NOTICES
Proposed Rate Setting Methodology and Fee Schedule Rates for Services Funded Through the Office of Developmental Programs' Community Living Waiver
[47 Pa.B. 5112]
[Saturday, August 26, 2017]The purpose of this notice is to announce the Department of Human Services' (Department) proposed rate setting methodology and Fee Schedule Rates for select services funded through the Community Living Waiver effective January 1, 2018. The Community Living Waiver is being developed in accordance with the Fiscal Year (FY) 2017-2018 budget for the development and implementation of a new intermediate waiver that will provide services to approximately 1,000 individuals with an intellectual disability or autism, as well as children under 9 years of age with a developmental disability who have a high probability of resulting in an intellectual disability or autism. The Community Living Waiver will have a $70,000 per person per fiscal year total limit for all services with an exception for supports coordination services. The Community Living Waiver will support individuals to live more independently in their homes and communities through the provision of a variety of services that promote community living, employment, communication, self-direction, choice and control over their lives.
Rate-Setting Methodology for Fee Schedule Rates
The Fee Schedule Rates are developed using a market-based approach. This process includes a review of the Community Living Waiver 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 (Office of Management—Budget 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 Commonwealth 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 waiver 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 waiver 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 and Agency with Choice/Financial Management Services (AWC/FMS), including benefit allowance and excluding benefit allowance.
Effective January 1, 2018, 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), supported employment, supports broker, supports coordination, small group employment, supported living, life sharing, 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 training and registration fees associated with the family/caregiver support counseling service and respite camp service are vendor services which are reimbursed by the Department as outcome-based services. The cost of these outcome-based services are based on the cost charged to the general public for the good or 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 Department 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).
Enhanced Communication Services
Effective January 1, 2018, the Enhanced Communication Services modifier, U1, is available for the following Community Living 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), 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. 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 are deaf and enrolled in the Community Living Waiver and who are 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.
Fee Schedule Rates for Community-Based Services through the Community Living Waiver
Effective January 1, 2018Modifier 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 Office of Developmental Program (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 Needs Group Modifiers.
Modifier UD is used 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 Community Participation Support 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 Community Participation Support 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 Assessment 1:1 W7235 $17.75 $21.12 Supported Employment—Job Finding and Development 1:1 H2023 $17.75 $21.12 Supported Employment—Job Coaching and Support 1:2 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 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
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 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 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
Agency with Choice Financial Management Services, Including Benefit Allowance**
Effective January 1, 2018
**No modifier is needed to indicate the benefit allowance is included. Modifier TD is used to identify services rendered by an RN.
Modifier TE is used to identify services rendered by an 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 Assessment 1:1 W7235 $6.96 $7.67 Supported Employment—Job Finding and Development 1:1 H2023 $6.96 $7.67 Supported Employment—Job Coaching and Support 1:1 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 Fee Per Person
Per MonthW7319 $231.21 N/A
Agency with Choice Financial Management Services, Excluding Benefit Allowance
Effective January 1, 2018
**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 an RN.
Modifier TE is used to identify services rendered by an 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 Assessment 1:1 W7235 U4 $6.34 $7.04 Supported Employment—Job Finding and Development 1:1 H2023 U4 $6.34 $7.04 Supported Employment—Job Coaching and Support 1:1 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 Fee Per Person
Per MonthW7319 $231.21 N/A
Rate-Setting Methodology for Transportation (per Trip) Services
Rates for Transportation (per Trip) services delivered on or after January 1, 2018, will be developed utilizing a standardized cost-based methodology. Transportation (per Trip) providers are both private and local government agency providers.
The cost-based methodology requires providers to use a standardized cost report and follow instructions provided by the Department. Cost reports undergo a desk review in which the reported data is analyzed by the Department or its designee for completeness and accuracy based on cost report instructions and standardized review procedures. The Department uses only costs allowable for federal financial participation from the cost report to develop the eligible rates.
The FY 2017-2018 proposed rates for transportation trip services were developed from expenses and utilization data reported in approved transportation cost reports that are based on the FY 2015-2016 historical expense period, when the procedure codes submitted by providers are the same as those entered in the services and supports directory. Cost report data is adjusted to reflect changes in the service definitions that were in effect in FY 2015-2016, the time period for which expense data is submitted, to account for differences in service definitions that are in effect for FY 2017-2018, the time period in which rates are effective.
Transportation Trip Services
Providers who are currently enrolled to provide transportation trip services in the Consolidated and Person/Family Directed Support Waivers will automatically be enrolled to provide transportation trip services in the Community Living Waiver and will be assigned the same rate. The FY 2017-2018 transportation trip proposed rates will be effective for services delivered beginning January 1, 2018, and are subject to the adjustments described as follows, and are assigned at the Master Provider Index—Service Location Code—Procedure Code/Modifier level based on the methodology outlined as follows.
Transportation Trip Outlier Review Process
The total unit cost for a provider and transportation trip service is based on the total expenses reported in the approved transportation cost report for that provider and service divided by the total utilization reported in the approved transportation cost report for that provider and service. The total expenses are equal to Schedule A, Line 12 (total net expenses). The total utilization is equal to Schedule A, Line 13. Each provider will be paid one payment rate for each trip service as this proposed rate reflects consideration for trips with and without aides as reported by the provider. For this reason, there will not be a separate rate for trips with an aide versus without an aide.
The Department reviewed each transportation trip unit cost submitted in approved transportation cost reports for accuracy, reasonableness and to ensure compliance with the Department's allowable cost policies. To support the Department's efforts to continue to standardize rates for similar services, the Department performed a more detailed review of unit costs that were at the upper or lower end of the range of unit costs for each transportation trip service.
Transportation Rate Assignment
The Department assigned proposed payment rates to providers with approved transportation cost reports using the following:
• For existing transportation services and service locations, the rate is calculated and assigned based on allowable costs in the provider's transportation cost report.
• For a new location with no cost history, the Department assigned the rate for the existing service for the provider based on the approved transportation cost report.
The Department assigned payment rates to existing providers who do not have approved cost reports based on the following:
• The lowest rate calculated Statewide based on all approved cost reports for transportation trip services was assigned to providers for an existing service which the provider delivered at any service location in FY 2015-2016.
• The average payment rate calculated based on all approved cost reports for transportation trip services was assigned to providers for a new service which the provider did not deliver at any service location in FY 2015-2016.
• The average payment rate calculated based on all approved cost reports for transportation trip was assigned to new providers who did not provide any services in FY 2015-2016.
The proposed payment rates should be used to process claims submitted to PROMISe in electronic format for services provided. A notice will be published announcing the final rates after the public comment period.
Fiscal Impact
It is estimated that there will be an additional cost to the Commonwealth of $32.00 million ($15.418 million in State funds) in FY 2017-2018 and $64.000 million ($30.752 million in State funds) in FY 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 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: P.O. Box 2675, 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 this notice 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 to the proposed rates or rate setting methodology.
TERESA D. MILLER,
Acting SecretaryFiscal Note: 14-NOT-1175. (1) General Fund; (2) Implementing Year 2017-18 is $15,418,000; (3) 1st Succeeding Year 2018-19 through 5th Succeeding Year 2022-23 are $30,752,000; (4) 2016-17 Program—$1,349,000,000; 2015-16 Program—$1,203,000,000; 2014-15 Program—$1,075,000,000; (7) ID—Community Waiver Program; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 17-1425. Filed for public inspection August 25, 2017, 9:00 a.m.]
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