NOTICES

Rate-Setting Methodology and Rates for Residential Habilitation Services and Structured Day Habilitation Services for Community Care and Omnibus Budget Reconciliation Act Waiver Providers

[41 Pa.B. 5134]
[Saturday, September 24, 2011]

 The Department of Public Welfare (Department) announces the development of a standardized rate-setting methodology and rates for residential habilitation and structured day habilitation services in the Department's Community Care (COMMCARE) and Omnibus Budget Reconciliation Act (OBRA) Home and Community-Based Waiver programs. These changes are effective for dates of service on and after October 1, 2011.

Background

 As part of the Department's renewal of the COMM-CARE Waiver with the Centers for Medicare and Medicaid Services (CMS), and as a condition of continued Federal funding, the Department was required by CMS to separate structured day habilitation services from residential habilitation services and to assure CMS that reimbursement for waiver services must be established using a standardized rate-setting methodology. To comply with these CMS requirements, the Department has developed a standardized rate-setting methodology for these services and established service rates.

 Residential habilitation reimbursement has historically varied by provider. As structured day habilitation is a new service that has been separated from the residential habilitation service, historical reimbursement does not exist. The Department surveyed current residential habilitation and structured day habilitation providers for financial information using cost survey tools. The Department also collected cost and staffing data from providers and compared the data across providers, to each provider's previous cost data submissions. When possible, the Department contacted providers to resolve any anomalies in their submitted cost data.

 Room and board and costs are not eligible for Federal funding, are billed separately from residential habilitation and structured day habilitation and, therefore, are not included in the rate development.

Methodology

Base rates

 The components utilized in the residential habilitation and structured day habilitation rate-setting methodologies are as follows:

 • Direct Staffing costs
— Staffing
— Employee-Related Expenses

 • Direct Program costs
— Transportation/Community Habilitation Transportation
— Program Supplies and Health Supplies/Program Supplies
— Day Habilitation Center

 • Indirect and Administrative costs

Enhanced rates

 The Department developed enhanced rates for supporting a participant needing 1 to 1 or 2 to 1 assistance in the residential habilitation or structured day habilitation service settings. The rate-setting methodology includes staffing for such assistance is provided by residential or clinical aides available in either setting.

 The components of the enhanced rate development are as follows:

 • Direct Staffing costs
— Staffing
— Employee-Related Expenses

 • Indirect and Administrative costs

Rates

Service	Unit Type	Rate
Residential Habilitation Services in a 1-3 individual setting	Per Diem	$264.15
Residential Habilitation Enhanced rate (Staff to individual ratio of 1:1)	Hourly (Supplemental)	$19.79
Residential Habilitation Enhanced rate (Staff to individual ratio of 2:1)	Hourly (Supplemental)	$39.58
Residential Habilitation Services in a 4-8 individual setting	Per Diem	$247.67
Residential Habilitation Enhanced rate (Staff to individual ratio of 1:1)	Hourly (Supplemental)	$19.62
Residential Habilitation Enhanced rate (Staff to individual ratio of 2:1)	Hourly (Supplemental)	$ 39.23
Structured Day Habilitation Group Setting	Hourly	$34.56
Structured Day Habilitation Enhanced rate (Staff to individual ratio of 1:1)	Hourly (Supplemental)	$19.62
Structured Day Habilitation Enhanced rate (Staff to individual ratio of 2:1)	Hourly (Supplemental)	$39.23

Fiscal Impact

 The estimated cost for Fiscal Year (FY) 2011-2012 is $1.774 million ($0.797 million in State funds). The annualized cost for FY 2012-2013 is $2.365 million ($1.070 million in State funds).

Public Comment

 Interested persons are invited to submit written comments regarding the rates and rate-setting methodology to RA-waiverstandard@pa.gov or Department of Public Welfare/Department of Aging, Office of Long-Term Living, Bureau of Policy and Strategic Planning, Attention: Elaine Smith, Forum Place, 5th Floor, 555 Walnut Street, Harrisburg, PA 17101-1919. Comments received within 30 days will be reviewed and considered for any subsequent revision of the notice.

 Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).

GARY D. ALEXANDER, 
Secretary

 Fiscal Note: 14-NOT-720. (1) General Fund; (2) Implementing Year 2011-12 is $797,000; (3) 1st Succeeding Year 2012-13 is $1,070,000; 2nd Succeeding Year 2013-14 is $1,070,000; 3rd Succeeding Year 2014-15 is $1,070,000; 4th Succeeding Year 2015-16 is $1,070,000; 5th Succeeding Year 2016-17 is $1,070,000; (4) 2010-11 Program—$115,635,000; 2009-10 Program—$95,063,000; 2008-09 Program—$74,268,000; (7) Services to Persons with Disabilities; (8) recommends adoption. The Department will absorb the increased cost.

[Pa.B. Doc. No. 11-1673. Filed for public inspection September 23, 2011, 9:00 a.m.]

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