NOTICES
DEPARTMENT OF
HUMAN SERVICES
Fee Schedule Rates for Community Participation Support Services Funded Through the Consolidated, Community Living and Person/Family Directed Support Waivers and the Community Intellectual Disability Base-Funded Program
[49 Pa.B. 2685]
[Saturday, May 25, 2019]The Department of Human Services (Department) is providing final notice of the Fee Schedule Rates for Community Participation Support services funded through the Consolidated, Community Living and Person/Family Directed Support waivers and the Community Intellectual Disability Base-Funded Program.
The Fee Schedule Rates for Community Participation Support services 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. §§ 4101—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).
The Fee Schedule Rates for Community Participation Support services were developed in accordance with 55 Pa. Code Chapter 51 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 established the Fee Schedule Rates for Community Participation Support services 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 for Community Participation Support services represent the maximum rates that the Department will pay for each service. In developing the proposed Fee Schedule Rates for each service, the following occurred:
• The Department evaluated and used various independent data sources such as a Commonwealth-specific compensation study to ensure the rates reflect the expected expenses for the delivery of Community Participation Support services under the waivers for the major allowable cost categories listed as follows:
o The support needs of the individual.
o Staff wages.
o Staff-related expenses.
o Productivity.
o Occupancy.
o Program expenses and administration-related expenses.
o 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.
o A review of the cost of implementing Federal, State and local statutes, regulations and ordinances.
The Department announced the proposed Fee Schedule Rates for Community Participation Support services in ODP Announcement 19-024 on March 6, 2019. The Department received comments from over 3,000 people and organizations regarding the proposed changes to the Fee Schedule Rates for Community Participation Support services. As a result of the comments received, the Department adjusted the assumptions regarding the use of full-time versus part-time staff, the cost for training and the staff wage ranges which were used to establish the Fee Schedule Rates for Community Participation Support services. As a result of these adjustments, the Department has increased the Fee Schedule Rates for Community Participation Support facility that were included in ODP Announcement 19-024 for procedure codes W7222, W7223 and W7226. The rate assumption logs containing the revised assumptions are available at http://www.dhs.pa.gov/provider/developmentalprograms/waiveramendment/index.htm. The Department has reduced the number of Community Participation Support procedure codes from 54 to 15 so that the service will be easier to plan for, authorize and bill.
The Department will also be adding an on-call and remote support component to the Community Participation Support service, which will enable waiver participants to have more independence while participating in community activities because provider staff will be available if an issue arises that impacts the waiver participant's health and safety. Because amendments to the Consolidated, Community Living and Person/Family Directed Support waivers must be approved by the Centers for Medicare and Medicaid Services (CMS) before the Department can implement an on-call and remote support component to the Community Participation Support services, the procedure code and Fee Schedule Rate for this component of the Community Participation Support services will not be effective until October 1, 2019.
A summary of the comments received on the Fee Schedule Rates for Community Participation Support services and the Department's responses is available at http://www.dhs.pa.gov/provider/developmentalprograms/waiveramendment/index.htm.
Fee Schedule Rates for Community Participation Support Services Effective July 1, 2019
Service Name Unit of Service Procedure Code Statewide Fee Enhanced Communication Statewide Fee
(U1 modifier)CPS Community 1:2 or 1:3 15 minutes W9351 $5.36 $6.15 CPS Community 2:3 15 minutes W9352 $8.01 $9.35 CPS Community 1:1 15 minutes W5996 $9.84 $11.52 CPS Community 1:1 Enhanced 15 minutes W5997 $13.68 $16.40 CPS Community 2:1 15 minutes W5993 $18.94 $22.30 CPS Community 2:1 Enhanced 15 minutes W5994 $22.78 $27.18 CPS Facility 1:11 to 1:15 15 minutes W7222 $2.27 $2.51 CPS Facility 1:7 to 1:10 15 minutes W7223 $2.44 $2.77 CPS Facility 1:4 to 1:6 15 minutes W7226 $4.01 $4.61 CPS Facility 1:2 to 1:3 15 minutes W7224 $5.26 $6.06 CPS Facility 1:1 15 minutes W7244 $9.52 $11.12 CPS Facility 1:1 Enhanced 15 minutes W9353 $13.25 $15.85 CPS Facility 2:1 15 minutes W7269 $18.26 $21.45 CPS Facility 2:1 Enhanced 15 minutes W9356 $21.98 $26.17
Fee Schedule Rates for Community Participation Support Services Effective October 1, 2019
Service Name Unit of Service Procedure Code Statewide Fee Enhanced Communication Statewide Fee
(U1 modifier)CPS Community On-Call and Remote Support 15 minutes W9400 $1.33 $6.15
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 (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, 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/ServicesSupportDirectory/Counties or by contacting the previously referenced regional ODP.
Interested persons are invited to submit written comments within 30 days regarding the final Fee Schedule Rates for Community Participation Supports services 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.'' The Department will consider comments received within 30 days in reviewing future adjustments to the Community Participation Support services Fee Schedule Rates.
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).
Fiscal Impact
It is anticipated that there will be no additional costs or savings associated with the final Fee Schedule Rates for Community Participation Supports services. The amount of funding available is dependent upon the funds appropriated by the General Assembly for the forthcoming fiscal year. Therefore, until a budget bill is enacted, the fiscal impact is estimated.
TERESA D. MILLER,
SecretaryFiscal Note: 14-NOT-1340. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 19-793. Filed for public inspection May 24, 2019, 9:00 a.m.]
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