NOTICES
Proposed Fee Schedule Rates and Department-Established Fees for Consolidated and Person/Family Directed Support Waivers Services, Targeted Service Management and the Community Intellectual Disability Base-Funded Program
[47 Pa.B. 4905]
[Saturday, August 19, 2017]The purpose of this notice is to announce the Department of Human Services (Department) proposed Fee Schedule Rates for Targeted Service Management and select services funded through the Consolidated and Person/Family Directed Support (P/FDS) waivers and Department-established fees for residential ineligible services effective July 1, 2017, as well as new services the Department will be placing on the Medical Assistance (MA) program fee schedule beginning January 1, 2018, and services that will no longer be available effective January 1, 2018.
The proposed Fee Schedule Rates in this notice also serve as the Department-established fees under 55 Pa. Code § 4300.115(a) (relating to Department established fees) for base-funded services managed through county programs for individuals with an intellectual disability under the Mental Health and Intellectual Disability Act of 1966 (50 P.S. §§ 4104—4704), 55 Pa. Code Chapter 4300 (relating to county mental health and intellectual disability fiscal manual) and 55 Pa. Code Chapter 51 (relating to Office of Developmental Programs home and community-based services).
Fee Schedule Rates
The Fee Schedule Rates are developed using a market-based approach. This process includes a review of the service definitions and a determination of allowable cost components which reflect costs that are reasonable, necessary and related to the delivery of 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 establishes the Fee Schedule Rates to fund services at a level sufficient to ensure access and encourage provider participation, while at the same time ensuring cost effectiveness and fiscal accountability. The Fee Schedule Rates represent the maximum rates that the Department will pay for each service. In developing the proposed Fee Schedule Rates for each service, the following occurs:
The Department evaluates and uses various independent data sources such as a Pennsylvania-specific compensation study and expense data from prior approved cost reports, as applicable, to ensure the rates reflect the expected expenses for the delivery of services under the waivers for the major allowable cost categories listed as follows:
• The support needs of the individual.
• Staff wages.
• Staff-related expenses.
• Productivity.
• Occupancy.
• Program expenses and administration-related expenses.
• A review of approved service definitions in the waivers and determinations made about allowable cost components that reflect expenses necessary and related to the delivery of each service.
• A review of the cost of implementing Federal, State and local statutes, regulations and ordinances.
One Fee Schedule Rate is developed for each service, and 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 licensed and unlicensed Residential Habilitation and Life Sharing.
Effective July 1, 2017, Community-Based Services include behavioral support, companion, in-home and community supports, homemaker/chore, therapy (physical, occupational, speech and language, and orientation, mobility and vision), shift nursing, older adult daily living centers, residential enhanced staffing (supplemental habilitation and additional individualized staffing), supported employment, supports broker, supports coordination, targeted services management, small group employment, supported living, advanced supported employment, community participation support, music therapy, art therapy, equine assisted therapy, benefits counseling, communication specialist, consultative nutritional services, housing transition and tenancy sustaining, family caregiver support counseling (excluding training registration and fees) and all waiver-funded respite care services, excluding respite camp. The Office of Developmental Programs (ODP) reimburses the training and registration fees associated with the family/caregiver support counseling service and respite camp services as outcome-based services. The amount of reimbursement for an outcome-based service is based on the cost charged to the general public for the good or service.
Effective January 1, 2018, rates for the following services, which were being reimbursed using a cost-based methodology, will transition to the MA program fee schedule: the eligible fees for unlicensed and licensed residential habilitation and life sharing. Effective January 1, 2018, additional individualized staffing will no longer be an available service.
AWC/FMS (including and excluding benefit allowance) include agency with choice administration, in-home and community support, companion services, in-home respite and unlicensed out-of-home respite, supported employment, supports broker and homemaker/chore services. There are two separate tables for AWC/FMS; one provides the Fee Schedule Rate including a benefit allowance and the other provides the Fee Schedule Rate excluding a benefit allowance. The benefit allowance is provided as an option to include consideration for benefits such as disability insurance, life insurance, retirement savings and paid time off.
The ODP will be using the proposed Fee Schedule Rates to support claims processing in the Provider Reimbursement and Operations Management Information System in electronic format (PROMISeTM). A notice will be published announcing the final Fee Schedule Rates after the public comment period.
