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' Adult Autism Waiver and Availability of a Proposed Amendment to the Adult Autism Waiver
[54 Pa.B. 2179]
[Saturday, April 20, 2024]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 Adult Autism Waiver and the proposed Department-Established Fees for residential ineligible services. The rates will be effective July 1, 2024.
The Department is also making available for public review and comment the proposed increase to the total allowable expenditure for all transportation services in the Adult Autism Waiver to ensure that proposed changes to the Fee Schedule Rates do not result in a reduction or loss of transportation services.
Background
The Department is required by 55 Pa. Code § 6100.571 (relating to fee schedule rates), to update the data used to establish the fee schedule rates for services funded through the Adult Autism Waiver at least every 3 years. In addition, the Home and Community-Based Waiver Instructions, Technical Guide and Review Criteria requires the Department to ensure that rates are adequate to maintain an ample provider base and ensure quality of services at a minimum of every 5 years.
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), 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 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/ODP-Proposed-Rate-Information.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 SERVICES
EFFECTIVE JULY 1, 2024Rates in the table are per 15-minute unit unless otherwise noted.
Service Name Staffing Level Procedure Code Statewide Fee Day Habilitation >1:6 W7063 $3.67 <1:6—1:3.5 W7064 $4.44 <1:3.5—>1:1 W7065 $6.93 1:1 W7066 $13.63 Day Habilitation Teleservices 1:1 to 1:5 W0065 $5.43 1:6 and above W0066 $2.10 Residential Habilitation Community Home Light W7228 $171.94
(per day)Limited W7229 $250.72
(per day)Extensive W7230 $315.10
(per day)Intensive W7231 $611.67
(per day)Intensive + W7232 $722.20
(per day)Life Sharing Low W7052 $189.82
(per day)Medium W7054 $230.51
(per day)High W7053 $271.18
(per day)Specialized Skill Development Behavioral Specialist (Plan Development) 1:1 96156 $2,018.25
(per unit)Behavioral Specialist (Consult) 1:1 96171 $25.23 Behavioral Specialist (Direct) 1:1 96159 $25.23 Systematic Skill Building (Plan Development) 1:1 W7214 $650.08
(per unit)Systematic Skill Building (Consult) 1:1 W7216 $20.31 Systematic Skill Building (Direct) 1:1 W7215 $20.31 Community Support 1:1 W7201 $12.39 1:2 W7204 $6.83 1:3 W7205 $4.98 Small Group Employment < 1:6 to > 1:3.5 W0012 $3.49 < 1:3.5 to > 1:1 W0011 $5.13 Supported Employment Intensive Job Coaching (Direct) 1:1 W7200 $21.44 Intensive Job Coaching (Indirect) 1:1 W7207 $21.44 Extended Employment Supports (Direct) 1:1 W7206 $21.44 Extended Employment Supports (Indirect) 1:1 W7202 $21.44 Career Planning Vocational Assessment 1:1 W7071 $21.44 Job Finding 1:1 W7077 $21.44 Therapies Counseling 1:1 T2025 $25.07 Speech/Language 1:1 T2025 $26.39 Nutritional Consultation 1:1 S9470 $19.58 Family Support 1:1 without participant present 90846 $21.83 1:1 with participant present 90847 $21.83 Other H0046 $21.83 Day unit Respite Licensed Out-of-Home All staffing levels W7211 $313.67
(per day)Unlicensed Out-of-Home All staffing levels W9495 $245.91
(per day)15-minute unit Respite In-Home 1:1 W7213 $10.89 Licensed Out-of-Home All staffing levels W7212 $7.84 Unlicensed Out-of-Home All staffing levels W9596 $6.15 Supports Coordination Plan Development 1:1 W7199 $1,367.17
(per unit)Ongoing 1:1 T2024 $30.46 Transportation—Trip Zone 1 W7274 $20.71 Zone 2 W7275 $37.24 Zone 3 W7276 $55.51 Temporary Supplemental Services 1:1 W7236 $12.49
DEPARTMENT-ESTABLISHED FEES FOR RESIDENTIAL HABILITATION INELIGIBLE SERVICES THROUGH THE ADULT AUTISM WAIVER
EFFECTIVE JULY 1, 2024Rates in the table are per day.
Service Staffing Level Procedure Code Statewide Fee Licensed Residential Habilitation
(Community Homes)—IneligibleAll staffing levels W7233 $38.01
Proposed Waiver Amendment
Whenever substantive changes are made to an approved waiver, the Department must submit an amendment to the Centers for Medicare & Medicaid Services for approval. The Department proposes to increase the total allowable expenditure for all transportation services in the Adult Autism Waiver to $10,000 for an individual in a single service plan year. This proposed increase will ensure that the proposed changes to the Fee Schedule Rates do not result in a reduction or loss of transportation services for individuals.
Fiscal Impact
It is anticipated that there will be a total cost to the Commonwealth in Fiscal Year 2024-2025 of $5.600 million ($2.515 million in State funds).
The amount of funding available is dependent upon the funds appropriated by the General Assembly for the forthcoming year. Therefore, the rates as proposed are dependent on approval by the General Assembly.
Public Comment
Copies of this notice may be obtained by contacting the Bureau of Supports for Autism and Special Populations at Forum Place, 8th Floor, Office of Developmental Programs Suite, P.O. Box 2675, Harrisburg, PA 17105, RA-odpautismwaiver@pa.gov.
Comments received within 45 days of publication of this notice will be reviewed and considered for revisions to the proposed Fee Schedule Rates and Department-Established Fees. Written comments should be addressed to Jamie Bonser, 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-ratesetting@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 ofthe toll-free numbers: (800) 654-5984 (TDD users), (800) 654-5988 (voice users), (844)-308-9292 (Speech-to-Speech) or (844)-308-9291 (Spanish).
VALERIE A. ARKOOSH,
SecretaryFiscal Note: 14-NOT-1620. Under section 612 of The Administrative Code of 1929 (71 P.S. § 232), (1) General Fund; (2) Implementing Year 2023-24 is $0; (3) 1st Succeeding Year 2024-25 through 5th Succeeding Year 2028-29 are $2,515,000; (4) 2022-23 Program—$27,610,000; 2021-22 Program—$27,493,000; 2020-21 Program—$27,262,000; (7) Autism Intervention and Services; (8) recommends adoption. Funds have been included in the proposed budget to cover this increase, but dependent on enactment of the 2024-2025 budget.
[Pa.B. Doc. No. 24-561. Filed for public inspection April 19, 2024, 9:00 a.m.]
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