NOTICES
DEPARTMENT OF HUMAN SERVICES
Medical Assistance Program Fee Schedule Addition; Private Duty Nursing
[52 Pa.B. 8292]
[Saturday, December 31, 2022]In accordance with 55 Pa. Code § 1150.61(a) (relating to guidelines for fee schedule changes), the Department of Human Services (Department) announces the addition of the following procedure code to the Medical Assistance (MA) Program Fee Schedule for a second nurse to shadow a nurse providing private duty/shift nursing to MA beneficiaries under 21 years of age, effective with dates of service on and after January 1, 2023.
Procedure
CodeCode Description Unit Limit MA Fee S5116 Home care training, nonfamily; per session 34 hours per 90 days $50 per hour
Background
Section 9817 of the American Rescue Plan Act of 2021 (ARP) (Pub.L. No. 117-2) provides a temporary 10 % increase to the Federal medical assistance percentage for certain Medicaid expenditures for home and community-based services (HCBS). The funding must be used to enhance, expand or strengthen HCBS. States submitted to the Centers for Medicare & Medicaid Services Spending Plans describing how they would use the funding available under the ARP. The Department included in its HCBS Spending Plan a proposal to pay for a nurse being trained by either the current or supervising nurse to shadow the current nurse assigned to private duty nursing cases. Currently, home health agencies cannot bill for a second nurse. By making payments for a nurse to shadow an assigned nurse while the nurse is trained on the care of the patient, the Department hopes to improve retention and continuity of care.
Fiscal Impact
The addition of this procedure code has a minimal fiscal impact on the MA-Fee-for-Service appropriation.
Public Comment
Interested persons are invited to submit written comments regarding this notice to the Department of Human Services, Office of Medical Assistance Programs, c/o Regulations Coordinator, P.O. Box 2675, Harrisburg, PA 17120 or RA-PWMAProgComments@pa.gov. Comments received within 30 days will be reviewed and considered for any subsequent revisions of the MA Program Fee Schedule.
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania Hamilton Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
MEG SNEAD,
Acting SecretaryFiscal Note: 14-NOT-1558. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 22-2039. Filed for public inspection December 30, 2022, 9:00 a.m.]
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