Enhanced Communication Services
Effective July 1, 2017, the Enhanced Communication Services modifier, U1, is available for the following Consolidated and P/FDS Waiver fee schedule services: behavioral support, companion, in-home and community supports, therapy (physical, occupational, speech and language, and orientation, mobility and vision), shift nursing, older adult daily living centers, residential enhanced staffing (supplemental habilitation and additional individualized staffing), supported employment, supports broker, supports coordination, targeted service management, small group employment, supported living, advanced supported employment, community participation support, music therapy, art therapy, equine assisted therapy, benefits counseling, communication specialist, consultative nutritional services, housing transition and tenancy sustaining, family caregiver support counseling (excluding training registration and fees) and all waiver-funded respite care services, excluding respite camp. Effective January 1, 2018, the Enhanced Communication Services modifier will also be available for life sharing and residential habilitation services when provided through the Consolidated Waiver.
The modifier U1 is utilized with the appropriate procedure code to allow providers, who are approved by the Department, to receive the Enhanced Communication Services Rate.
Enhanced Communication Services can be provided to individuals who meet all of the following:
• Enrolled in the Consolidated or P/FDS Waiver.
• Deaf.
• Determined to need services that are provided by staff who are proficient in sign language.
Providers who wish to receive the Enhanced Communication Services rate must be approved to do so by the Department. Requests for enhanced rates should be directed to the Deaf Services Coordinator at RA-ODPDeafServices@pa.gov.
Department-Established Fees
The Department-established fees, residential habilitation ineligible fees, effective July 1, 2017, represent a per-person, per-day net fee based on the size of the home (such as a one-individual home or two-individual home) and type of home (defined as licensed or unlicensed residential habilitation). Effective January 1, 2018, the residential habilitation ineligible procedure codes will change, but the rates will remain the same.
Department-established fees were not developed for the waiver-funded life sharing and supported living services. The fee does not include consideration for room and board payment by the participant, as it is the provider's responsibility to collect that portion of payment from the participant.
The ODP will be using the proposed Department-established fees to support claims processing in PROMISeTM. A notice will be published announcing the final Department-established fees after the public comment period.
Fee Schedule Rates for Community-Based Services Effective July 1, 2017 The Supports Coordination fee identified as follows is also applicable to base-funded supports coordination.
Modifier SE is used to identify the amount of units that are being billed when the individual spent time in the community during the provision of Community Participation Support services.
Modifier SE is used when billing for Benefits Counseling to identify that it is an ODP service.
Modifier SE is used when billing for Music Therapy.
Modifier SE is used when billing for Consultative Nutritional Services to identify that it is an ODP service.
Modifier SE is used when billing for Family Caregiver Support Counseling to identify that it is an ODP service.
Modifier TD is used to identify services rendered by a Registered Nurse (RN).
Modifier TE is used to identify services rendered by a Licensed Practical Nurse (LPN).
Modifiers U5, U6, U7 and U8 are Support Intensity Scale (SIS) Needs Group Modifiers.
Modifier UD is used to when billing for Advanced Supported Employment.
Modifier GP is used to identify services rendered by a Physical Therapist.
Modifier GO is used to identify services rendered by an Occupational Therapist.
Modifier GN is used to identify services rendered by a Speech and Language Therapist.
Modifier UN is used to identify shift nursing at the 1:2 ratio.
Modifier UA is used to identify the Homemaker/Chore service when it is authorized as a temporary service.
Modifier U1 is utilized with the appropriate procedure code to allow providers, who are approved by the Department, to receive the Enhanced Communication Services Rate.
All rates in the table are per 15-minute unit unless otherwise noted.
