NOTICES
Medical Assistance Fee Schedule; Addition of Maximum Overtime Rates for Personal Assistance Services (Consumer) and Respite (Consumer) in the Aging, Attendant Care, COMMCARE, Independence and OBRA Waivers and the Act 150 Program
[46 Pa.B. 106]
[Saturday, January 2, 2016]This notice announces the Department of Human Services (Department) addition of maximum overtime rates for Personal Assistance Services (Consumer) and Respite (Consumer) in the Medical Assistance (MA) Aging, Attendant Care, COMMCARE, Independence and OBRA waivers and the Act 150 Program under 55 Pa. Code § 52.45(a) and (b) (relating to fee schedule rates).
The Department established maximum overtime rates, separate from the regular rates, to enable consumer-employers to pay direct care workers 1.5 times their regular wage for hours worked over 40 hours per week. Providing overtime rates and additional procedure codes with modifier combination to the MA Fee Schedule will ensure compliance with changes to the United States Department of Labor, Fair Labor Standards Act, regulations in 29 CFR Part 552 (relating to application of the Fair Labor Standards Act to domestic service). The following tables indicate the applicable waiver, the new procedure code with modifier combination for billing overtime in 15 minute increments, and the highest rate per unit of overtime. The maximum overtime rates and changes to the fee schedule are effective January 1, 2016. The overtime rates may not exceed the rates in the following tables:
Maximum Personal Assistance Services (Consumer) Overtime Fee Schedule Rates
Region Aging Attendant Care Act 150 CC IW OW Procedure
CodeRate Unit 1 X X X X X X W1792 TU $5.12 15 min 2 X X X X X X W1792 TU $4.89 15 min 3 X X X X X X W1792 TU $5.36 15 min 4 X X X X X X W1792 TU $6.02 15 min CC = COMMCARE
IW = Independence
OW = OBRA
Maximum Respite (Consumer) Overtime Fee Schedule Rates
Region Aging Attendant Care Act 150 CC IW OW Procedure
CodeRate Unit 1 X X X X S5150 TU $5.01 15 min 2 X X X X S5150 TU $4.80 15 min 3 X X X X S5150 TU $5.25 15 min 4 X X X X S5150 TU $5.90 15 min CC = COMMCARE IW = Independence OW = OBRA
Rate-Setting Methodology
The Department used the same rate methodology for the fee schedule rates as previously provided in the public notice, Rate-Setting Methodology, Fee Schedule Rates and Vendor Goods and Services for the Medical Assistance Aging, Attendant Care, COMMCARE, Independence and OBRA Waivers and the Act 150 Program, published at 42 Pa.B. 3343 (June 9, 2012). The Department will also be issuing an Office of Long-Term Living bulletin to include further information and instruction for providers.
Fiscal Impact
The estimated fiscal impact of this change is $6.202 million ($3.086 million in State funds) for Fiscal Year 2015-2016.
Public Comment
Interested persons are invited to submit written comments regarding this notice to the Department of Human Services, Office of Long-Term Living, Bureau of Policy and Regulatory Management, Attention: Elaine Smith, P. O. Box 8025, Harrisburg, PA 17105-8025. Comments can also be sent to RA-waiverstandard@pa.gov. Comments received within 30 days will be considered in subsequent revisions to the fee schedule.
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (Voice users).
THEODORE DALLAS,
SecretaryFiscal Note: 14-NOT-987. (1) General Fund;
(7) Home and Community-Based Services; (2) Implementing Year 2015-16 is $1,011,000; (3) 1st Succeeding Year 2016-17 through 5th Succeeding Year 2020-21 are $2,030,000; (4) 2014-15 Program—$102,983,000; 2013-14 Program—$225,008,000; 2012-13 Program—$184,500,000;
(7) Attendant Care; (2) Implementing Year 2015-16 is $929,000; (3) 1st Succeeding Year 2016-17 through 5th Succeeding Year 2020-21 are $1,862,000; (4) 2014-15 Program—$122,750,000; 2013-14 Program—$116,084,000; 2012-13 Program—$107,830,000;
(7) Services to Persons with Disabilities; (2) Implementing Year 2015-16 is $1,146,000; (3) 1st Succeeding Year 2016-17 through 5th Succeeding Year 2020-21 are $2,301,000; (4) 2014-15 Program—$255,173,000; 2013-14 Program—$233,104,000; 2012-13 Program—$195,135,000;
(8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 16-23. Filed for public inspection December 31, 2015, 9:00 a.m.]
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