NOTICES
DEPARTMENT OF
HUMAN SERVICES
Availability of Amendments to the Office of Developmental Programs' Consolidated, Person/Family Directed Support, Community Living, and Adult Autism Waivers as Well as Rate Setting Methodology and Fee Schedule Rates for Services Impacted by Waiver Amendments
[51 Pa.B. 6564]
[Saturday, October 16, 2021]The Department of Human Services (Department) is making available for public review and comment the Office of Developmental Programs' proposed amendments to the Consolidated, Person/Family Directed Support (P/FDS), Community Living and Adult Autism waivers. The Department is also making available for public review and comment the rate setting methodology and proposed Fee Schedule Rates for services in the waivers that are impacted by the proposed amendments.
Background
Whenever substantive changes are made to an approved waiver, the Department must submit an amendment to the Centers for Medicare and Medicaid Services (CMS) for approval. The Department proposes the following substantive amendments to all four waivers effective January 1, 2022:
• Promote health, wellness and safety by allowing certain services to be provided in a hospital consistent with amendments to the Social Security Act (42 U.S.C.A. §§ 1396—1396w-6) by the Coronavirus Aid, Relief, and Economic Security Act (Pub.L. No. 116-136).
o In the Consolidated, P/FDS and Community Living waivers, services that can be provided when a participant is hospitalized are: Supplemental Habilitation; In-Home and Community Support; Companion; Supports Broker; Supports Coordination; and Behavioral Support.
o In the Adult Autism waiver, Specialized Skill Development Services can be provided when a participant is hospitalized.
o Participants who receive services when hospitalized will not be disenrolled from the waiver and will not need to have waiver capacity reserved for them to allow them to reenroll in the waiver when discharged from the hospital.
• Promote self-direction, choice and control by allowing certain services to be provided directly to the participant using remote technology.
o In the Consolidated, P/FDS and Community Living waivers, direct services that can be rendered using remote technology are: Community Participation Support; In-Home and Community Support; Companion; Behavioral Support; Supported Employment; Communication Specialist; Music Therapy; Art Therapy; Therapy Services; Consultative Nutritional Services; and Supports Broker.
o In the Adult Autism waiver, direct services that can be rendered using remote technology are: Day Habilitation; Career Planning; Supported Employment; Specialized Skill Development; Therapies—Counseling; and Nutritional Consultation.
• Reduce duplication of services by clarifying that the waivers cannot be used to fund home accessibility durable medical equipment that is covered under the Medical Assistance State Plan.
The following proposed changes solely apply to the Consolidated, P/FDS and Community Living waivers:
• Support people with complex needs by expanding waiver eligibility for children under 22 years of age with a developmental disability due to a medically complex condition. This includes adding a new service, Family Medical Support Assistance service, and amending definitions and provider qualifications for Homemaker/Chore, Home Accessibility Adaptations, Life Sharing, Residential Habilitation and Respite services to meet the needs of these participants.
• Increase participants' access to needed vendor goods and services by allowing Supports Coordination Organizations to be Organized Health Care Delivery Systems.
• Promote independence and choice by implementing payments to providers that successfully transition participants from a licensed home where Residential Habilitation services are provided to four or fewer people to a home where Life Sharing or Supported Living services are provided.
Fee Schedule Rates
The revisions to the waivers resulted in the need for the following proposed changes to Fee Schedule Rates:
• Effective January 1, 2022, additional Fee Schedule Rates will be added for Life Sharing provided through the Consolidated waiver and for the new Family Medical Support Assistance service to support children under 22 years of age with a medically complex condition provided through the Consolidated, Community Living and P/FDS waivers.
• Effective January 1, 2022, two one-time per participant Transition to Independent Living fee schedule payments will be paid to Consolidated waiver providers that successfully transition participants from a licensed home where Residential Habilitation services are provided to four or fewer people to a home where Life Sharing or Supported Living services are provided. The first payment will be made after the new Life Sharing or Supported Living service is rendered to the participant. The second payment will be made after the participant has received 6 consecutive months of Life Sharing or Supported Living services from the provider if, the participant is still residing in the setting to which the participant transitioned and is expected to continue to reside in that location and receive the Life Sharing or Supported Living services.
• Effective 6 months after the expiration of the Federal public health emergency, two additional Fee Schedule Rates will be added for the provision of Community Participation Support using remote technology through the Consolidated, Community Living, P/FDS and Adult Autism waivers.
The proposed Fee Schedule Rates were developed using a market-based approach. The process for the development of the Fee Schedule Rates included a review of the applicable waivers 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 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 represent the maximum rates that the Department will pay for the service.
In developing the proposed Fee Schedule Rates, 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 waivers.
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 waivers 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.
A notice will be published announcing the final Fee Schedule Rates after the public comment period.
The proposed Fee Schedule Rates are included in the following table. The assumption logs used to develop the Fee Schedule Rates are available at https://dhs.pa.gov/Services/Disabilities-Aging/Pages/2022-Proposed-Waiver-Amendments.aspx.
