Pennsylvania Bulletin

PA Bulletin, Doc. No. 22-25

NOTICES

DEPARTMENT OF
HUMAN SERVICES

Availability of the Proposed Rate Setting Methodology, Fee Schedule Rates and Department-Established Fees for Services Funded Through the Office of Developmental Programs' Consolidated, Community Living and Person/Family Directed Support Waivers and the Community Intellectual Disability Base-Funded Program and Availability of Proposed Amendments to the Community Living and Person/Family Directed Support Waivers

[52 Pa.B. 102]
[Saturday, January 1, 2022]

The Department of Human Services (Department) is making available for public review and comment the rate setting methodology used to develop the proposed Fee Schedule Rates for services funded through the Consolidated, Community Living and Person/Family Directed Support (P/FDS) Waivers and the Community Intellectual Disability Base-Funded Program and the proposed Department-Established Fees for residential ineligible services.

The proposed Fee Schedule Rates will be effective January 1, 2022, with the exception of the rates for direct Community Participation Support services. The temporary increases to the Fee Schedule Rates for direct Community Participation Support services published at 51 Pa.B. 1907 (April 3, 2021) will remain in effect until 6 months after the expiration of the Federal novel coronavirus (COVID-19) public health emergency. The proposed Department-Established Fees will be effective July 1, 2022.

The Department is also making available for public review and comment the proposed increases to the maximum available annual funding per individual for services in the Community Living and P/FDS Waivers to ensure that proposed changes to the Fee Schedule Rates do not result in a reduction or loss of waiver services.

Background

Under 55 Pa. Code § 6100.571 (relating to fee schedule rates), which was effective October 5, 2019, the Department is required to update the data used in establishing the fee schedule rates at least every 3 years. The Department has reviewed and revised its rates for services funded through the Consolidated, Community Living and P/FDS Waivers and the Community Intellectual Disability Base-Funded Program to comply with this requirement as well as to comply with the requirement in the Home and Community-Based Waiver Instructions, Technical Guide and Review Criteria to ensure at a minimum of every 5 years that rates are adequate to maintain an ample provider base and ensure quality of services.

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 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 Consolidated, Community Living and P/FDS Waivers.

As required by 55 Pa. Code § 6100.571(b), 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 Consolidated, Community Living and P/FDS 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.

One Fee Schedule Rate was developed for each service. The Fee Schedule Rates are identified under the following categories: Community-Based Services, Agency with Choice/Financial Management Services (AWC/FMS), including benefit allowance and excluding benefit allowance, Community Participation Support and Residential Waiver Services. The AWC/FMS benefit allowance is provided as an option to include consideration for benefits such as disability insurance, life insurance, retirement savings and paid time off.

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.

Two Department-Established Fees were developed for each Residential Habilitation Ineligible service based on geographic costs based on the location where the service is provided.

The proposed Fee Schedule Rates 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/providers/Providers/Pages/2022-Proposed-Rates-for-Consolidated-Community-Living-PFDS-Waivers.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 COMMUNITY BASED SERVICES EFFECTIVE JANUARY 1, 2022

Rates in the table are per 15-minute unit unless otherwise noted.

Service Name Staffing Level Procedure Code Statewide Fee Enhanced Communication Statewide Fee

Companion 1:3 W1724 $3.19 $4.24

1:2 W1725 $4.42 $5.99

1:1 W1726 $7.71 $10.69

Homemaker/Chore 1:1 W7283 $22.73
(hour) N/A

1:1 W7282 $22.73
(hour) N/A

In-Home and Community Supports 1:3 W7058 $4.09 $5.61

1:2 W7059 $5.76 $8.01

1:1 W7060 $10.28 $14.49

1:1 enhanced W7061 $14.18 $19.14

2:1 W7068 $19.83 $28.20

2:1 enhanced W7069 $23.74 $32.85

Older Adult Daily Living Centers 1:1 W7094 $3.72 $4.41

Community Participation Support—
On Call and Remote Support N/A W9400 $1.64 $1.78

Small Group Employment 1:10 to 1:6 W7237 $2.30 $2.79

<1:6 to 1:3.5 W7239 $3.54 $4.31

<1:3.5 to >1:1 W7241 $6.96 $8.49

1:1 W7245 $13.15 $16.03

Benefits Counseling 1:1 W1740 $13.36 $16.09

Supported Employment Job Finding and Development 1:1 H2023 $17.91 $21.53

Job Coaching and
Support 1:1 W9794 $17.91 $21.53

1:2 to 1:4 H2025 $10.72 $12.88

Career Assessment 1:1 W7235 $17.91 $21.53

Advanced Supported Employment Discovery Profile 1:1 W7235 $3,998.78
(outcome) $4,856.22
(outcome)

Job Acquisition 1:1 H2023 $3,998.78
(outcome) $4,856.22
(outcome)

Job Retention 1:1 H2025 $9,597.08
(outcome)
$11,654.93
(outcome)

