NOTICES
DEPARTMENT OF
HUMAN SERVICES
Medical Assistance Fee Schedule Revisions in the Independence Waiver
[47 Pa.B. 6445]
[Saturday, October 14, 2017]This notice announces the Department of Human Services' (Department) addition of the following services in the Medical Assistance (MA) Independence Waiver under 55 Pa. Code § 52.45(a) and (d) (relating to fee schedule rates): Residential Habilitation 1-3; Residential Habilitation 1-3 Support 1:1; Residential Habilitation 1-3 Support 2:1; Residential Habilitation 4-8; Residential Habilitation 4-8 Support 1:1; Residential Habilitation 4-8 Support 2:1; and the addition of Structured Day Habilitation Group, Structured Day Habilitation 1:1 and Structured Day Habilitation 2:1. The addition of these services to the Independence Waiver is necessary to allow individuals to transfer from the CommCare Waiver to the Independence Waiver as part of the migration to Community HealthChoices.
The rate and changes to the fee schedule are effective October 1, 2017.
Rate-Setting Methodology
The Department used the same rate methodology for the fee schedule rates as that used in the public notice published at 42 Pa.B. 3343 (June 9, 2012). Fee schedule rates were developed using a standardized market-based rate setting methodology. Relevant market-based information used to determine the fee schedule rates included Commonwealth-specific wage information from the Center for Workforce Information and Analysis, Occupational Wages by County, Bureau of Labor Statistics Employer Costs, cost surveys from providers, Medicare rate information and MA State Plan Fee Schedules.
Fee Schedule Rates
The following table provides the procedure code and rates for Residential Habilitation services:
Residential Habilitation 1-3
Region Aging Attendant Care Act 150 CC IW OW Procedure
CodeModifier Rate Unit 1 N/A N/A N/A X X X W0100 N/A 264.15 1 day 2 N/A N/A N/A X X X W0100 N/A 264.15 1 day 3 N/A N/A N/A X X X W0100 N/A 264.15 1 day 4 N/A N/A N/A X X X W0100 N/A 264.15 1 day CC = CommCare IW = Independence OW = OBRA
Residential Habilitation 1-3 Support 1:1
Region Aging Attendant Care Act 150 CC IW OW Procedure Code Modifier Rate Unit 1 N/A N/A N/A X X X W0101 U4 19.79 1 hour 2 N/A N/A N/A X X X W0101 U4 19.79 1 hour 3 N/A N/A N/A X X X W0101 U4 19.79 1 hour 4 N/A N/A N/A X X X W0101 U4 19.79 1 hour CC = CommCare IW = Independence OW = OBRA
Residential Habilitation 1-3 Support 2:1
Region Aging Attendant Care Act 150 CC IW OW Procedure Code Modifier Rate Unit 1 N/A N/A N/A X X X W0101 U5 39.58 1 hour 2 N/A N/A N/A X X X W0101 U5 39.58 1 hour 3 N/A N/A N/A X X X W0101 U5 39.58 1 hour 4 N/A N/A N/A X X X W0101 U5 39.58 1 hour CC = CommCare IW = Independence OW = OBRA
Residential Habilitation 4-8
Region Aging Attendant Care Act 150 CC IW OW Procedure Code Modifier Rate Unit 1 N/A N/A N/A X X X W0102 N/A 247.67 1 day 2 N/A N/A N/A X X X W0102 N/A 247.67 1 day 3 N/A N/A N/A X X X W0102 N/A 247.67 1 day 4 N/A N/A N/A X X X W0102 N/A 247.67 1 day CC = CommCare IW = Independence OW = OBRA
Residential Habilitation 4-8 Support 1:1
Region Aging Attendant Care Act 150 CC IW OW Procedure Code Modifier Rate Unit 1 N/A N/A N/A X X X W0103 U4 19.62 1 hour 2 N/A N/A N/A X X X W0103 U4 19.62 1 hour 3 N/A N/A N/A X X X W0103 U4 19.62 1 hour 4 N/A N/A N/A X X X W0103 U4 19.62 1 hour CC = CommCare IW = Independence OW = OBRA