Service Name Staffing Level Procedure Code Statewide Fee Enhanced Communication Statewide Fee Medically Complex Life Sharing
Needs Group 41-person home TBD $435.94
(per day unit)$501.33
(per day unit)2-person home TBD $274
(per day unit)$315.10
(per day unit)Family Medical Support Assistance 1:1 TBD $18.41
(per 15-minute unit)$21.17
(per 15-minute unit)Remote Community Participation Support 1:1 to 1:5 TBD $4.94
(per 15-minute unit)$5.68
(per 15-minute unit)1:6 and above TBD $1.91
(per 15-minute unit)$2.20
(per 15-minute unit)Transition to Independent Living Payment First Payment TBD $15,000
(paid when outcome achieved)N/A Second Payment TBD $15,000
(paid when outcome achieved)N/A
Fiscal Impact
It is anticipated that there will be a total net savings to the Commonwealth in Fiscal Year (FY) 2021-2022 of $3.222 million ($1.525 million in State funds). The net fiscal impact for FY 2021-2022 to Intellectual Disabilities—Community Waiver Program is a savings of $2.633 million ($1.246 million in State funds) and a savings of $0.589 million ($0.279 million in State funds) to Medical Assistance—Capitation.
In FY 2022-2023 and subsequent years, it is anticipated there will be additional net costs to the Commonwealth of $3.936 million ($1.871 million in State funds). The net fiscal impact for FY 2022-2023 and subsequent years to Intellectual Disabilities—Community Waiver Program is an additional cost of $8.651 million ($4.108 million in State funds) and savings of $4.715 million ($2.237 million in State funds) to Medical Assistance—Capitation.
Public Comment
The proposed amendments to the Consolidated, P/FDS, Community Living and Adult Autism waivers, effective January 1, 2022, are available at https://dhs.pa.gov/Services/Disabilities-Aging/Pages/2022-Proposed-Waiver-Amendments.aspx.
Interested persons are invited to submit written comments regarding the proposed waiver amendments and proposed Fee Schedule Rates. Comments should be addressed to Julie Mochon, Department of Human Services, Office of Developmental Programs, 625 Forster Street, Room 510, Harrisburg, PA 17120. Comments may be submitted to the Department at RA-odpcomment@pa.gov using the subject header ''Waiver Amendment Comments.''
Comments received within 30 days of publication of this notice will be reviewed and considered for revisions to the proposed waiver amendments and proposed Fee Schedule Rates.
The Department will hold three webinars to receive comments on the proposed waiver amendments; two webinars for the Consolidated, P/FDS and Community Living waivers and one for the Adult Autism waiver. The date, time and link for registration to attend the webinars for the Consolidated, P/FDS and Community Living waivers are as follows:
November 2, 2021
10 a.m. to 12 p.m.
https://register.gotowebinar.com/register/79013522320162318November 4, 2021
1 p.m. to 3 p.m.
https://register.gotowebinar.com/register/2957278777628553998The date, time and link for registration to attend the webinar for the Adult Autism waiver is as follows:
November 3, 2021
1 p.m. to 2:30 p.m.
https://register.gotowebinar.com/register/6427060397959469070Participants who are interested in participating in the webinars may do so by phone but will need a computer to provide comments during the webinars. To assist the Department in accurately capturing comments provided during the webinars, individuals are asked to submit a written copy of their comments by e-mail or mail to the previously provided address.
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).
Copies of this notice and documents containing the changes proposed in the waiver amendments may be obtained by contacting Julie Mochon, Office of Developmental Programs, 625 Forster Street, Room 510, Harrisburg, PA 17120, RA-odpcomment@pa.gov.
MEG SNEAD,
Acting SecretaryFiscal Note: 14-NOT-1466. (1) General Fund;
(7) Intellectual Disabilities—Community Waiver Program; (2) Implementing Year 2021-22 is -$1,246,000; (3) 1st Succeeding Year 2022-23 through 5th Succeeding Year 2026-27 are $4,108,000; (4) 2020-21 Program—$1,621,000,000; 2019-20 Program—$1,664,000,000; 2018-19 Program—$1,643,000,000;
(7) Autism Intervention and Services; (2) Implementing Year 2021-22 is $0; (3) 1st Succeeding Year 2022-23 through 5th Succeeding Year 2026-27 are $0; (4) 2020-21 Program—$27,262,000; 2019-20 Program—$25,252,000; 2018-19 Program—$30,842,000;
(7) Medical Assistance—Capitation; (2) Implementing Year 2021-22 is -$279,000; (3) 1st Succeeding Year 2022-23 through 5th Succeeding Year 2026-27 are -$2,237,000; (4) 2020-21 Program—$3,060,000,000; 2019-20 Program—$2,507,000,000; 2018-19 Program—$3,303,000,000;
(8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 21-1736. Filed for public inspection October 15, 2021, 9:00 a.m.]
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