Service Name Staffing Level Procedure Code Modifier 1 Modifier 2 Statewide Fee Enhanced Communication Statewide Fee (U1 modifier) Companion Services 1:3 W1724 $2.64 $3.03 1:2 W1725 $3.67 $4.25 1:1 W1726 $6.33 $7.43 Homemaker/Chore 1:1 W7283 $16.73
(per hour)N/A 1:1 (temporary) W7283 UA $16.73
(per hour)N/A In-Home and Community Supports 1:3 W7058 $3.17 $3.67 1:2 W7059 $4.52 $5.27 1:1 W7060 $8.08 $9.48 1:1 enhanced W7061 TD and TE $11.44 $13.74 2:1 W7068 $15.72 $18.52 2:1 enhanced W7069 TD and TE $19.07 $22.77 Older Adult Daily Living Centers N/A W7094 $2.73 $3.08 Community Participation Support (CPS) <25% Community 1:2 or 1:3 and >75% Facility 1:11 to 1:15 W5945 SE $2.45 $2.75 <25% Community 1:2 or 1:3 and >75% Facility 1:7 to 1:10 W5946 SE $2.75 $3.10 <25% Community 1:2 or 1:3 and >75% Facility 1:2 to 1:6 W5947 SE $4.45 $5.10 <25% Community 1:1 and >75% Facility 1:7 to 1:15 W5948 SE $3.70 $4.23 <25% Community 1:1 and >75% Facility 1:2 to 1:6 W5950 SE $5.58 $6.44 <25% Community 1:1 and >75% Facility 1:1 W5951 SE $9.55 $11.17 <25% Community 1:1 Enhanced and >75% Facility 1:1 Enhanced W5952 SE TD and TE $13.28 $15.91 <25% Community 2:1 and >75% Facility 2:1 to 1:1 W5943 SE $18.32 $21.55 <25% Community 2:1 Enhanced and >75% Facility 2:1 Enhanced W5944 SE TD and TE $22.05 $26.29 <25% Community 2:3 and >75% Facility 1:11 to 1:15 W5940 SE $3.14 $3.57 <25% Community 2:3 and >75% Facility 1:7 to 1:10 W5941 SE $3.43 $3.92 <25% Community 2:3 and >75% Facility 1:2 to 1:6 W5942 SE $5.14 $5.92 25% Community 1:2 or 1:3 and 75% Facility 1:11 to 1:15 W5958 SE $2.93 $3.32 25% Community 1:2 or 1:3 and 75% Facility 1:7 to 1:10 W5959 SE $3.17 $3.60 25% Community 1:2 or 1:3 and 75% Facility 1:2 to 1:6 W5960 SE $4.57 $5.25 25% Community 1:1 and 75% Facility 1:7 to 1:15 W5961 SE $4.79 $5.53 25% Community 1:1 and 75% Facility 1:2 to 1:6 W5962 SE $6.33 $7.35 25% Community 1:1 and 75% Facility 1:1 W5963 SE $9.60 $11.23 25% Community 1:1 Enhanced and 75% Facility 1:1 Enhanced W5964 SE TD and TE $13.36 $16.00 25% Community 2:1 and 75% Facility 2:1 W5956 SE $18.43 $21.68 25% Community 2:1 Enhanced and 75% Facility 2:1 Enhanced W5957 SE TD and TE $22.18 $26.45 25% Community 2:3 and 75% Facility 1:11 to 1:15 W5953 SE $4.00 $4.60 25% Community 2:3 and 75% Facility 1:7 to 1:10 W5954 SE $4.25 $4.88 25% Community 2:3 and 75% Facility 1:2 to 1:6 W5955 SE $5.65 $6.53 50% Community 1:2 or 1:3 and 50% Facility 1:11 to 1:15 W5970 SE $3.81 $4.36 50% Community 1:2 or 1:3 and 50% Facility 1:7 to 1:10 W5971 SE $3.96 $4.53 50% Community 1:2 or 1:3 and 50% Facility 1:2 to 1:6 W5972 SE $4.80 $5.52 50% Community 1:1 and 50% Facility 1:7 to 1:15 W5973 SE $6.81 $7.92 50% Community 1:1 and 50% Facility 1:2 to 1:6 W5974 SE $7.74 $9.02 50% Community 1:1 and 50% Facility 1:1 W5975 SE $9.70 $11.35 50% Community 1:1 Enhanced and 50% Facility 1:1 Enhanced W5976 SE TD and TE $13.49 $16.16 50% Community 2:1 and 50% Facility 2:1 W5968 SE $18.63 $21.93 50% Community 2:1 Enhanced and 50% Facility 2:1 Enhanced W5969 SE TD and TE $22.42 $26.74 50% Community 2:3 and 50% Facility 1:11 to 1:15 W5965 SE $5.61 $6.50 50% Community 2:3 and 50% Facility 1:7 to 1:10 W5966 SE $5.75 $6.67 50% Community 