Shift Nursing—RN 1:2 T2025 $9.72 $12.24

1:1 T2025 $19.07 $24.12

Shift Nursing—LPN 1:2 T2025 $7.07 $8.82

1:1 T2025 $13.77 $17.28

Therapies—Physical 1:1 T2025 $23.96 $30.43

Therapies—Occupational 1:1 T2025 $22.74 $28.87

Therapies—Speech/Language 1:1 T2025 $21.88 $27.76

Therapies—Orientation, Mobility, Vision 1:1 W7246 $20.78 $26.34

Music Therapy 1:1 G0176 $17.42 $22.02

Art Therapy 1:1 G0176 $17.42 $22.02

Equine Therapy 1:1 S8940 $12.12 $14.78

Behavioral Supports—Level 1 1:1 W7095 $22.08 $27.10

Behavioral Supports—Level 2 1:1 W8996 $23.66 $29.90

Communication Specialist 1:1 T1013 $16.89 $21.33

Consultative Nutritional Services 1:1 S9470 $13.96 $17.56

Family Caregiver Training and Support 1:1 without participant present 90846 $13.32 $16.73

1:1 with participant present 90847 $13.32 $16.73

24 hour Respite—In-Home and Unlicensed Out-Of-Home 1:4 W9795 $90.59
(per day) $119.20
(per day)

1:3 W9796 $119.11
(per day) $157.26
(per day)

1:2 W9797 $176.17
(per day) $233.39
(per day)

1:1 W9798 $317.80
(per day) $422.84
(per day)

1:1 enhanced W9799 $491.89
(per day) $606.23
(per day)

2:1 W9800 $630.98
(per day) $841.06
(per day)

2:1 enhanced W9801 $805.07
(per day) $1,024.45
(per day)

15-Minute Respite (In-Home Respite and Unlicensed Out-Of-Home Respite) 1:4 W8096 $2.26 $2.98

1:3 W9860 $2.98 $3.93

1:2 W9861 $4.40 $5.83

1:1 W9862 $7.95 $10.57

1:1 enhanced W9863 $12.30 $15.16

2:1 W9864 $15.77 $21.03

2:1 enhanced W8095 $20.13 $25.61

Supports Broker 1:1 W7096 $18.02 $21.44

Supports Coordination 1:1 W7210 $25.19 N/A

Targeted Supports Management 1:1 T1017 $25.19 N/A

Housing Transition and Tenancy Sustaining Services 1:1 H0043 $20.24 $24.42

AGENCY WITH CHOICE FINANCIAL MANAGEMENT SERVICES, INCLUDING BENEFIT ALLOWANCE EFFECTIVE JANUARY 1, 2022

Rates in the table are per 15-minute unit unless otherwise noted

Service Name Staffing Level Procedure Code Statewide Fee Enhanced Communication Statewide Fee (U1 modifier)

In-Home and Community Supports 1:1 W7060 $7.55 $9.42

2:1 W7068 $15.09 $18.85

In-Home and Community Supports—Enhanced 1:1
(Enhanced) W7061 $9.66 $12.15

2:1
(Enhanced) W7069 $14.20 $17.69

Companion Services 1:1 W1726 $6.07 $7.52

In-Home Respite and Unlicensed Out-of-Home Respite Services 1:1 W9862 $5.18 $6.36

2:1 W9864 $10.35 $12.72

1:1 W9798 $393.09
(per day) $483.32
(per day)

2:1 W9800 $649.80
(per day) $790.73
(per day)

In-home Respite and Unlicensed Out-of-Home Respite Services—Enhanced 1:1 W9863 $10.08 $12.69

2:1 W8095 $15.26 $19.05

1:1 W9799 $707.77
(per day) $889.26
(per day)

2:1 W9801 $1,032.67
(per day) $1,284.62
(per day)

Supported Employment—Career Assessment 1:1 W7235 $8.53 $10.69

Supported Employment—Job Finding and Development 1:1 H2023 $8.53 $10.69

Supported Employment—Job Coaching and Support 1:1 W9794 $8.53 $10.69

Supports Broker 1:1 W7096 $7.15 $8.91

Homemaker 1:1 W7283 $16.73
(per hour) N/A

Chore 1:1 W7282 $16.73
(per hour) N/A

AWC FMS Monthly Administrative Fee Per Person
Per Month W7319 $285.28 N/A

AGENCY WITH CHOICE FINANCIAL MANAGEMENT SERVICES, EXCLUDING BENEFIT ALLOWANCE EFFECTIVE JANUARY 1, 2022

Rates in the table are per 15-minute unit unless otherwise noted.

