NOTICES
DEPARTMENT OF
HUMAN SERVICES
Availability of Proposed Appendices I and J of the Renewal of the Office of Developmental Programs' Adult Autism Waiver and Proposed Rate Setting Methodology, Fee Schedule Rates and Department-Established Fees for Services Funded through the Office of Developmental Programs' Adult Autism Waiver
[51 Pa.B. 2882]
[Saturday, May 22, 2021]The Department of Human Services (Department) is making available for public review and comment proposed Appendices I and J of the renewal of the Adult Autism Waiver, as well as the rate setting methodology used to develop the proposed Fee Schedule Rates for services funded through the Adult Autism Waiver and the proposed Department-Established Fees for residential ineligible services. The rates will be effective October 1, 2021.
Background
Home and Community-Based Waivers permitted under section 1915(c) of the Social Security Act (42 U.S.C.A. § 1396n(c)) are approved by the Centers for Medicare & Medicaid Services (CMS) for a 5-year renewal period. The current Adult Autism Waiver expires on June 30, 2021; therefore, the proposed Adult Autism Waiver renewal must be submitted to CMS for review and approval. The Department had previously made available for public review and comment proposed Appendices A—H of the Adult Autism Waiver, 51 Pa.B. 1087 (February 27, 2021).
In Appendices I and J of the request for renewal of the Adult Autism Waiver, the Department proposes the following substantive changes effective October 1, 2021:
• Homemaker/Chore, which will be added as an Adult Autism Waiver service, has been added to the services for which there will be a Medical Assistance Fee Schedule rate effective October 1, 2021.
• The factors related to estimated annual average per capita Medicaid costs in Appendix J have been updated to reflect the most recent data available. These factors are Factor D' Derivation, Factor G Derivation and Factor G' Derivation.
• The 5-year average cost per unit of service estimates in Appendix J have been updated to reflect the proposed Fee Schedule Rates contained in this notice.
CMS through its Home and Community-Based Waiver Instructions, Technical Guide and Review Criteria (Technical Guide), requires the Department to review its rate setting methodology at a minimum every 5 years to ensure that rates are adequate to maintain an ample provider base and to ensure quality of services. The Department has not reviewed its rates for Adult Autism Waiver services since it submitted its last renewal of the Adult Autism Waiver in 2016. The Department has reviewed and revised its rates for Adult Autism Waiver services to comply with the requirements of the Technical Guide. The Department has also added to the Fee Schedule Rates a rate for Homemaker/Chore services.
Appendices I and J and the proposed Fee Schedule Rates and Department-Established Fees are available at https://www.dhs.pa.gov/Services/Disabilities-Aging/Pages/Adult-Autism-Waiver-Renewal.aspx.
Rate-Setting Methodology for Fee Schedule Rates and Department-Established Fees:
The proposed Fee Schedule Rates and Department-Established Fees were developed using a market-based approach. The process for the development of the Fee Schedule Rates and Department-Established Fees included a review of the Adult Autism Waiver service definitions and a determination of allowable cost components which reflected costs that are reasonable, necessary and related to 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 and Department-Established Fees to fund services at a level sufficient to ensure access, encourage provider participation, and promote provider choice, while at the same time ensuring cost effectiveness and fiscal accountability. The Fee Schedule Rates and Department-Established Fees represent the maximum rates that the Department will pay for each service.
In developing the proposed Fee Schedule Rates and Department-Established fees for each service, 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 the service under the Adult Autism Waiver.
As required by 55 Pa. Code § 6100.571(b) (relating to fee schedule rates), to establish the Fee Schedule Rates the Department examined and used data relating to the following factors:
• The service needs of the individuals.
• Staff wages.
• Staff-related expenses.
• Productivity.
• Occupancy.
• Program and administration-related expenses.
• Geographic costs based on the location where the service is provided.
• Proposed service definitions in the Adult Autism Waiver and determinations made about allowable cost components that reflect reasonable and necessary costs related to the delivery of each service.
• Cost of implementing applicable Federal and State statutes and regulations and local ordinances.
As required by 55 Pa. Code § 6100.711(c) (relating to fee for the ineligible portion of residential service), to establish the Department-Established Fees the Department examined and used data relating to the following factors:
• Occupancy.
• Meals for staff persons.
• Custodial and maintenance expenses.
• Geographic costs based on the location where the service is provided.
The Department did not develop Department-Established Fees for the Life Sharing service. Life Sharing providers are responsible for complying with 55 Pa. Code §§ 6100.681—6100.694 (relating to room and board) and collecting room and board payment from the participant.
