NOTICES
DEPARTMENT OF PUBLIC WELFARE
Addition of Home Finding and Supported Employment to the Medical Assistance Program Fee Schedule for Select Services in the Consolidated and Person/Family Directed Support Waivers and Community Mental Retardation Base Program
[41 Pa.B. 1709]
[Saturday, March 26, 2011]
The Department of Public Welfare is making an addition to the Fee Schedule Tables published at 40 Pa.B. 5413 (September 18, 2010). Specifically, home finding and supported employment services are being added to the Fee Schedule Tables. No other services or fees published at 40 Pa.B. 5413 are impacted by these additions.
Home finding service has been added to the Select Community-Based Services Fee Schedule Table. Supported employment service has been added to the Agency with Choice Financial Management Services, Excluding Benefits and the Agency with Choice Financial Management Services, Including Benefits Fee Schedule Tables.
Geographic Areas:
Area 1: Bucks, Chester, Delaware, Lehigh, Montgomery, Northampton, Philadelphia
Area 2: Adams, Allegheny, Beaver, Berks, Carbon, Cumberland, Dauphin, Erie, Franklin, Fulton, Greene, Lancaster, Lawrence, Lebanon, Monroe, Perry, Pike, Schuylkill, Washington, York
Area 3: Armstrong, Bradford, Butler, Cameron, Centre, Clarion, Clinton, Columbia, Crawford, Elk, Forest, Indiana, Huntingdon, Juniata, Lackawanna, Luzerne, Lycoming, McKean, Mercer, Mifflin, Montour, Northumberland, Potter, Snyder, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Wayne, Westmoreland, Wyoming
Area 4: Bedford, Blair, Cambria, Clearfield, Fayette, Jefferson, Somerset
Revised Fee Schedule Rates Tables:
Select Community-Based Services*
* Modifier ET must be used with applicable procedures codes when billing for temporary base-funded services.
(PA) Prior authorization by the Office of Developmental Programs (ODP) must be obtained for this service.
| Service | Procedure Code | Modifier | Provider Type | Specialty Code | Unit
| Area 1
| Area 2
| Area 3
| Area 4 |
|---|
| Nursing Services: LPN | T2025 | TE | 05 | 051 | 15 min. | $11.02 | $10.31 | $9.78 | $8.89 |
| TE & ET |
| TE | 16 | 161 |
| TE & ET |
| Nursing Services: RN | T2025 | TD | 05 | 051 | 15 min. | $16.55 | $15.48 | $14.68 | $13.35 |
| TD & ET |
| TD | 16 | 160 |
| TD & ET |
| Physical Therapy | T2025 | GP | 17 | 170 | 15 min. | $20.20 | $18.90 | $17.92 | $16.29 |
| GP & ET |
| Occupational Therapy | T2025 | GO | 17 | 171 | 15 min. | $21.29 | $19.92 | $18.89 | $17.17 |
| GO & ET |
| Speech and Language Therapy | T2025 | GN | 17 | 173 | 15 min. | $21.72 | $20.32 | $19.27 | $17.52 |
| GN & ET |
| Individual Behavioral Therapy | T2025 | HE | 19 | 208 | 15 min. | $20.79 | $19.45 | $18.44 | $16.77 |