2:3 and 50% Facility 1:2 to 1:6 W5967 SE $5.59 $7.66 75% Community 1:2 or 1:3 and 25% Facility 1:11 to 1:15 W5982 SE $4.70 $5.41 75% Community 1:2 or 1:3 and 25% Facility 1:7 to 1:10 W5983 SE $4.75 $5.46 75% Community 1:2 or 1:3 and 25% Facility 1:2 to 1:6 W5984 SE $5.03 $5.79 75% Community 1:1 and 25% Facility 1:7 to 1:15 W5985 SE $8.83 $10.32 75% Community 1:1 and 25% Facility 1:2 to 1:6 W5990 SE $9.14 $10.69 75% Community 1:1 and 25% Facility 1:1 W5991 SE $9.79 $11.46 75% Community 1:1 Enhanced and 25% Facility 1:1 Enhanced W5992 SE TD and TE $13.62 $16.32 75% Community 2:1 and 25% Facility 2:1 W5980 SE $18.84 $22.18 75% Community 2:1 Enhanced and 25% Facility 2:1 Enhanced W5981 SE TD and TE $22.66 $27.03 75% Community 2:3 and 25% Facility 1:11 to 1:15 W5977 SE $7.21 $8.40 75% Community 2:3 and 25% Facility 1:7 to 1:10 W5978 SE $7.26 $8.46 75% Community 2:3 and 25% Facility 1:2 to 1:6 W5979 SE $7.54 $8.79 100% Community 1:2 or 1:3 W5995 $5.14 $5.93 100% Community 2:3 H2015 $8.01 $9.35 100% Community 1:1 W5996 $9.84 $11.52 100% Community 1:1 Enhanced W5997 TD and TE $13.68 $16.40 100% Community 2:1 W5993 $18.94 $22.30 100% Community 2:1 Enhanced W5994 TD and TE $22.78 $27.18 Small Group Employment 1:10 to 1:6 W7237 $2.21 $2.65 < 1:6 to 1:3.5 W7239 $3.40 $4.09 < 1:3.5 to > 1:1 W7241 $6.60 $7.95 1:1 W7245 $12.05 $14.53 Benefits Counseling 1:1 W1740 SE $11.40 $13.57 Supported Employment—
Career Assessment1:1 W7235 $17.75 $21.12 Supported Employment—Job
Finding and Development1:1 H2023 $17.75 $21.12 Supported Employment—
Job Coaching and Support1:2 H2025 $10.45 $12.40 1:1 W9794 $17.75 $21.12 Advanced Supported Employment 1:1 (Discovery Profile Outcome) W7235 UD $3,810.00 $4,594.00 Advanced Supported Employment 1:1 (Job Acquisition Outcome) H2023 UD $3,810.00 $4,594.00 Advanced Supported Employment 1:1 (Job Retention Outcome) H2025 UD $9,144.00 $11,025.60 Shift Nursing—RN 1:2 T2025 TD UN $8.06 $9.90 1:1 T2025 TD $15.78 $19.46 Shift Nursing—LPN 1:2 T2025 TE UN $5.88 $7.13 1:1 T2025 TE $11.41 $13.92 Therapies—Physical 1:1 T2025 GP $21.29 $26.46 Therapies—Occupational 1:1 T2025 GO $19.71 $24.45 Therapies—Speech/Language 1:1 T2025 GN $19.12 $23.71 Therapies—Orientation, Mobility and Vision 1:1 W7246 $18.16 $22.48 Music Therapy 1:1 G0176 SE $15.34 $18.93 Art Therapy 1:1 G0176 $15.34 $18.93 Equine Assisted Therapy 1:1 S8940 $10.36 $12.30 Behavioral Supports—Level 1 1:1 W7095 $21.12 $25.44 Behavioral Supports—Level 2 1:1 W8996 $21.39 $26.42 Communication Specialist 1:1 T1013 $15.32 $18.90 Consultative Nutritional Services 1:1 S9470 SE $12.36 $15.15 Family Caregiver Support Counseling 1:1 without participant present 90846 SE $12.12 N/A 1:1 with participant present 90847 SE $12.12 $14.85 24 Hour Respite (In-Home Respite and Unlicensed Out-of-Home Respite Services) 1:4 W9795 $69.86
(per day)$83.12
(per day)1:3 W9796 $93.09
(per day)$110.78
(per day)1:2 W9797 $139.56
(per day)$166.10
(per day)1:1 W9798 $245.13
(per day)$291.75
(per day)1:1 Enhanced W9799 $416.93
(per day)$509.93
(per day)2:1 W9800 $490.11
(per day)$583.34
(per day)2:1 Enhanced W9801 $661.90
(per day)$801.53