Residential Habilitation 4-8 Support 2:1
Region Aging Attendant Care Act 150 CC IW OW Procedure Code Modifier Rate Unit 1 N/A N/A N/A X X X W0103 U5 39.23 1 hour 2 N/A N/A N/A X X X W0103 U5 39.23 1 hour 3 N/A N/A N/A X X X W0103 U5 39.23 1 hour 4 N/A N/A N/A X X X W0103 U5 39.23 1 hour CC = CommCare IW = Independence OW = OBRA
The following table provides the procedure code and rates for Structured Day Habilitation services:
Structured Day Habilitation Group
Region Aging Attendant Care Act 150 CC IW OW Procedure Code Modifier Rate Unit 1 N/A N/A N/A X X X W0104 N/A 34.56 1 hour 2 N/A N/A N/A X X X W0104 N/A 34.56 1 hour 3 N/A N/A N/A X X X W0104 N/A 34.56 1 hour 4 N/A N/A N/A X X X W0104 N/A 34.56 1 hour CC = CommCare IW = Independence OW = OBRA
Structured Day Habilitation 1:1
Region Aging Attendant Care Act 150 CC IW OW Procedure Code Modifier Rate Unit 1 N/A N/A N/A X X X W0105 U4 19.62 1 hour 2 N/A N/A N/A X X X W0105 U4 19.62 1 hour 3 N/A N/A N/A X X X W0105 U4 19.62 1 hour 4 N/A N/A N/A X X X W0105 U4 19.62 1 hour CC = CommCare IW = Independence OW = OBRA
Structured Day Habilitation 2:1
Region Aging Attendant Care Act 150 CC IW OW Procedure Code Modifier Rate Unit 1 N/A N/A N/A X X X W0105 U5 39.23 1 hour 2 N/A N/A N/A X X X W0105 U5 39.23 1 hour 3 N/A N/A N/A X X X W0105 U5 39.23 1 hour 4 N/A N/A N/A X X X W0105 U5 39.23 1 hour CC = CommCare IW = Independence OW = OBRA
Fiscal Impact
The Department anticipates that the usage or cost associated with the individuals in the CommCare Waiver who are moving to the Independence Waiver will be budget neutral. However, a potential fiscal impact could occur when the population currently in the Independence Waiver, who have not been eligible for Residential Habilitation or Structured Day Habilitation services, or both, become eligible for, enroll in and begin receiving the added services. The fiscal impact of this change is estimated at $5.375 million ($2.590 million in State funds) for Fiscal Year (FY) 2017-2018 and $2.581 million ($1.241 million in State funds) for FY 2018-2019.
Public Comment
Interested persons are invited to submit written comments regarding this notice to the Department of Human Services, Office of Long-Term Living, Bureau of Policy and Regulatory Management, Attention: Chris Barnard, P.O. Box 8025, Harrisburg, PA 17105-8025. Comments can also be sent to RA-waiverstandard@pa.gov. Comments received within 30 days will be considered in subsequent revisions to the fee schedule.
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service by calling (800) 654-5984 (TDD users) or (800) 654-5988 (Voice users).
TERESA D. MILLER,
Acting SecretaryFiscal Note: 14-NOT-1188. (1) General Fund; (2) Implementing Year 2017-18 is $2,590,000; (3) 1st Succeeding Year 2018-19 is $1,241,000; 2nd Succeeding Year 2019-20 through 5th Succeeding Year 2022-23 are $0; (4) 2016-17 Program—$434,607,000; 2015-16 Program—$339,077,000; 2014-15 Program—$273,538,000; (7) Services to Persons with Disabilities; (8) recommends adoption.
[Pa.B. Doc. No. 17-1699. Filed for public inspection October 13, 2017, 9:00 a.m.]
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