| HE & ET |
| Group Behavioral Therapy | T2025 | HE & HQ | 19 | 208 | 15 min. | $5.20 | $4.86 | $4.61 | $4.19 |
| HE, HQ & ET |
| Visual/Mobility Therapy | W7246 | | 51 | 517 | 15 min. | $21.73 | $20.33 | $19.28 | $17.52 |
| ET |
| Companion Services, Basic staff support | W1724 | | 51 | 363 | 15 min. | $ .78 | $ .73 | $ .69 | $ .63 |
| ET |
| Companion Services, level 1 | W1725 | | 51 | 363 | 15 min. | $ .98 | $ .92 | $.87 | $ .79 |
| ET |
| Companion Services, level 2 | W1726 | | 51 | 363 | 15 min. | $2.07 | $1.94 | $1.84 | $1.67 |
| ET |
| Companion Services, level 3 | W1727 | | 51 | 363 | 15 min. | $4.65 | $4.35 | $4.13 | $3.75 |
| ET |
| Supplemental Habilitation, 1:1 (PA) | W7070 | | 52 | 456, 520, 521 or 522 | 15 min. | $4.87 | $4.56 | $4.32 | $3.93 |
| ET |
| Supplemental Habilitation, 2:1 (PA) | W7084 | | 52 | 456, 520, 521 or 522 | 15 min. | $9.75 | $9.12 | $8.65 | $7.86 |
| ET |
| Additional Individualized Staffing, 1:1 (PA) | W7085 | | 52 | 456, 520, 521 or 522 | 15 min. | $4.87 | $4.56 | $4.32 | $3.93 |
| Additional Individualized Staffing, 2:1 (PA) | W7086 | | 52 | 456, 520, 521 or 522 | 15 min. | $9.75 | $9.12 | $8.65 | $7.86 |
| Older Adult Day Habilitation | W7094 | | 51 | 410 | 15 min. | $2.88 | $2.69 | $2.55 | $2.32 |
| ET |
| Behavioral Support | W7095 | | 51 | 510 | 15 min. | $21.52 | $20.13 | $19.09 | $17.35 |
| ET |
| Supports Broker | W7096 | | 51 | 510 | 15 min. | $10.85 | $10.15 | $9.63 | $8.75 |
| Home Finding | W7277 | | 51 or 55 | 571 | 15 min. | $9.94 | $9.30 | $8.82 | $8.02 |
| Homemaker/Chore (permanent) | W7283 | | 43 | 430 | 1 hour | $22.87 | $21.39 | $20.29 | $18.44 |
| 51 | 430 or 431 |
| 55 | 430 or 431 |
| Homemaker/Chore (temporary) | W7283 | UA | 43 | 430 | | | | |
| UA & ET |
| UA | 51 | 430 or 431 |
| UA & ET |
| UA | 45 | 430 or 431 |
| UA & ET |
Unlicensed Out-of-Home Respite and Respite Camp Ineligible Services (Room and Board)
| Service | Procedure Code | Provider Type | Specialty Code | Unit | Areas 1 through 4 Respite-unlicensed, out of home, ineligible | W6060 | 51 | 513 | 1 day $12.00/unit, max of 1 ineligible unit per day
|---|
| W6061 | 51 | 513 |
| W6062 | 51 | 513 |
| 54 | 540 or 541 |
| W6063 | 51 | 513 |
| 54 | 540 or 541 |
| W6064 | 51 | 513 |
| 54 | 540 or 541 |
| W6065 | 51 | 513 |
| 54 | 540 or 541 |
| W6066 | 51 | 513 | 15 minutes $4.00/unit, max of 3 ineligible units per day
| W6067 | 51 | 513 |
| W6068 | 51 | 513 |
| 54 | 540 or 541 |
| W6069 | 51 | 513 |
| 54 | 540 or 541 |
| W6070 | 51 | 513 |
| 54 | 540 or 541 |
| W6071 | 51 | 513 |
| 54 | 540 or 541 |
| Respite-camp, ineligible | W8400 | 55 | 555 | 15 minutes | $4.00/unit, max of 3 ineligible units per day |