(per day)15 Minute Respite (In-Home Respite and Unlicensed Out-of-Home Respite Services) 1:4 W8096 $1.75 $2.08 1:3 W9860 $2.33 $2.77 1:2 W9861 $3.49 $4.15 1:1 W9862 $6.13 $7.29 1:1 Enhanced W9863 $10.42 $12.75 2:1 W9864 $12.25 $14.58 2:1 Enhanced W8095 $16.55 $20.04 24 Hour Respite (Licensed Respite Group Homes) Needs Group 1-2 Person W9791 U5 $456.17
(per day)$543.52
(per day)Needs Group 1-3 Person W9792 U5 $331.94
(per day)$395.06
(per day)Needs Group 1-4 Person W9793 U5 $263.76
(per day)$313.54
(per day)Needs Group 2-2 Person W9791 U6 $538.09
(per day)$643.36
(per day)Needs Group 2-3 Person W9792 U6 $365.87
(per day)$436.50
(per day)Needs Group 2-4 Person W9793 U6 $292.42
(per day)$348.59
(per day)Needs Group 3-1 Person W9790 U7 $787.76
(per day)$940.81
(per day)Needs Group 3-2 Person W9791 U7 $644.77
(per day)$774.54
(per day)Needs Group 3-3 Person W9792 U7 $457.38
(per day)$548.81
(per day)Needs Group 3-4 Person W9793 U7 $360.12
(per day)$431.68
(per day)Needs Group 4-1 Person W9790 U8 $861.70
(per day)$1,034.28
(per day)Needs Group 4-2 Person W9791 U8 $702.24
(per day)$847.32
(per day)Needs Group 4-3 Person W9792 U8 $499.39
(per day)$601.96
(per day)Needs Group 4-4 Person W9793 U8 $393.36
(per day)$473.69
(per day)24 Hour Respite (Respite Only Home) Needs Group 1-2 Person W9865 U5 $520.58
(per day)$620.26
(per day)Needs Group 1-3 Person W9866 U5 $378.80
(per day)$450.83
(per day)Needs Group 1-4 Person W9871 U5 $300.98
(per day)$357.79
(per day)Needs Group 2-2 Person W9865 U6 $614.06
(per day)$734.20
(per day)Needs Group 2-3 Person W9866 U6 $417.52
(per day)$498.13
(per day)Needs Group 2-4 Person W9871 U6 $333.70
(per day)$397.80
(per day)Needs Group 3-2 Person W9865 U7 $735.80
(per day)$883.89
(per day)Needs Group 3-3 Person W9866 U7 $521.94
(per day)$626.29
(per day)Needs Group 3-4 Person W9871 U7 $410.95
(per day)$492.62
(per day)Needs Group 4-2 Person W9865 U8 $801.39
(per day)$966.95
(per day)Needs Group 4-3 Person W9866 U8 $569.89
(per day)$686.95
(per day)Needs Group 4-4 Person W9871 U8 $448.88
(per day)$540.56
(per day)Supports Broker Services 1:1 W7096 $16.88 $19.66 Supports Coordination 1:1 W7210 $23.62 $27.39 Targeted Services Management 1:1 T1017 $23.62 $27.39 Housing Transition and Tenancy Sustaining 1:1 H0043 $10.48 $12.50 Supplemental Habilitation 1:1 W7070 $5.46 $6.67 2:1 W7084 $10.93 $13.32 Additional Individualized Staffing (effective July 1, 2017, through December 31, 2017) 1:1 W7085 $5.46 $6.67 2:1 W7086 $10.93 $13.32
Service Group Needs Group Procedure Code Modifier 1 Modifier 2 Approved Program Capacity or Staffing Level Statewide Fee Enhanced Communication Statewide Fee Supported Living Needs Group 1 W9872 U5 1 Person $133.10 $156.12 W9873 U5 2 People $93.17 $109.29 W9874 U5 3 People $66.55 $78.06 Needs Group 2 W9872 U6 1 Person $208.26 $244.33 W9873 U6 2 People $166.61 $195.47 W9874 U6 3 People $110.79 $129.97 Needs Group 3 W9872 U7 1 Person $341.36 $400.46 W9873 U7 2 People $286.40 $335.98 W9874 U7 3 People $198.17 $232.47 Needs Group 4 W9872 U8 1 Person $428.58 $502.87 W9873 U8 2 People $428.58 $502.87 W9874 U8 3 People $299.32 $351.20
Department-Established Fees Effective July 1, 2017, through December 31, 2017 All rates in the table are per day.