Service Name Staffing Level Procedure Code Statewide Fee Enhanced Communication Statewide Fee (U1 Modifier)

In-Home and Community Supports 1:1 W7060 $6.79 $8.66

2:1 W7068 $13.57 $17.32

In-Home and Community Supports—Enhanced 1:1
(Enhanced) W7061 $8.90 $11.38

2:1
(Enhanced) W7069 $12.67 $16.16

Companion Services 1:1 W1726 $5.30 $6.75

In-Home Respite and Unlicensed Out-of-Home Respite Services 1:1 W9862 $4.41 $5.59

2:1 W9864 $8.82 $11.19

1:1 W9798 $334.99
(per day) $425.23
(per day)

2:1 W9800 $533.61
(per day) $674.53
(per day)

In-home Respite and Unlicensed Out-of-Home Respite Services—Enhanced 1:1 W9863 $9.32 $11.93

2:1 W8095 $13.73 $17.52

1:1 W9799 $649.68
(per day) $831.17
(per day)

2:1 W9801 $916.48
(per day) $1,168.84
(per day)

Supported Employment—Career Assessment 1:1 W7235 $7.77 $9.93

Supported Employment—Job Finding and Development 1:1 H2023 $7.77 $9.93

Supported Employment—Job Coaching and Support 1:1 W9794 $7.77 $9.93

Supports Broker 1:1 W7096 $6.39 $8.15

Homemaker 1:1 W7283 $13.67
(per hour) N/A

Chore 1:1 W7282 $13.67
(per hour) N/A

AWC FMS Monthly Administrative Fee Per Person
Per Month W7319 $285.28 N/A

FEE SCHEDULE RATES FOR COMMUNITY PARTICIPATION SUPPORT SERVICES EFFECTIVE SIX MONTHS AFTER THE EXPIRATION OF THE FEDERAL PUBLIC HEALTH EMERGENCY

Rates in the table are per 15-minute unit unless otherwise noted.

Service Name Staffing Level Procedure Code Statewide Fee Enhanced Communication Statewide Fee

Community Participation Support Community 1:2 or 1:3 W9351 $5.85 $7.04
2:3 W9352 $8.99 $10.97

1:1 W5996 $11.84 $14.56

1:1 enhanced W5997 $15.87 $19.15

2:1 W5993 $22.58 $28.03

2:1 enhanced W5994 $26.61 $32.62

Facility 1:11 to 1:15 W7222 $2.38 $2.63

1:7 to 1:10 W7223 $2.49 $2.82

1:4 to 1:6 W7226 $4.13 $4.82

1:2 to 1:3 W7224 $5.33 $6.38

1:1 W7244 $11.68 $14.36

1:1 enhanced W9353 $15.64 $18.86

2:1 W7269 $22.20 $27.57

2:1 enhanced W9356 $26.16 $32.06

FEE SCHEDULE RATES FOR CONSOLIDATED AND COMMUNITY LIVING RESIDENTIAL WAIVER SERVICES EFFECTIVE JANUARY 1, 2022

Rates in the table are per day unit unless otherwise noted.

Service Group Needs Group Program Capacity or Staffing Level Procedure Code Statewide Fee Enhanced Communication Statewide Fee

Licensed Residential
Habilitation With Day Needs Group 1 1 person W9000 $408.54 $483.85
2 people W9029 $408.54 $483.85

3 people W9045 $294.49 $348.86

4 people W9047 $232.07 $273.03

5—8 people W9064 $212.03 $249.80

Needs Group 2 1 person W9000 $515.01 $616.78

2 people W9029 $515.01 $616.78

3 people W9045 $341.21 $407.36

4 people W9047 $268.22 $318.28

5—8 people W9064 $250.71 $296.52

Needs Group 3 1 person W9000 $746.22 $904.71

2 people W9029 $630.70 $763.82

3 people W9045 $440.90 $533.42

4 people W9047 $341.91 $411.61

5—8 people W9064 $314.42 $377.36

Needs Group 4 1 person W9000 $822.23 $1,001.00

2 people W9029 $689.49 $839.39

3 people W9045 $484.03 $588.28

4 people W9047 $376.12 $454.77

5—8 people W9064 $338.58 $409.29

Licensed Residential
Habilitation Without Day Needs Group 1 1 person W9000 $523.00 $625.89
2 people W9029 $523.00 $625.89

3 people W9045 $387.76 $464.60

4 people W9047 $304.14 $362.46

5—8 people W9064 $267.15 $318.19

Needs Group 2 1 person W9000 $606.92 $731.03

2 people W9029 $606.92 $731.03

3 people W9045 $441.87 $532.49

4 people W9047 $347.00 $416.21

5—8 people W9064 $311.99 $372.69

Needs Group 3 1 person W9000 $924.89 $1,127.34

2 people W9029 $685.68 $832.32

3 people W9045 $514.20 $624.76

4 people W9047 $401.47 $485.81

5—8 people W9064 $360.24 $434.44

Needs Group 4 1 person W9000 $1,118.74 $1,371.94

2 people W9029 $820.15 $1,002.85

3 people W9045 $624.74 $764.32

4 people W9047 $481.66 $586.80

5—8 people W9064 $429.04 $522.45

Unlicensed Residential Habilitation N/A 1 person W7078 $132.49 $148.08

2 people W7080 $83.20 $95.08

3 people W7082 $60.10 $69.68

Life Sharing—Over 30 Hours Per Week On Average Needs Group 1 1 person W8593 $171.35 $175.71