| 54 | 540 or 541 |
| W8401 | 55 | 554 | 1 day | $12.00/unit, max of 1 ineligible unit per day |
| 54 | 540 or 541 |
Agency with Choice Financial Management Services, Excluding Benefits**
** Modifier U4 must be used with all procedures codes when billing for services excluding benefits.
| Service | Procedure code | Modifier** | Provider Type | Specialty Code | Unit
| Area 1
| Area 2
| Area 3
| Area 4 |
|---|
| Companion, level 3 | W1727 | U4 | 54 | 540 | 15 min. | $3.06 | $2.87 | $2.72 | $2.47 |
Home & Community Habilitation—
unlicensed, level 3 | W7060 | U4 | 54 | 540 | 15 min. | $5.07 | $4.74 | $4.50 | $4.09 |
Home & Community Habilitation—
unlicensed, level 3, enhanced | W7061 | U4 | 54 | 540 | 15 min. | $8.39 | $7.85 | $7.44 | $6.77 |
| TD & U4 |
| TE & U4 |
Home & Community Habilitation—
unlicensed, level 4 | W7068 | U4 | 54 | 540 | 15 min. | $10.13 | $9.48 | $8.99 | $8.17 |
Home & Community Habilitation—
unlicensed, level 4, enhanced | W7069 | U4 | 54 | 540 | 15 min. | $16.77 | $15.69 | $14.88 | $13.52 |
| TD & U4 |
| TE & U4 |
| Supports Broker | W7096 | U4 | 54 | 540 | 15 min. | $6.15 | $5.76 | $5.46 | $4.96 |
| Supported Employment | W7235 | U4 | 54 | 540 | 15 min. | $6.12 | $5.73 | $5.43 | $4.94 |
| Respite—unlicensed, in home, level 2 | W7250 | U4 | 54 | 540 | 1 day | $223.14 | $208.74 | $197.94 | $179.95 |
| W7258 | U4 | 54 | 540 | 15 min. | $3.48 | $3.26 | $3.09 | $2.81 |
| Respite—unlicensed, in home, level 2, enhanced | W7251 | U4 | 54 | 540 | 1 day | $478.66 | $447.77 | $424.61 | $386.01 |
| TD & U4 |
| TE & U4 |
| W7264 | U4 | 54 | 540 | 15 min. | $7.48 | $7.00 | $6.64 | $6.03 |
| TD & U4 |
| TE & U4 |
| Respite—unlicensed in home, level 3 | W7252 | U4 | 54 | 540 | 1 day | $446.27 | $417.48 | $395.89 | $359.90 |
| W7265 | U4 | 54 | 540 | 15 min. | $6.97 | $6.52 | $6.19 | $5.62 |
| Respite—unlicensed, in home, level 3, enhanced | W7253 | U4 | 54 | 540 | 1 day | $957.31 | $895.55 | $849.23 | $772.02 |
| TD & U4 |
| TE & U4 |
| W7266 | U4 | 54 | 540 | 15 min. | $14.95 | $13.99 | $13.26 | $12.06 |
| TD & U4 |
| TE & U4 |
| TD & U4 |
| TE & U4 |
| Respite—unlicensed, out of home, level 2 | W8002 | U4 | 54 | 540 | 1day | $223.14 | $208.74 | $197.94 | $179.95 |
| W8012 | U4 | 54 | 540 | 15 min. | $3.48 | $3.26 | $3.09 | $2.81 |
| Respite—unlicensed, out of home, level 2, enhanced | W8003 | U4 | 54 | 540 | 1 day | $478.66 | $447.77 | $424.61 | $386.01 |
| TD & U4 |
| TE & U4 |
| W8013 | U4 | 54 | 540 | 15 min. | $7.48 | $7.00 | $6.64 | $6.03 |
| TD & U4 |
| TE & U4 |
| Respite—unlicensed, out of home, level 3 | W8004 | U4 | 54 | 540 | 1 day | $446.27 | $417.48 | $395.89 | $359.90 |
| W8014 | U4 | 54 | 540 | 15 min. | $6.97 | $6.52 | $6.19 | $5.62 |
| Respite—unlicensed, out of home, level 3, enhanced | W8005 | U4 | 54 | 540 | 1 day | $957.31 | $895.55 | $849.23 | $772.02 |