Service Procedure Code Modifier Unit Statewide Fee Licensed Community Homes—Ineligible W6091 Day $84.15 W6093 $45.88 W6095 $30.59 W6097 $23.03 W6099 $16.82 Licensed Child Residential Services—Ineligible W7011 Day $84.15 W7013 $45.88 W7015 $30.59 W7017 $23.03 W7019 $16.82 Licensed Community Residential Rehabilitation Services—Ineligible W7021 Day $84.15 W7023 $45.88 W7025 $30.59 W7027 $23.03 W7029 $16.82 Unlicensed Residential Services—Ineligible W7079 Day $20.57 W7081 $12.39 W7083 $6.36
Agency with Choice Financial Management Services, Including Benefit Allowance** Effective July 1, 2017
**No modifier is needed to indicate the benefit allowance is included. Modifier TD is used to identify services rendered by a RN.
Modifier TE is used to identify services rendered by a LPN.
Modifier U1 is utilized with the appropriate procedure code to allow providers, who are approved by the Department, to receive the Enhanced Communication Services Rate.
All rates in the table are per 15 minute unit unless otherwise noted.
Service Name Staffing Level Procedure Code Modifier 1 Modifier 2 Statewide Fee Enhanced Communication Statewide Fee In-Home and Community supports 1:1 W7060 $5.53 $6.76 2:1 W7068 $11.04 $13.51 In-Home and Community supports—Enhanced 1:1 (Enhanced) W7061 TD and TE $7.55 $9.34 2:1 (Enhanced) W7069 TD and TE $11.31 $13.86 Companion Services 1:1 W1726 $4.54 $5.51 In-Home Respite and Unlicensed Out-of-Home Respite Services 1:1 W9862 $3.49 $4.18 2:1 W9864 $6.97 $8.34 1:1 W9798 $264.75
(per day$317.07
(per day)2:1 W9800 529.51
(per day)$634.14
(per day)In-Home Respite and Unlicensed Out-of-Home Respite Services—Enhanced 1:1 W9863 $7.50 $9.28 2:1 W8095 $10.99 $13.45 1:1 W9799 $570.23
(per day)$705.01
(per day)2:1 W9801 $834.98
(per day)$1,022.08
(per day)Supported Employment—
Career Assessment1:1 W7235 $6.96 $7.67 Supported Employment—
Job Finding and Development1:1 H2023 $6.96 $7.67 Supported Employment—
Job Coaching and Support1:1 W9794 $6.96 $7.67 Supports Broker 1:1 W7096 $5.42 $6.63 Homemaker/Chore 1:1 W7283 $13.78
(per hour)N/A AWC/FMS Monthly
Administrative FeePer Person
Per MonthW7319 $231.21 N/A
Agency with Choice Financial Management Services, Excluding Benefit Allowance Effective July 1, 2017
**Modifier U4 must be used with all procedures codes when billing for services excluding benefit allowance. Modifier TD is used to identify services rendered by a RN.
Modifier TE is used to identify services rendered by a LPN.
Modifier U1 is utilized with the appropriate procedure code to allow providers, who are approved by the Department, to receive the Enhanced Communication Services Rate.
All rates in the table are per 15 minute unit unless otherwise noted.