2 people W8595 $120.79 $123.14

Needs Group 2 1 person W8593 $204.29 $211.85

2 people W8595 $144.84 $148.79

Needs Group 3 1 person W8593 $279.58 $300.48

2 people W8595 $197.06 $208.48

Needs Group 4 1 person W8593 $355.61 $394.90

2 people W8595 $237.16 $257.42

Life Sharing—Under 30 Hours Per Week On Average N/A 1 person W7037 $147.63 $149.02

2 people W7039 $105.13 $105.97

24 Hour Respite (Licensed Respite Group Homes) Needs Group 1 2 people W9791 $474.70 $550.01
3 people W9792 $348.80 $403.17

4 people W9793 $278.56 $319.52

Needs Group 2 2 people W9791 $581.17 $682.94

3 people W9792 $395.52 $461.67

4 people W9793 $314.71 $364.77

Needs Group 3 1 person W9790 $855.36 $1,013.85

2 people W9791 $696.86 $829.98

3 people W9792 $495.21 $587.73

4 people W9793 $388.40 $458.10

Needs Group 4 1 person W9790 $931.37 $1,110.14

2 people W9791 $755.65 $905.55

3 people W9792 $538.34 $642.59

4 people W9793 $422.61 $501.26

24 Hour Respite (Respite Only Home) Needs Group 1 2 people W9865 $541.71 $627.66
3 people W9866 $398.05 $460.09

4 people W9871 $317.88 $364.62

Needs Group 2 2 people W9865 $663.22 $779.36

3 people W9866 $451.36 $526.85

4 people W9871 $359.14 $416.27

Needs Group 3 2 people W9865 $795.25 $947.16

3 people W9866 $565.12 $670.71

4 people W9871 $443.23 $522.77

Needs Group 4 2 people W9865 $862.33 $1,033.39

3 people W9866 $614.34 $733.31

4 people W9871 $482.27 $572.03

Supplemental Habilitation N/A 1:1 W7070 $5.77
(15-minute unit) $7.56

2:1 W7084 $11.53
(15-minute unit) $15.12

Supported Living Needs Group 1 1 person W9872 $151.12 $183.39
2 people W9873 $105.79 $128.37

3 people W9874 $75.56 $91.70

Needs Group 2 1 person W9872 $253.26 $307.60

2 people W9873 $202.61 $246.08

3 people W9874 $134.19 $162.97

Needs Group 3 1 person W9872 $404.38 $490.99

2 people W9873 $338.62 $411.13

3 people W9874 $235.07 $285.43

Needs Group 4 1 person W9872 $543.72 $660.72

2 people W9873 $543.72 $660.72

3 people W9874 $378.48 $459.90

DEPARTMENT-ESTABLISHED FEES FOR RESIDENTIAL HABILITATION INELIGIBLE
EFFECTIVE JULY 1, 2022

Rates in the table are per day.

Service Procedure Code Approved Program Capacity Area 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 $99.10 $88.34

W9030 2 people $54.05 $47.38

W9046 3 people $38.74 $33.46

W9048 4 people $30.10 $25.61

W9065 5—8 people $21.58 $17.86

Unlicensed Residential Habilitation—Ineligible W7079 1 person $26.69 $23.74

W7081 2 people $15.45 $13.16

W7083 3 people $9.04 $7.08

Proposed Waiver Amendments

Whenever substantive changes are made to an approved waiver, the Department must submit an amendment to the Centers for Medicare & Medicaid Services (CMS) for approval. The Department proposes to increase the limits on the maximum dollar amount of waiver services in Appendix C-4 as follows effective January 1, 2022:

• The current limit of $70,000 per person per fiscal year for Community Living Waiver services will be increased to $85,000. Supports Coordination services will continue to be excluded from this limit.

• The current limit of $33,000 per person per fiscal year for P/FDS Waiver services will be increased to $41,000. Supports Coordination and Supports Broker services will continue to be excluded from this limit. The limit can continue to be exceeded by $15,000 for Advanced Supported Employment or Supported Employment services.

The proposed increases will ensure that the proposed changes to the Fee Schedule Rates do not result in a reduction or loss of waiver services for individuals.

Fiscal Impact

It is anticipated that there will be a total cost to the Commonwealth in Fiscal Year (FY) 2021-2022 of $190.636 million ($81.196 million in State funds). For FY 2021-2022, the increased costs to the ID-Community Waiver Program are $185.870 million ($76.430 million in State funds) and an increase of $4.766 million in State funds to the ID-Community Base Program.

In FY 2022-2023, the cost is $395.640 million ($201.890 million in State funds). ID-Community Waiver Program costs are $385.749 million ($191.999 million in State funds) and ID-Community Base Program costs are $9.891 million in State funds.

