W8095 | $15.38 | $19.62 |
| 1:1 | W9799 | $727.64
(per day) | $930.91
(per day) |
| 2:1 | W9801 | $1,026.46
(per day) | $1,309.10
(per day) |
| Supported Employment—Career Assessment | 1:1 | W7235 | $8.70 | $11.12 |
| Supported Employment—Job Finding and Development | 1:1 | H2023 | $8.70 | $11.12 |
| Supported Employment—Job Coaching and Support | 1:1 | W9794 | $8.70 | $11.12 |
| Supports Broker | 1:1 | W7096 | $7.16 | $9.13 |
| Homemaker | 1:1 | W7283 | $15.31
(per hour) | N/A |
| Chore | 1:1 | W7282 | $15.31
(per hour) | N/A |
| AWC FMS Monthly Administrative Fee | Per Person
Per Month | W7319 | $349.08 | N/A |
FEE SCHEDULE RATES FOR CONSOLIDATED AND COMMUNITY LIVING RESIDENTIAL WAIVER SERVICES EFFECTIVE JULY 1, 2024
Rates in the table are per day unit unless otherwise noted.
| Service Group | Needs Group | Program Capacity or Staffing Level | Procedure Code | Statewide Fee | Enhanced Communication Statewide Fee |
|---|
Licensed Residential Habilitation With Day Needs Group 1 | 1 person | W9000 | $441.22 | $541.91
| | 2 people | W9029 | $441.22 | $541.91 |
| 3 people | W9045 | $318.05 | $390.72 |
| 4 people | W9047 | $250.64 | $305.79 |
| 5—8 people | W9064 | $228.99 | $279.78 |
| Needs Group 2 | 1 person | W9000 | $556.21 | $690.79 |
| 2 people | W9029 | $556.21 | $690.79 |
| 3 people | W9045 | $368.51 | $456.24 |
| 4 people | W9047 | $289.68 | $356.47 |
| 5—8 people | W9064 | $270.77 | $332.10 |
| Needs Group 3 | 1 person | W9000 | $809.06 | $1,013.28 |
| 2 people | W9029 | $683.25 | $855.48 |
| 3 people | W9045 | $476.88 | $597.43 |
| 4 people | W9047 | $369.26 | $461.00 |
| 5—8 people | W9064 | $339.57 | $422.64 |
| Needs Group 4 | 1 person | W9000 | $918.73 | $1,141.16 |
| 2 people | W9029 | $770.11 | $956.59 |
| 3 people | W9045 | $539.60 | $669.18 |
| 4 people | W9047 | $417.73 | $515.32 |
| 5—8 people | W9064 | $375.80 | $463.51 |
| Needs Group 5 | 1 person | W9000 | $1,329.20 | $1,701.37 |
| 2 people | W9029 | $1,203.70 | $1,540.74 |
| 3 people | W9045 | $827.58 | $1,059.30 |
| 4 people | W9047 | $636.77 | $815.07 |
| 5—8 people | W9064 | $574.28 | $735.08 |
Licensed Residential Habilitation Without Day Needs Group 1 | 1 person | W9000 | $564.84 | $701.00
| | 2 people | W9029 | $564.84 | $701.00 |
| 3 people | W9045 | $418.78 | $520.35 |
| 4 people | W9047 | $328.47 | $405.96 |
| 5—8 people | W9064 | $288.52 | $356.37 |
| Needs Group 2 | 1 person | W9000 | $655.47 | $818.75 |
| 2 people | W9029 | $655.47 | $818.75 |
| 3 people | W9045 | $477.22 | $596.39 |
| 4 people | W9047 | $374.76 | $466.16 |
| 5—8 people | W9064 | $336.95 | $417.41 |
| Needs Group 3 | 1 person | W9000 | $1,005.41 | $1,262.62 |
| 2 people | W9029 | $743.58 | $932.20 |
| 3 people | W9045 | $557.32 | $699.73 |
| 4 people | W9047 | $434.09 | $544.11 |
| 5—8 people | W9064 | $389.06 | $486.57 |
| Needs Group 4 | 1 person | W9000 | $1,241.80 | $1,571.25 |
| 2 people | W9029 | $910.37 | $1,146.12 |
| 3 people | W9045 | $693.46 | $873.29 |
| 4 people | W9047 | $534.64 | $668.40 |
| 5—8 people | W9064 | $476.23 | $594.73 |
| Needs Group 5 | 1 person | W9000 | $1,737.96 | $2,224.59 |
| 2 people | W9029 | $1,300.18 | $1,664.23 |
| 3 people | W9045 | $994.84 | $1,273.40 |
| 4 people | W9047 | $759.06 | $971.59 |
| 5—8 people | W9064 | $677.09 | $866.68 |
| Unlicensed Residential Habilitation | N/A | 1 person | W7078 | $151.76 | $165.85 |
