STATEMENTS OF POLICY

Title 55—PUBLIC WELFARE

DEPARTMENT OF PUBLIC WELFARE

[ 55 PA. CODE CH. 4300 ]

Department-Established Fees for the Ineligible Portion of Payment for Respite Services Provided at Waiver Service Locations

[41 Pa.B. 6681]
[Saturday, December 10, 2011]

Scope

 This statement of policy applies to Administrative Entity (AE) administrators or directors, County Mental Health and Mental Retardation (MH/MR) Program administrators or directors, Supports Coordination Organization directors and providers of services.

Purpose

 The purpose of this statement of policy is to provide the Department of Public Welfare (Department) established fees for the ineligible portion of payment for respite services. For waiver funding, only a portion of payment for specific respite services is eligible for Federal reimbursement. Therefore, the Department-established fees cover the ineligible portion of these respite services. These Department-established fees are for service locations that serve both waiver individuals under the Consolidated and Person/Family Directed Support (P/FDS) waivers and based-funded individuals. The Department-established fees are effective July 1, 2011.

Discussion

 This statement of policy interprets § 4300.115(a) (relating to Department established fees) to apply to fees for reimbursement of the ineligible portion of payment for respite services. These services are funded from State-only funds for individuals enrolled in the Consolidated and P/FDS waivers.

 In addition, these Department-established fees for the ineligible portion of payment for services apply to an individual receiving a base-funded service in a waiver-funded service location as the ineligible portion of the total rate.

 The Department-established fees for the ineligible portion of payment for respite services in a waiver service location are as follows:

Service	Procedure Code	Provider Type	Specialty	Unit	Area 1	Area 2	Area 3	Area 4
Respite— Unlicensed Out of Home, 24 hours— Ineligible	W6060	51	513	day	$12.00	$12.00	$12.00	$12.00
	W6061	51	513	day	$12.00	$12.00	$12.00	$12.00
	W6062	51	513	day	$12.00	$12.00	$12.00	$12.00
		54	540 or 541
	W6063	51	513	day	$12.00	$12.00	$12.00	$12.00
		54	540 or 541
	W6064	51	513	day	$12.00	$12.00	$12.00	$12.00
		54	540 or 541
	W6065	51	513	day	$12.00	$12.00	$12.00	$12.00
		54	540 or 541
Respite— Unlicensed Out of Home, 15 minutes— Ineligible Ineligible units depend on number of eligible units	W6066	51	513	15 min	$4.00	$4.00	$4.00	$4.00
	W6067	51	513	15 min	$4.00	$4.00	$4.00	$4.00
0-4 hours eligible = 1 ineligible unit	W6068	51	513	15 min	$4.00	$4.00	$4.00	$4.00
		54	540 or 541
4-8 hour eligible = 2 ineligible units	W6069	51	513	15 min	$4.00	$4.00	$4.00	$4.00
		54	540 or 541
More than 8 hours eligible = 3 eligible units	W6070	51	513	15 min	$4.00	$4.00	$4.00	$4.00
		54	540 or 541
	W6071	51	513	15 min	$4.00	$4.00	$4.00	$4.00
		54	540 or 541
Respite Camp—Ineligible	W8400	55	555	15 min	$4.00	$4.00	$4.00	$4.00
		54	540 or 541
	W8401	55	554	day	$12.00	$12.00	$12.00	$12.00

 These fees are also available through a link titled ''Respite Ineligible Fees'' at http://www.dpw.state.pa.us/provider/doingbusinesswithdpw/developmentalprograms/index.htm

Effective Date

 This statement of policy is effective July 1, 2011.

Contact Person

 Questions about this statement of policy should be directed to the Regional Program Manager at the following appropriate regional office. Copies of this statement of policy may be obtained at the local MH/MR County Program, AE or regional office 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

GARY D. ALEXANDER, 
Secretary

 (Editor's Note: Title 55 of the Pennsylvania Code is amended by adding a statement of policy in § 4300.115a to read as set forth in Annex A.)

 Fiscal Note: 14-BUL-96. No fiscal impact; (8) recommends adoption.

Annex A

TITLE 55. PUBLIC WELFARE

PART VI. MENTAL HEALTH/MENTAL RETARDATION MANUAL

Subpart C. ADMINISTRATION AND FISCAL MANAGEMENT

CHAPTER 4300. COUNTY MENTAL HEALTH AND MENTAL RETARDATION FISCAL MANUAL

UNIT OF SERVICE FUNDING

§ 4300.115a. Department-established fees for the ineligible portion of payment for respite services provided at waiver service locations—statement of policy.

 (a) Section 4300.115(a) (relating to Department established fees) applies to fees for reimbursement of the ineligible portion of payment for respite services funded with State-only funds for participants enrolled in the Consolidated and Person/Family Directed Support waivers.

 (b) The Department-established fees under subsection (a) also apply to an individual receiving a base-funded service in a waiver-funded service location as the ineligible portion of a provider's total rate.

 (c) The Department-established fees for the ineligible portion of payment for respite services are available on the Department's web site.

[Pa.B. Doc. No. 11-2109. Filed for public inspection December 9, 2011, 9:00 a.m.]

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