Service Name Staffing Level Procedure Code Modifier 1 Modifier 2 Statewide Fee Enhanced Communication Statewide Fee In-Home and Community supports 1:1 W7060 U4 $4.91 $6.14 2:1 W7068 U4 $9.80 $12.27 Companion Services 1:1 W1726 U4 $3.92 $4.89 In-Home Respite and Unlicensed Out-of-Home Respite Services 1:1 W9862 U4 $3.11 $3.86 2:1 W9864 U4 $5.73 $7.10 1:1 W9798 U4 $217.58
(per day)$269.90
(per day)2:1 W9800 U4 $435.17
(per day)$539.80
(per day)In-Home and Community supports—Enhanced 1:1 W7061 U4 TD and TE $6.93 $8.72 2:1 W7069 U4 TD and TE $10.07 $12.61 In-Home Respite and Unlicensed Out-of-Home Respite Services—Enhanced 1:1 W9863 U4 $6.88 $8.66 2:1 W8095 U4 $9.75 $12.21 1:1 W9799 U4 $523.05
(per day)$657.84
(per day)2:1 W9801 U4 $740.63
(per day)$927.74
(per day)Supported Employment—
Career Assessment1:1 W7235 U4 $6.34 $7.04 Supported Employment—
Job Finding and Development1:1 H2023 U4 $6.34 $7.04 Supported Employment—
Job Coaching and Support1:1 W9794 U4 $6.34 $7.04 Supports Broker 1:1 W7096 U4 $4.80 $6.00 Homemaker/Chore 1:1 W7283 U4 $11.29
(per hour)N/A AWC/FMS Monthly
Administrative FeePer Person
Per MonthW7319 $231.21 N/A
Fee Schedule Rates Effective January 1, 2018 The modifier HI is used when the individual is not receiving Waiver-funded service during the day.
The modifier SE is used when the Life Sharing Service is being provided by a family member.
Modifier TD is used to identify services rendered by a RN.
Modifier TE is used to identify services rendered by a LPN.
Modifiers U5, U6, U7 and U8 are Needs Group Modifiers.
Modifier U1 is utilized with the appropriate procedure code to allow providers, who are approved by the Department, to receive the Enhanced Communication Services Rate.
All rates in the table are per day.
Service Group Needs Group Procedure Code Modifier 1 Modifier 2 Approved Program Capacity or Staffing Level Statewide Fee Enhanced Communication Statewide Fee Licensed Residential Habilitation with Day Needs Group 1 W9000 U5 1 Person $392.42 $479.77 W9029 U5 2 People $392.42 $479.77 W9045 U5 3 People $283.48 $346.60 W9047 U5 4 People $222.86 $272.64 W9064 U5 5—8 People $204.55 $250.24 Needs Group 2 W9000 U6 1 Person $474.34 $579.61 W9029 U6 2 People $474.34 $579.61 W9045 U6 3 People $317.41 $388.94 W9047 U6 4 People $251.52 $307.69 W9064 U6 5—8 People $226.72 $277.25 Needs Group 3 W9000 U7 1 Person $685.74 $838.79 W9029 U7 2 People $581.02 $710.79 W9045 U7 3 People $408.92 $500.35 W9047 U7 4 People $319.22 $390.78 W9064 U7 5—8 People $285.32 $349.20 Needs Group 4 W9000 U8 1 Person $759.68 $932.26 W9029 U8 2 People $638.49 $783.57 W9045 U8 3 People $450.93 $553.50 W9047 U8 4 People $352.46 $432.79 W9064 U8 5—8 People $309.17 $379.49 Licensed Residential Habilitation without Day Needs Group 1 W9000 U5 HI 1 Person $488.16 $596.00 W9029 U5 HI 2 People $488.16 $596.00 W9045 U5 HI 3 People $362.28 $442.29 W9047 U5 HI 4 People $283.94 $346.82 W9064 U5 HI 5—8 People $250.13 $305.55 Needs Group 2 W9000 U6 HI 1 Person $548.26 $669.42 W9029 U6 HI 2 People $548.26 $669.42 W9045 U6 HI 3 People $399.23 $487.46 W9047 U6 HI 4 People $313.60 $383.05 W9064 U6 HI 5—8 People $282.01 $344.58 Needs Group 3 W9000 U7 HI 1 Person $838.54 $1,025.06 W9029 U7 HI 2 People $621.80 $760.35 W9045 U7 HI 3 People $466.30 $570.16 W9047 U7 HI 4 People $364.15 $445.40 W9064 U7 HI 5—8 People $326.81 $399.83 Needs Group 4 W9000 U8 HI 1 Person $1,021.19 $1,252.44 W9029 U8 HI 2 People $748.70 $918.39 W9045 U8 HI 3 People $570.30 $699.55 W9047 U8 HI 