| 2 people | W7080 | $95.72 | $106.49 |
| 3 people | W7082 | $69.34 | $78.04 |
| Life Sharing—Over 30 Hours Per Week On Average With Day | Needs Group 1 | 1 person | W8593 | $197.05 | $202.07 |
| 2 people | W8595 | $138.91 | $141.61 |
| Needs Group 2 | 1 person | W8593 | $234.93 | $243.63 |
| 2 people | W8595 | $166.57 | $171.11 |
| Needs Group 3 | 1 person | W8593 | $321.52 | $345.55 |
| 2 people | W8595 | $226.62 | $239.75 |
| Needs Group 4 | 1 person | W8593 | $408.95 | $454.14 |
| 2 people | W8595 | $272.73 | $296.03 |
| Life Sharing—Over 30 Hours Per Week On Average Without Day | Needs Group 1 | 1 person | W8593 | $227.44 | $250.18 |
| 2 people | W8595 | $181.64 | $199.80 |
| Needs Group 2 | 1 person | W8593 | $260.90 | $286.99 |
| 2 people | W8595 | $206.83 | $227.51 |
| Needs Group 3 | 1 person | W8593 | $351.62 | $386.78 |
| 2 people | W8595 | $282.83 | $311.11 |
| Needs Group 4 | 1 person | W8593 | $436.36 | $480.00 |
| 2 people | W8595 | $333.50 | $366.85 |
| Life Sharing—Under 30 Hours Per Week On Average | N/A | 1 person | W7037 | $169.77 | $171.37 |
| 2 people | W7039 | $120.90 | $121.87 |
| Medically Complex Life Sharing | Needs Group 4 | 1 person | W0062 | $501.33 | $561.49 |
| 2 people | W0063 | $315.10 | $352.91 |
24 Hour Respite (Licensed Respite Group Homes) Needs Group 1 | 2 people | W9791 | $545.91 | $616.01
| | 3 people | W9792 | $401.12 | $451.55 |
| 4 people | W9793 | $320.34 | $357.86 |
| Needs Group 2 | 2 people | W9791 | $668.35 | $764.89 |
| 3 people | W9792 | $454.85 | $517.07 |
| 4 people | W9793 | $361.92 | $408.54 |
| Needs Group 3 | 1 person | W9790 | $983.66 | $1,135.51 |
| 2 people | W9791 | $801.39 | $929.58 |
| 3 people | W9792 | $569.49 | $658.26 |
| 4 people | W9793 | $446.66 | $513.07 |
| Needs Group 4 | 1 person | W9790 | $1,071.08 | $1,250.69 |
| 2 people | W9791 | $869.00 | $1,023.53 |
| 3 people | W9792 | $619.09 | $724.64 |
| 4 people | W9793 | $486.00 | $562.47 |
24 Hour Respite (Respite Only Home) Needs Group 1 | 2 people | W9865 | $622.97 | $702.98
| | 3 people | W9866 | $457.76 | $515.30 |
| 4 people | W9871 | $365.56 | $408.37 |
| Needs Group 2 | 2 people | W9865 | $762.70 | $872.88 |
| 3 people | W9866 | $519.06 | $590.07 |
| 4 people | W9871 | $413.01 | $466.22 |
| Needs Group 3 | 2 people | W9865 | $914.54 | $1,060.82 |
| 3 people | W9866 | $649.89 | $751.20 |
| 4 people | W9871 | $509.71 | $585.50 |
| Needs Group 4 | 2 people | W9865 | $991.68 | $1,170.77 |
| 3 people | W9866 | $706.49 | $829.69 |
| 4 people | W9871 | $554.61 | $644.62 |
| Supplemental Habilitation | N/A | 1:1 | W7070 | $6.27
(15-minute unit)
| $8.47
(15-minute unit)
|
| 2:1 | W7084 | $12.45
(15-minute unit)
| $16.93
(15-minute unit)
|
Supported Living Needs Group 1 | 1 person | W9872 | $173.79 | $210.90
| | 2 people | W9873 | $121.66 | $149.20 |
| 3 people | W9874 | $89.81 | $110.14 |
| Needs Group 2 | 1 person | W9872 | $291.25 | $353.74 |
| 2 people | W9873 | $233.00 | $282.99 |
| 3 people | W9874 | $154.32 | $187.42 |
| Needs Group 3 | 1 person | W9872 | $465.04 | $564.64 |
| 2 people | W9873 | $389.41 | $472.80 |
| 3 people | W9874 | $270.33 | $328.24 |
| Needs Group 4 | 1 person | W9872 | $625.28 | $759.83 |
| 2 people | W9873 | $625.28 | $759.83 |
| 3 people | W9874 | $435.25 | $528.89 |
DEPARTMENT-ESTABLISHED FEES FOR RESIDENTIAL HABILITATION INELIGIBLE
EFFECTIVE JULY 1, 2024
Rates in the table are per day.