For FY 2023-2024 and subsequent years, the cost is $395.640 million ($202.522 million in State funds). ID-Community Waiver Program costs are $385.749 million ($192.631 million in State funds) and ID-Community Base Program costs are $9.891 million in State funds.

Public Comment

Interested persons are invited to submit written comments regarding the proposed rates and waiver amendments. Comments should be addressed 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 may also be submitted to the Department at ra-ratesetting@pa.gov using subject header ''Proposed ID/A Rates.''

Comments received within 30 days of publication of this notice will be reviewed and considered for revisions to the proposed rates and waiver amendments.

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 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, ra-ratesetting@pa.gov.

MEG SNEAD,
Acting Secretary

Fiscal Note: 14-NOT-1481. (1) General Fund;

(7) ID—Community Waiver Program; (2) Implementing Year 2021-22 is $76,430,000; (3) 1st Succeeding Year 2022-23 is $191,999,000; 2nd Succeeding Year 2023-24 through 5th Succeeding Year 2026-27 are $192,631,000; (4) 2020-21 Program—$1,622,000,000; 2019-20 Program—$1,664,000,000; 2018-19 Program—$1,644,000,000;

(7) ID—Community Base Program; (2) Implementing Year 2021-22 is $4,766,000; 1st Succeeding Year 2022-23 through 5th Succeeding Year 2026-27 are $9,891,000; (4) 2020-21 Program—$144,432,000; 2019-20 Program—$148,943,000; 2018-19 Prgram—$149,379,000;

(8) recommends adoption. Funds have been included in the budget.

[Pa.B. Doc. No. 22-25. Filed for public inspection December 30, 2021, 9:00 a.m.]

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NOTICES

DEPARTMENT OF
HUMAN SERVICES

[52 Pa.B. 102]
[Saturday, January 1, 2022]

FEE SCHEDULE RATES FOR COMMUNITY BASED SERVICES EFFECTIVE JANUARY 1, 2022

AGENCY WITH CHOICE FINANCIAL MANAGEMENT SERVICES, INCLUDING BENEFIT ALLOWANCE EFFECTIVE JANUARY 1, 2022

AGENCY WITH CHOICE FINANCIAL MANAGEMENT SERVICES, EXCLUDING BENEFIT ALLOWANCE EFFECTIVE JANUARY 1, 2022

FEE SCHEDULE RATES FOR COMMUNITY PARTICIPATION SUPPORT SERVICES EFFECTIVE SIX MONTHS AFTER THE EXPIRATION OF THE FEDERAL PUBLIC HEALTH EMERGENCY

FEE SCHEDULE RATES FOR CONSOLIDATED AND COMMUNITY LIVING RESIDENTIAL WAIVER SERVICES EFFECTIVE JANUARY 1, 2022

DEPARTMENT-ESTABLISHED FEES FOR RESIDENTIAL HABILITATION INELIGIBLE
EFFECTIVE JULY 1, 2022

[Pa.B. Doc. No. 22-25. Filed for public inspection December 30, 2021, 9:00 a.m.]