The proposed Fee Schedule Rate and the proposed Department-Established Fees for each service are included in the following tables. The assumption logs used to develop the Fee Schedule Rates and Department-Established fees are available at https://www.dhs.pa.gov/Services/Disabilities-Aging/Pages/Adult-Autism-Waiver-Renewal.aspx.
A notice will be published announcing the final Fee Schedule Rates and Department-Established Fees after the public comment period.
FEE SCHEDULE RATES FOR ADULT AUTISM WAIVER NON-RESIDENTIAL SERVICES
EFFECTIVE OCTOBER 1, 2021All rates in the table are per 15-minute unit unless otherwise noted.
Service Name Staffing Level Procedure Code Statewide Fee Homemaker/Chore Homemaker 1:1 W7283 $16.73 (per hour) Chore 1:1 W7282 $16.73 (per hour) Specialized Skill Development Behavioral Specialist (Plan Development) 1:1 96156 $1,711.20 (per unit) Behavioral Specialist (Consult) 1:1 96171 $21.39 Behavioral Specialist (Direct) 1:1 96159 $21.39 Systematic Skill Building (Plan Development) 1:1 W7214 $507.58 (per unit) Systematic Skill Building (Consult) 1:1 W7216 $15.86 Systematic Skill Building (Direct) 1:1 W7215 $15.86 Community Support 2:1 W7068 $15.72 1:1 W7201 $9.84 1:2 W7204 $5.00 1:3 W7205 $3.33 Community Participation Support
(CPS)Facility 2:1 W7269 $18.26 Facility 1:1 W7244 $9.52 Facility 1:2 to 1:3 W7224 $5.26 Facility 1:4 to 1:6 W7226 $4.01 Community 2:1 W5993 $18.94 Community 2:3 W9352 $8.01 Community 1:1 W5996 $9.84 Community 1:2 to 1:3 W9351 $5.36 Community On-Call/Remote Support W9400 $1.33 Older Adult Daily Living Center W7094 $2.73 Small Group Employment < 1:6 to 1:3.5 W0012 $3.40 < 1:3.5 to > 1:1 W0011 $6.60 Supported Employment—
Intensive Job Coaching (Direct)1:1 W7200 $17.75 Supported Employment—
Intensive Job Coaching (Consult)1:1 W7207 $17.75 Supported Employment—
Extended Job Coaching (Direct)1:1 W7202 $17.75 Supported Employment—
Extended Job Coaching (Consult)1:1 W7206 $17.75 Career Planning—Vocational Assessment 1:1 W7071 $17.75 Career Planning—Job Finding 1:1 W7077 $17.75 Therapy: Counseling 1:1 T2025 $21.29 Nutritional Consultation 1:1 S9470 $15.95 1:1 without participant present 90846 $12.12 Family Support 1:1 with participant present 90847 $12.12 Other H0046 $12.12 Day Respite (Licensed Out-of-Home
Respite Services)1:1 W7211 $238.48 (per day) 1:4 (Basic) W9795 $69.86 (per day) Day Respite (In-Home Respite and Unlicensed 1:3 (Level 1) W9796 $93.09 (per day) Out-of-Home Respite Services) 1:2 (Level 2) W9797 $139.56 (per day) 1:1 (Level 3) W9798 $245.13 (per day) 2:1 (Level 4) W9800 $490.11 (per day) 1:4 (Basic) W8096 $1.75 15 Minute Respite (In-Home Respite and 1:3 (Level 1) W9860 $2.33 Unlicensed Out-of-Home Respite Services) 1:2 (Level 2) W9861 $3.49 1:1 (Level 3) W9862 $6.13 2:1 (Level 4) W9864 $12.25 Supports Coordination Plan Development W7199 $1,016.94 (per unit) Ongoing T2024 $21.19 Zone 1 W7274 $17.85 Transportation—Trip Zone 2 W7275 $32.14 Zone 3 W7276 $36.51 Supplemental Habilitation 1:1 W7070 $5.46 2:1 W7084 $10.93
FEE SCHEDULE RATES FOR RESIDENTIAL HABILITATION AND LIFE SHARING
SERVICES THROUGH THE ADULT AUTISM WAIVER
EFFECTIVE OCTOBER 1, 2021Modifiers U5, U6, U7 and U8 are Needs Group Modifiers.
All rates in the table are per day.