| TD & U4 |
| TE & U4 |
| W8015 | U4 | 54 | 540 | 15 min. | $14.95 | $13.99 | $13.26 | $12.06 |
| TD & U4 |
| TE & U4 |
Agency with Choice Financial Management Services, Including Benefits***
***No modifier is needed to indicate the benefit allowance is included.
| Service | Procedure code | Modifier** | Provider Type | Specialty Code | Unit
| Area 1
| Area 2
| Area 3
| Area 4 |
|---|
| Companion, level 3 | W1727 | | 54 | 540 | 15 min. | $3.88 | $3.63 | $3.44 | $3.13 |
Home & Community Habilitation—
unlicensed, level 3 | W7060 | | 54 | 540 | 15 min. | $6.42 | $6.01 | $5.70 | $5.18 |
Home & Community Habilitation—
unlicensed, level 3, enhanced | W7061 | | 54 | 540 | 15 min. | $10.62 | $9.93 | $9.42 | $8.56 |
| TD |
| TE |
Home & Community Habilitation—
unlicensed, level 4 | W7068 | | 54 | 540 | 15 min. | $12.83 | $12.00 | $11.38 | $10.35 |
Home & Community Habilitation—
unlicensed, level 4, enhanced | W7069 | | 54 | 540 | 15 min. | $21.23 | $19.86 | $18.83 | $17.12 |
| TD |
| TE |
| Supports Broker | W7096 | | 54 | 540 | 15 min. | $7.79 | $7.29 | $6.91 | $6.28 |
| Supported Employment | W7235 | | 54 | 540 | 15 min. | $7.75 | $7.25 | $6.88 | $6.25 |
| Respite—unlicensed, in home, level 2 | W7250 | | 54 | 540 | 1 day | $282.49 | $264.26 | $250.60 | $227.81 |
| W7258 | | 54 | 540 | 15 min. | $4.41 | $4.13 | $3.91 | $3.56 |
| Respite—unlicensed, in home, level 2, enhanced | W7251 | | 54 | 540 | 1 day | $605.98 | $566.88 | $537.56 | $488.69 |
| TD |
| TE |
| W7264 | | 54 | 540 | 15 min. | $9.47 | $8.86 | $8.40 | $7.64 |
| TD |
| TE |
| Respite—unlicensed, in home, level 3 | W7252 | | 54 | 540 | 1 day | $564.98 | $528.53 | $501.19 | $455.63 |
| W7265 | | 54 | 540 | 15 min. | $8.83 | $8.26 | $7.83 | $7.12 |
| Respite—unlicensed, in home, level 3, enhanced | W7253 | | 54 | 540 | 1 day | $1,211.96 | $1,133.76 | $1,075.12 | $977.38 |
| TD |
| TE |
| W7266 | | 54 | 540 | 15 min. | $18.93 | $17.71 | $16.79 | $15.27 |
| TD |
| TE |
| Homemaker/ Chore | W7283 | | 54 | 540 | 1 hour | $16.99 | $15.89 | $15.07 | $13.70 |
| UA |
| Respite—unlicensed, out of home, level 2 | W8002 | | 54 | 540 | 1 day | $282.49 | $264.26 | $250.60 | $227.81 |
| W8012 | | 54 | 540 | 15 min. | $4.41 | $4.13 | $3.91 | $3.56 |
| Respite—unlicensed, out of home, level 2, enhanced | W8003 | | 54 | 540 | 1 day | $605.98 | $566.88 | $537.56 | $488.69 |
| TD |
| TE |
| W8013 | | 54 | 540 | 15 min. | $9.47 | $8.86 | $8.40 | $7.64 |
| TD |
| TE |
| Respite—unlicensed, out of home, level 3 | W8004 | | 54 | 540 | 1 day | $564.98 | $528.53 | $501.19 | $455.63 |
| W8014 | | 54 | 540 | 15 min. | $8.83 | $8.26 | $7.83 | $7.12 |
| Respite—unlicensed, out of home, level 3, enhanced | W8005 | | 54 | 540 | 1 day | $1,211.96 | $1,133.76 | $1,075.12 | $977.38 |
| TD |
| TE |
| W8015 | | 54 | 540 | 15 min. | $18.93 | $17.71 | $16.79 | $15.27 |
| TD |
| TE |
Fiscal Impact
There is no anticipated net State fund cost associated with implementation of the addition of services.
Public Comment
Copies of this notice may be obtained at the local Mental Health/Mental Retardation (MH/MR) County Program, Administrative Entity (AE) or regional ODP in the corresponding regions:
• Western region: Piatt Place, Room 4900, 301 5th Avenue, Pittsburgh, PA 15222, (412) 565-5144
• Northeast region: Room 315, Scranton State Office Building, 100 Lackawanna Avenue, Scranton, PA 18503, (570) 963-4749
• Southeast region: 801 Market Street, Suite 5071, Philadelphia, PA 19107, (215) 560-2242 or (215) 560-2245
• Central region: Room 430, Willow Oak Building, P. O. Box 2675, DGS Annex Complex, Harrisburg, PA 17105, (717) 772-6507
Contact information for the local MH/MR County Program or AE may be accessed through a link at https://www.hcsis.state.pa.us/hcsis-ssd/pgm/asp/PRCNT.ASP or contact the previously referenced regional ODP. Interested persons are invited to submit written comments regarding this notice to the Department at the following addresses:
By e-mail:
Use subject header ''PN Fee Schedule'' to ODP's rate-setting mailbox at ra-ratesetting@state.pa.us.
By postal mail:
Department of Public Welfare
Office of Developmental Programs
Division of Provider Assistance and Rate Setting
4th Floor, Health and Welfare Building
Forster and Commonwealth Avenues
Harrisburg, PA 17120
Persons with a disability who require an auxiliary aid or service may submit comments using the AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
GARY D. ALEXANDER,
Acting Secretary
Fiscal Note: 14-NOT-683. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 11-527. Filed for public inspection March 25, 2011, 9:00 a.m.]
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