Service Name		Staffing Level	Procedure Code	Statewide Fee	Enhanced Communication Statewide Fee
Companion		1:3	W1724	$3.19	$4.24
		1:2	W1725	$4.42	$5.99
		1:1	W1726	$7.71	$10.69
Homemaker/Chore		1:1	W7283	$22.73 (hour)	N/A
Homemaker/Chore		1:1	W7282	$22.73 (hour)	N/A
In-Home and Community Supports		1:3	W7058	$4.09	$5.61
		1:2	W7059	$5.76	$8.01
		1:1	W7060	$10.28	$14.49
		1:1 enhanced	W7061	$14.18	$19.14
		2:1	W7068	$19.83	$28.20
		2:1 enhanced	W7069	$23.74	$32.85
Older Adult Daily Living Centers		1:1	W7094	$3.72	$4.41
Community Participation Support— On Call and Remote Support		N/A	W9400	$1.64	$1.78
Small Group Employment		1:10 to 1:6	W7237	$2.30	$2.79
		<1:6 to 1:3.5	W7239	$3.54	$4.31
		<1:3.5 to >1:1	W7241	$6.96	$8.49
		1:1	W7245	$13.15	$16.03
Benefits Counseling		1:1	W1740	$13.36	$16.09
Supported Employment	Job Finding and Development	1:1	H2023	$17.91	$21.53
	Job Coaching and Support	1:1	W9794	$17.91	$21.53
	Job Coaching and Support	1:2 to 1:4	H2025	$10.72	$12.88
	Career Assessment	1:1	W7235	$17.91	$21.53
Advanced Supported Employment	Discovery Profile	1:1	W7235	$3,998.78 (outcome)	$4,856.22 (outcome)
	Job Acquisition	1:1	H2023	$3,998.78 (outcome)	$4,856.22 (outcome)
	Job Retention	1:1	H2025	$9,597.08 (outcome)	$11,654.93 (outcome)
Shift Nursing—RN		1:2	T2025	$9.72	$12.24
Shift Nursing—RN		1:1	T2025	$19.07	$24.12
Shift Nursing—LPN		1:2	T2025	$7.07	$8.82
Shift Nursing—LPN		1:1	T2025	$13.77	$17.28
Therapies—Physical		1:1	T2025	$23.96	$30.43
Therapies—Occupational		1:1	T2025	$22.74	$28.87
Therapies—Speech/Language		1:1	T2025	$21.88	$27.76
Therapies—Orientation, Mobility, Vision		1:1	W7246	$20.78	$26.34
Music Therapy		1:1	G0176	$17.42	$22.02
Art Therapy		1:1	G0176	$17.42	$22.02
Equine Therapy		1:1	S8940	$12.12	$14.78
Behavioral Supports—Level 1		1:1	W7095	$22.08	$27.10
Behavioral Supports—Level 2		1:1	W8996	$23.66	$29.90
Communication Specialist		1:1	T1013	$16.89	$21.33
Consultative Nutritional Services		1:1	S9470	$13.96	$17.56
Family Caregiver Training and Support		1:1 without participant present	90846	$13.32	$16.73
Family Caregiver Training and Support		1:1 with participant present	90847	$13.32	$16.73
24 hour Respite—In-Home and Unlicensed Out-Of-Home		1:4	W9795	$90.59 (per day)	$119.20 (per day)
		1:3	W9796	$119.11 (per day)	$157.26 (per day)
		1:2	W9797	$176.17 (per day)	$233.39 (per day)
		1:1	W9798	$317.80 (per day)	$422.84 (per day)
		1:1 enhanced	W9799	$491.89 (per day)	$606.23 (per day)
		2:1	W9800	$630.98 (per day)	$841.06 (per day)
		2:1 enhanced	W9801	$805.07 (per day)	$1,024.45 (per day)
15-Minute Respite (In-Home Respite and Unlicensed Out-Of-Home Respite)		1:4	W8096	$2.26	$2.98
		1:3	W9860	$2.98	$3.93
		1:2	W9861	$4.40	$5.83
		1:1	W9862	$7.95	$10.57
		1:1 enhanced	W9863	$12.30	$15.16
		2:1	W9864	$15.77	$21.03
		2:1 enhanced	W8095	$20.13	$25.61
Supports Broker		1:1	W7096	$18.02	$21.44
Supports Coordination		1:1	W7210	$25.19	N/A
Targeted Supports Management		1:1	T1017	$25.19	N/A
Housing Transition and Tenancy Sustaining Services		1:1	H0043	$20.24	$24.42

Service Name	Staffing Level	Procedure Code	Statewide Fee	Enhanced Communication Statewide Fee (U1 modifier)
In-Home and Community Supports	1:1	W7060	$7.55	$9.42
In-Home and Community Supports	2:1	W7068	$15.09	$18.85
In-Home and Community Supports—Enhanced	1:1 (Enhanced)	W7061	$9.66	$12.15
In-Home and Community Supports—Enhanced	2:1 (Enhanced)	W7069	$14.20	$17.69
Companion Services	1:1	W1726	$6.07	$7.52
In-Home Respite and Unlicensed Out-of-Home Respite Services	1:1	W9862	$5.18	$6.36
	2:1	W9864	$10.35	$12.72
	1:1	W9798	$393.09 (per day)	$483.32 (per day)
	2:1	W9800	$649.80 (per day)	$790.73 (per day)
In-home Respite and Unlicensed Out-of-Home Respite Services—Enhanced	1:1	W9863	$10.08	$12.69
	2:1	W8095	$15.26	$19.05
	1:1	W9799	$707.77 (per day)	$889.26 (per day)
	2:1	W9801	$1,032.67 (per day)	$1,284.62 (per day)
Supported Employment—Career Assessment	1:1	W7235	$8.53	$10.69
Supported Employment—Job Finding and Development	1:1	H2023	$8.53	$10.69
Supported Employment—Job Coaching and Support	1:1	W9794	$8.53	$10.69
Supports Broker	1:1	W7096	$7.15	$8.91
Homemaker	1:1	W7283	$16.73 (per hour)	N/A
Chore	1:1	W7282	$16.73 (per hour)	N/A
AWC FMS Monthly Administrative Fee	Per Person Per Month	W7319	$285.28	N/A

