NOTICES

Medical Assistance Program Fee Schedule for Select Services in the Consolidated and Person/Family Directed Support Waivers and Community Mental Retardation Base Program; Correction Effective July 1, 2011, through November 14, 2011

[41 Pa.B. 6168]
[Saturday, November 12, 2011]

 The Department of Public Welfare is correcting the Medical Assistance Fee Schedule Tables published at 41 Pa.B. 3292 (June 25, 2011).

 Specifically, payment rates for providers of the Consolidated waiver, Person/Family Directed Support waiver and base funded services for a waiver service location identified as fee schedule services in Fiscal Year (FY) 2010-2011 will continue to have the same payment rates as the FY 2010-2011 final fee schedule payment rate for the period of July 1, 2011, through November 14, 2011.

 The revised Fee Schedule Tables reflect carryover of the FY 2010-2011 fee schedule services for the period July 1, 2011, through November 14, 2011, and are as follows:

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

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

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
Homemaker/Chore	W7283	U4	54	540	1 hour	$13.42	$12.55	$11.91	$10.82
		UA & U4
Respite—unlicensed, out of home, level 2	W8002	U4	54	540	1 day	$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 fiscal impact to the Commonwealth.

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 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 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. E-mail should be sent to ODP's rate-setting mailbox at ra-ratesetting@pa.gov (use ''PN Fee Schedule'' in the subject line).

 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-729. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 11-1965. Filed for public inspection November 11, 2011, 9:00 a.m.]

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