4 People $439.74 $539.52 W9064 U8 HI 5—8 People $391.70 $480.60 Unlicensed Residential Habilitation N/A W7078 TD and TE 1 Person $120.05 $147.27 W7080 TD and TE 2 People $75.40 $92.33 W7082 TD and TE 3 People $54.46 $66.62 Life Sharing—over 30 hours per week on average Needs Group 1 W8593 U5 SE (provided by relative) 1 Person $144.22 $180.99 W8595 U5 SE (provided by relative) 2 People $102.45 $128.80 Needs Group 2 W8593 U6 SE (provided by relative) 1 Person $171.82 $215.60 W8595 U6 SE (provided by relative) 2 People $122.88 $154.54 Needs Group 3 W8593 U7 SE (provided by relative) 1 Person $262.95 $328.60 W8595 U7 SE (provided by relative) 2 People $184.93 $231.69 Needs Group 4 W8593 U8 SE (provided by relative) 1 Person $321.74 $401.75 W8595 U8 SE (provided by relative) 2 People $220.57 $276.14 Life Sharing—under 30 hours per week on average N/A W7037 SE (provided by relative) TD and TE 1 Person $142.23 $178.45 W7039 SE (provided by relative) TD and TE 2 People $100.72 $126.60
Department-Established Fees Effective January 1, 2018 All rates in the table are per day.
Service Name Procedure Code Approved Program Capacity Statewide Fee Licensed—Residential Habilitation Ineligible
Needs Groups 1—4W9001 1 Person $84.15 W9030 2 People $45.88 W9046 3 People $30.59 W9048 4 People $23.03 W9065 5—8 People $16.82 Unlicensed Residential Habilitation Ineligible
Needs Groups 1—4W7079 1 Person $20.57 W7081 2 People $12.39 W7083 3 People $6.36
Fiscal Impact
It is estimated that there will be additional cost to the Commonwealth of $361.394 million ($174.183 million in State funds) in Fiscal Year 2017-2018 and $475.732 million ($229.380 million in State funds) in Fiscal Year 2018-2019 and subsequent years.
Public Comment
Copies of this notice may be obtained at the local Mental Health/Intellectual Disability (MH/ID) County Program, Administrative Entity (AE) or regional Office of Developmental Programs 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: P.O. Box 2675, DGS Annex Complex, Harrisburg, PA 17105, (717) 772-6507
Contact information for the local MH/ID County Program or AE may be found 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 the proposed Fee Schedule Rates, Department-established fees, new services the Department will be placing on the MA program fee schedule and services that will no longer be available to the Department 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 can also be sent to ra-ratesetting@pa.gov. Use subject header ''PN Fee Schedule.''
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania AT&T 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).
Comments received within 30 days of publication of this notice will be reviewed and considered for revisions.
THEODORE DALLAS,
SecretaryFiscal Note: 14-NOT-1174. (1) General Fund;
(7) ID—Community Waiver Program; (2) Implementing Year 2017-18 is $173,886,000; (3) 1st Succeeding Year 2018-19 through 5th Succeeding Year 2022-23 are $228,786,000; (4) 2016-17 Program—$1,349,000,000; 2015-16 Program—$1,202,000,000; 2014-15 Program—$1,074,000,000;
(7) ID—Community Base Program; (2) Implementing Year 2017-18 is $297,000; (3) 1st Succeeding Year 2018-19 through 5th Succeeding Year 2022-23 are $594,000; (4) 2016-17 Program—$149,950,000; 2015-16 Program—$148,229,000; 2014-15 Program—$149,681,000;
(8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 17-1381. Filed for public inspection August 18, 2017, 9:00 a.m.]
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