Service Name	Staffing Level	Procedure Code	Statewide Fee	Enhanced Communication Statewide Fee (U1 Modifier)
In-Home and Community Supports	1:1	W7060	$6.79	$8.66
In-Home and Community Supports	2:1	W7068	$13.57	$17.32
In-Home and Community Supports—Enhanced	1:1 (Enhanced)	W7061	$8.90	$11.38
In-Home and Community Supports—Enhanced	2:1 (Enhanced)	W7069	$12.67	$16.16
Companion Services	1:1	W1726	$5.30	$6.75
In-Home Respite and Unlicensed Out-of-Home Respite Services	1:1	W9862	$4.41	$5.59
	2:1	W9864	$8.82	$11.19
	1:1	W9798	$334.99 (per day)	$425.23 (per day)
	2:1	W9800	$533.61 (per day)	$674.53 (per day)
In-home Respite and Unlicensed Out-of-Home Respite Services—Enhanced	1:1	W9863	$9.32	$11.93
	2:1	W8095	$13.73	$17.52
	1:1	W9799	$649.68 (per day)	$831.17 (per day)
	2:1	W9801	$916.48 (per day)	$1,168.84 (per day)
Supported Employment—Career Assessment	1:1	W7235	$7.77	$9.93
Supported Employment—Job Finding and Development	1:1	H2023	$7.77	$9.93
Supported Employment—Job Coaching and Support	1:1	W9794	$7.77	$9.93
Supports Broker	1:1	W7096	$6.39	$8.15
Homemaker	1:1	W7283	$13.67 (per hour)	N/A
Chore	1:1	W7282	$13.67 (per hour)	N/A
AWC FMS Monthly Administrative Fee	Per Person Per Month	W7319	$285.28	N/A

Service Name		Staffing Level	Procedure Code	Statewide Fee	Enhanced Communication Statewide Fee
Community Participation Support	Community	1:2 or 1:3	W9351	$5.85	$7.04
		2:3	W9352	$8.99	$10.97
		1:1	W5996	$11.84	$14.56
		1:1 enhanced	W5997	$15.87	$19.15
		2:1	W5993	$22.58	$28.03
		2:1 enhanced	W5994	$26.61	$32.62
	Facility	1:11 to 1:15	W7222	$2.38	$2.63
		1:7 to 1:10	W7223	$2.49	$2.82
		1:4 to 1:6	W7226	$4.13	$4.82
		1:2 to 1:3	W7224	$5.33	$6.38
		1:1	W7244	$11.68	$14.36
		1:1 enhanced	W9353	$15.64	$18.86
		2:1	W7269	$22.20	$27.57
		2:1 enhanced	W9356	$26.16	$32.06

Service Group	Needs Group	Program Capacity or Staffing Level	Procedure Code	Statewide Fee	Enhanced Communication Statewide Fee
Licensed Residential Habilitation With Day	Needs Group 1	1 person	W9000	$408.54	$483.85
		2 people	W9029	$408.54	$483.85
		3 people	W9045	$294.49	$348.86
		4 people	W9047	$232.07	$273.03
		5—8 people	W9064	$212.03	$249.80
	Needs Group 2	1 person	W9000	$515.01	$616.78
		2 people	W9029	$515.01	$616.78
		3 people	W9045	$341.21	$407.36
		4 people	W9047	$268.22	$318.28
		5—8 people	W9064	$250.71	$296.52
	Needs Group 3	1 person	W9000	$746.22	$904.71
		2 people	W9029	$630.70	$763.82
		3 people	W9045	$440.90	$533.42
		4 people	W9047	$341.91	$411.61
		5—8 people	W9064	$314.42	$377.36
	Needs Group 4	1 person	W9000	$822.23	$1,001.00
		2 people	W9029	$689.49	$839.39
		3 people	W9045	$484.03	$588.28
		4 people	W9047	$376.12	$454.77
		5—8 people	W9064	$338.58	$409.29
Licensed Residential Habilitation Without Day	Needs Group 1	1 person	W9000	$523.00	$625.89
		2 people	W9029	$523.00	$625.89
		3 people	W9045	$387.76	$464.60
		4 people	W9047	$304.14	$362.46
		5—8 people	W9064	$267.15	$318.19
	Needs Group 2	1 person	W9000	$606.92	$731.03
		2 people	W9029	$606.92	$731.03
		3 people	W9045	$441.87	$532.49
		4 people	W9047	$347.00	$416.21
		5—8 people	W9064	$311.99	$372.69
	Needs Group 3	1 person	W9000	$924.89	$1,127.34
		2 people	W9029	$685.68	$832.32
		3 people	W9045	$514.20	$624.76
		4 people	W9047	$401.47	$485.81
		5—8 people	W9064	$360.24	$434.44
	Needs Group 4	1 person	W9000	$1,118.74	$1,371.94
		2 people	W9029	$820.15	$1,002.85
		3 people	W9045	$624.74	$764.32
		4 people	W9047	$481.66	$586.80
		5—8 people	W9064	$429.04	$522.45
Unlicensed Residential Habilitation	N/A	1 person	W7078	$132.49	$148.08
		2 people	W7080	$83.20	$95.08
		3 people	W7082	$60.10	$69.68
Life Sharing—Over 30 Hours Per Week On Average	Needs Group 1	1 person	W8593	$171.35	$175.71
	Needs Group 1	2 people	W8595	$120.79	$123.14
	Needs Group 2	1 person	W8593	$204.29	$211.85
	Needs Group 2	2 people	W8595	$144.84	$148.79
	Needs Group 3	1 person	W8593	$279.58	$300.48
	Needs Group 3	2 people	W8595	$197.06	$208.48
	Needs Group 4	1 person	W8593	$355.61	$394.90
	Needs Group 4	2 people	W8595	$237.16	$257.42
Life Sharing—Under 30 Hours Per Week On Average	N/A	1 person	W7037	$147.63	$149.02
Life Sharing—Under 30 Hours Per Week On Average	2 people	W7039	$105.13	$105.97
24 Hour Respite (Licensed Respite Group Homes)	Needs Group 1	2 people	W9791	$474.70	$550.01
		3 people	W9792	$348.80	$403.17
		4 people	W9793	$278.56	$319.52
	Needs Group 2	2 people	W9791	$581.17	$682.94
		3 people	W9792	$395.52	$461.67
		4 people	W9793	$314.71	$364.77
	Needs Group 3	1 person	W9790	$855.36	$1,013.85
		2 people	W9791	$696.86	$829.98
		3 people	W9792	$495.21	$587.73
		4 people	W9793	$388.40	$458.10
	Needs Group 4	1 person	W9790	$931.37	$1,110.14
		2 people	W9791	$755.65	$905.55
		3 people	W9792	$538.34	$642.59
		4 people	W9793	$422.61	$501.26
24 Hour Respite (Respite Only Home)	Needs Group 1	2 people	W9865	$541.71	$627.66
		3 people	W9866	$398.05	$460.09
		4 people	W9871	$317.88	$364.62
	Needs Group 2	2 people	W9865	$663.22	$779.36
		3 people	W9866	$451.36	$526.85
		4 people	W9871	$359.14	$416.27
	Needs Group 3	2 people	W9865	$795.25	$947.16
		3 people	W9866	$565.12	$670.71
		4 people	W9871	$443.23	$522.77
	Needs Group 4	2 people	W9865	$862.33	$1,033.39
		3 people	W9866	$614.34	$733.31
		4 people	W9871	$482.27	$572.03
Supplemental Habilitation	N/A	1:1	W7070	$5.77 (15-minute unit)	$7.56
Supplemental Habilitation	N/A	2:1	W7084	$11.53 (15-minute unit)	$15.12
Supported Living	Needs Group 1	1 person	W9872	$151.12	$183.39
		2 people	W9873	$105.79	$128.37
		3 people	W9874	$75.56	$91.70
	Needs Group 2	1 person	W9872	$253.26	$307.60
		2 people	W9873	$202.61	$246.08
		3 people	W9874	$134.19	$162.97
	Needs Group 3	1 person	W9872	$404.38	$490.99
		2 people	W9873	$338.62	$411.13
		3 people	W9874	$235.07	$285.43
	Needs Group 4	1 person	W9872	$543.72	$660.72
		2 people	W9873	$543.72	$660.72
		3 people	W9874	$378.48	$459.90