| Service | Procedure Code | Approved Program Capacity | Area 1
(Bucks, Carbon, Chester, Delaware, Lehigh, Monroe, Montgomery, Northampton, Philadelphia and Pike) | Area 2
(Remaining counties in Pennsylvania) |
|---|
| Licensed Residential Habilitation—Ineligible | W9001 | 1 person | $109.01 | $97.17 |
| W9030 | 2 people | $59.46 | $52.12 |
| W9046 | 3 people | $42.61 | $36.81 |
| W9048 | 4 people | $33.11 | $28.17 |
| W9065 | 5—8 people | $23.74 | $19.65 |
| Unlicensed Residential Habilitation—Ineligible | W7079 | 1 person | $29.36 | $26.11 |
| W7081 | 2 people | $17.00 | $14.48 |
| W7083 | 3 people | $9.94 | $7.79 |
Proposed Waiver Amendments
Whenever substantive changes are made to an approved waiver, the Department must submit an amendment to the Centers for Medicare and Medicaid Services for approval. The Department proposes to increase the limits on the maximum dollar amount of waiver services in Appendix C-4 as follows effective July 1, 2024:
• The current limit of $85,000 per person per fiscal year for Community Living Waiver services will be increased to $97,000. Supports Coordination services will continue to be excluded from this limit.
• The current limit of $41,000 per person per fiscal year for P/FDS Waiver services will be increased to $47,000. Supports Coordination and Supports Broker services will continue to be excluded from this limit. The limit can continue to be exceeded by $15,000 for Advanced Supported Employment, Supported Employment or Benefits Counseling services.
The proposed increases will ensure that the proposed changes to the Fee Schedule Rates do not result in a reduction or loss of waiver services for individuals.
Fiscal Impact
It is anticipated that there will be a total cost to the Commonwealth in Fiscal Year 2024-2025 of $427.400 million ($191.945 million in State funds).
The amount of funding available is dependent upon the funds appropriated by the General Assembly for the forthcoming year. Therefore, the rates as proposed are dependent on approval by the General Assembly.
Public Comment
Interested persons are invited to submit written comments regarding the proposed rates and waiver amendments. Comments should be addressed to the Department of Human Services, Office of Developmental Programs, Division of Provider Assistance and Rate Setting, 4th Floor, Health and Welfare Building, 625 Forster Street, Harrisburg, PA 17120. Comments may also be submitted to the Department at ra-ratesetting@pa.gov using subject header ''Proposed ID/A Rates.''
Comments received within 45 days of publication of this notice will be reviewed and considered for revisions to the proposed rates and waiver amendments.
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania Hamilton Relay Service by dialing 711 or by using one of the toll-free numbers: (800) 654-5984 (TDD users), (800) 654-5988 (voice users), (844) 308-9292 (Speech-to-Speech) or (844) 308-9291 (Spanish).
Copies of this notice and documents containing the changes proposed in the waiver amendments may be obtained by contacting the Department of Human Services, Office of Developmental Programs, Division of Provider Assistance and Rate Setting, 4th Floor, Health and Welfare Building, 625 Forster Street, Harrisburg, PA 17120, ra-ratesetting@pa.gov.
VALERIE A. ARKOOSH,
Secretary
Fiscal Note: 14-NOT-1619. Under section 612 of The Administrative Code of 1929 (71 P.S. § 232), (1) General Fund;
(7) Intellectual Disabilities (ID)—Community Waiver Program; (2) Implementing Year 2023-24 is $0; (3) 1st Succeeding Year 2024-25 through 5th Succeeding Year 2028-29 are $190,861,000; (4) 2022-23 Program—$1,877,000,000; 2021-22 Program—$1,798,000,000; 2020-21 Program—$1,621,000,000;
(7) ID—Community Base Program; (2) Implementing Year 2023-24 is $0; (3) 1st Succeeding Year 2024-25 through 5th Succeeding Year 2028-29 are $1,084,000; (4) 2022-23 Program—$146,126,000; 2021-22 Program—$144,189,000; 2020-21 Program—$144,432,000;
(8) recommends adoption. Funds have been included in the proposed budget to cover this increase, but are dependent on the enactment of the budget.
[Pa.B. Doc. No. 24-562. Filed for public inspection April 19, 2024, 9:00 a.m.]
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