Service Needs Group Procedure Code Modifier Approved Program Capacity Statewide Fee Licensed Residential Habilitation with Day Needs Group 1 W9000 U5 1 Person $392.42 W9029 U5 2 People $392.42 W9045 U5 3 People $283.48 W9047 U5 4 People $222.86 Needs Group 2 W9000 U6 1 Person $474.34 W9029 U6 2 People $474.34 W9045 U6 3 People $317.41 W9047 U6 4 People $251.52 Needs Group 3 W9000 U7 1 Person $685.74 W9029 U7 2 People $581.02 W9045 U7 3 People $408.92 W9047 U7 4 People $319.22 Needs Group 4 W9000 U8 1 Person $759.68 W9029 U8 2 People $638.49 W9045 U8 3 People $450.93 W9047 U8 4 People $352.46 Licensed Residential Habilitation without Day Needs Group 1 W9000 U5 1 Person $488.16 W9029 U5 2 People $488.16 W9045 U5 3 People $362.28 W9047 U5 4 People $283.94 Needs Group 2 W9000 U6 1 Person $548.26 W9029 U6 2 People $548.26 W9045 U6 3 People $399.23 W9047 U6 4 People $313.60 Needs Group 3 W9000 U7 1 Person $838.54 W9029 U7 2 People $621.80 W9045 U7 3 People $466.30 W9047 U7 4 People $364.15 Needs Group 4 W9000 U8 1 Person $1,021.19 W9029 U8 2 People $748.70 W9045 U8 3 People $570.30 W9047 U8 4 People $439.74 Life Sharing—over 30 hours per week on average Needs Group 1 W8593 U5 1 Person $144.22 W8595 U5 2 People $102.45 Needs Group 2 W8593 U6 1 Person $171.82 W8595 U6 2 People $122.88 Needs Group 3 W8593 U7 1 Person $262.95 W8595 U7 2 People $184.93 Needs Group 4 W8593 U8 1 Person $321.74 W8595 U8 2 People $220.57 Life Sharing—under 30 hours per week on average N/A W7037 1 Person $142.23 W7039 2 People $100.72
DEPARTMENT-ESTABLISHED FEES FOR RESIDENTIAL HABILITATION
SERVICES THROUGH THE ADULT AUTISM WAIVER
EFFECTIVE OCTOBER 1, 2021All rates in the table are per day.
Service Procedure Code Approved
Program
CapacityArea 1
(Bucks, Carbon, Chester, Delaware, Lehigh, Monroe, Montgomery, Northampton, Philadelphia and Pike)Area 2
(Remaining counties
in Pennsylvania)Licensed Residential Habilitation—Ineligible W9001 1 Person $92.57 $84.15 W9030 2 People $50.47 $45.88 W9046 3 People $33.65 $30.59 W9048 4 People $25.33 $23.03 Fiscal Impact
It is anticipated that there will be an additional cost of $4.822 million ($1.989 million in State funds) to the Commonwealth in Fiscal Year 2021-2022 and subsequent years.
The amount of funding available is dependent upon the funds appropriated by the General Assembly for the forthcoming year. Therefore, until a budget bill is enacted, the fiscal impact is estimated.
Public Comment
Copies of this notice may be obtained by contacting the Bureau of Supports for Autism and Special Populations at P.O. Box 2675, Harrisburg, PA 17105, RA-odpautismwaiver@pa.gov.
Comments received within 30 days of publication of this notice will be reviewed and considered for revisions to Appendices I and J of the proposed renewal of the Adult Autism Waiver as well as the proposed rates. Written comments should be addressed to Laura Cipriani, Department of Human Services, Office of Developmental Programs, 625 Forster Street, Room 510, Harrisburg, PA 17120. Comments may also be submitted to the Department at RA-odpcomment@pa.gov using subject header ''AAW Rates.''
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania Hamilton 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).
MEG SNEAD,
Acting SecretaryFiscal Note: 14-NOT-1443. (1) General Fund; (2) Implementing Year 2021-22 is $1,989,000; (3) 1st Succeeding Year 2022-23 through 5th Succeeding Year 2026-27 are $1,989,000; (4) 2020-21 Program—$26,448,000; 2019-20 Program—$25,252,000; 2018-19 Program—$30,842,000; (7) Autism Intervention and Services; (8) recommends adoption. The Autism Intervention and Services appropriation is able to absorb this increase.
[Pa.B. Doc. No. 21-812. Filed for public inspection May 21, 2021, 9:00 a.m.]
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