Service	Procedure Code	Approved Program Capacity	Area 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	$99.10	$88.34
	W9030	2 people	$54.05	$47.38
	W9046	3 people	$38.74	$33.46
	W9048	4 people	$30.10	$25.61
	W9065	5—8 people	$21.58	$17.86
Unlicensed Residential Habilitation—Ineligible	W7079	1 person	$26.69	$23.74
	W7081	2 people	$15.45	$13.16
	W7083	3 people	$9.04	$7.08

NOTICES

DEPARTMENT OF HUMAN SERVICES

[52 Pa.B. 102][Saturday, January 1, 2022]

FEE SCHEDULE RATES FOR COMMUNITY BASED SERVICES EFFECTIVE JANUARY 1, 2022

AGENCY WITH CHOICE FINANCIAL MANAGEMENT SERVICES, INCLUDING BENEFIT ALLOWANCE EFFECTIVE JANUARY 1, 2022

AGENCY WITH CHOICE FINANCIAL MANAGEMENT SERVICES, EXCLUDING BENEFIT ALLOWANCE EFFECTIVE JANUARY 1, 2022

FEE SCHEDULE RATES FOR COMMUNITY PARTICIPATION SUPPORT SERVICES EFFECTIVE SIX MONTHS AFTER THE EXPIRATION OF THE FEDERAL PUBLIC HEALTH EMERGENCY

FEE SCHEDULE RATES FOR CONSOLIDATED AND COMMUNITY LIVING RESIDENTIAL WAIVER SERVICES EFFECTIVE JANUARY 1, 2022

DEPARTMENT-ESTABLISHED FEES FOR RESIDENTIAL HABILITATION INELIGIBLE EFFECTIVE JULY 1, 2022

[Pa.B. Doc. No. 22-25. Filed for public inspection December 30, 2021, 9:00 a.m.]

DEPARTMENT OF
HUMAN SERVICES

[52 Pa.B. 102]
[Saturday, January 1, 2022]

DEPARTMENT-ESTABLISHED FEES FOR RESIDENTIAL HABILITATION INELIGIBLE
EFFECTIVE JULY 1, 2022