NOTICES
DEPARTMENT OF
HUMAN SERVICES
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
[52 Pa.B. 1328]
[Saturday, February 26, 2022]The Department of Human Services (Department) is providing final notice of the Fee Schedule Rates and Department-Established Fees for services funded through the Consolidated, Community Living and Person/Family Directed Support (P/FDS) Waivers and the Community Intellectual Disability Base-Funded Program.
The Fee Schedule Rates are effective January 1, 2022, with the exception of the rates for Agency With Choice Financial Management Services (AWC FMS) and direct Community Participation Support services. The Fee Schedule Rates for AWC-FMS will be effective on March 1, 2022. The Fee Schedule Rates for direct Community Participation Support services will be effective 6 months after the expiration of the Federal novel coronavirus (COVID-19) public health emergency and the temporary increases to the Fee Schedule Rates that are currently in place will end. The Department-Established Fees are effective July 1, 2022.
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, as well as the Community Intellectual Disability Base-Funded Program to comply with this requirement and 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.
Fee Schedule Rates and Department-Established Fees:
The proposed Fee Schedule Rates and Department-Established Fees for Consolidated, Community Living and P/FDS Waiver services, as well as the Community Intellectual Disability Base-Funded Program were published at 52 Pa.B. 102 (January 1, 2022). The Department received comments from 134 stakeholders regarding the proposed changes to the Fee Schedule Rates and Department-Established Fees. A summary of the comments received and the Department's responses is available at https://www.dhs.pa.gov/providers/Providers/Documents/ODP/Public%20Notices%20Related%20to %20Rates/IDA%202022%20Rate%20Comment%20and%20 Response%20Summary.pdf. After reviewing the comments on the proposed rates, the Department determined that an increase to the Fee Schedule Rates for the AWC FMS monthly administrative fee from $285.28 to $311.68 was necessary to cover staff wages and the costs of implementing participant directed services in accordance with requirements in the approved waivers.
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, including benefit allowance and excluding benefit allowance, Community Participation Support Services and Residential Services. The benefit allowance under the Agency with Choice Financial Management Services is provided as an option to include consideration for benefits such as disability insurance, life insurance, retirement savings and paid time off. 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 final Fee Schedule Rates and the Department-Established Fees represent the maximum rates the Department will pay for each service. The final Fee Schedule Rates and the Department-Established Fees are included in the following tables and can also be found online at https://www.dhs.pa.gov/providers/Providers/Pages/ODP-Rates.aspx.
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
CodeStatewide Fee Enhanced
Communication
Statewide FeeCompanion 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 SupportN/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, Vision1:1 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 N/A 1:1 with participant present 90847 $13.32 $16.73 24-Hour Respite (In-Home Respite and Unlicensed Out-of-Home Respite) 1:4 W9795 $90.59
(day unit)$119.20
(day unit)1:3 W9796 $119.11
(day unit)$157.26
(day unit)1:2 W9797 $176.17
(day unit)$233.39
(day unit)1:1 W9798 $317.80
(day unit)$422.84
(day unit)1:1 enhanced W9799 $491.89
(day unit)$606.23
(day unit)2:1 W9800 $630.98
(day unit)$841.06
(day unit)2:1 enhanced W9801 $805.07
(day unit)$1,024.45
(day unit)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 MARCH 1, 2022 Rates in the table are per 15-minute unit unless otherwise noted.
Service Name Staffing Level Procedure
CodeStatewide 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
(day unit)$483.32
(day unit)2:1 W9800 $649.80
(day unit)$790.73
(day unit)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
(day unit)$889.26
(day unit)2:1 W9801 $1,032.67
(day unit)$1,284.62
(day unit)Supported Employment—
Career Assessment1:1 W7235 $8.53 $10.69 Supported Employment—
Job Finding and Development1:1 H2023 $8.53 $10.69 Supported Employment—
Job Coaching and Support1:1 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 FeePer Person
Per MonthW7319 $311.68 N/A
AGENCY WITH CHOICE FINANCIAL MANAGEMENT SERVICES, EXCLUDING BENEFIT ALLOWANCE, EFFECTIVE MARCH 1, 2022 Rates in the table are per 15-minute unit unless otherwise noted.
Service Name Staffing
LevelProcedure
CodeStatewide 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
(day unit)$425.23
(day unit)2:1 W9800 $533.61
(day unit)$674.53
(day unit)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
(day unit)$831.17
(day unit)2:1 W9801 $916.48
(day unit)$1,168.84
(day unit)Supported Employment—
Career Assessment1:1 W7235 $7.77 $9.93 Supported Employment—
Job Finding and Development1:1 H2023 $7.77 $9.93 Supported Employment—
Job Coaching and Support1:1 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 FeePer Person
Per MonthW7319 $311.68 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.
Service Name Staffing Level Procedure
CodeStatewide Fee Enhanced
Communication
Statewide FeeCommunity 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 WAIVER RESIDENTIAL SERVICES, EFFECTIVE JANUARY 1, 2022 Rates in the table are per day unit unless otherwise noted.
Service Group Needs Group Program
Capacity or
Staffing
LevelProcedure
CodeStatewide
FeeEnhanced
Communication
Statewide FeeLicensed 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 AverageNeeds 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 AverageN/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
(15-minute unit)2:1 W7084 $11.53
(15-minute unit)$15.12
(15-minute unit)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, 2022Rates in the table are per day unit.
Service Procedure
CodeApproved
Program
CapacityArea 1 (Bucks, Carbon, Chester, Delaware, Lehigh, Monroe, Montgomery, Northampton, Philadelphia and Pike) Area 2
(Remaining
Counties in Pennsylvania)Licensed Residential Habilitation—
IneligibleW9001 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—
IneligibleW7079 1 person $26.69 $23.74 W7081 2 people $15.45 $13.16 W7083 3 people $9.04 $7.08
Copies of this notice 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.
Fiscal Impact
It is anticipated that there will be a total cost to the Commonwealth in Fiscal Year (FY) 2021-2022 of $191.378 million ($81.501 million in State funds). For FY 2021-2022 the increased costs to the Intellectual Disability (ID)—Community Waiver Program are $186.612 million ($76.735 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 total cost is $397.125 million ($202.601 million in State funds). ID—Community Waiver Program costs are $387.234 million ($192.710 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 total cost is $397.125 million ($203.235 million in State funds). ID—Community Waiver Program costs are $387.234 million ($193.344 million in State funds) and ID—Community Base Program costs are $9.891 million in State funds.
MEG SNEAD,
Acting SecretaryFiscal Note: 14-NOT-1499. (1) General Fund;
(7) ID—Community Waiver Program; (2) Implementing Year 2021-22 is $76,735,000; (3) 1st Succeeding Year 2022-23 is $192,710,000; 2nd Succeeding Year 2023-24 through 5th Succeeding Year 2026-27 are $193,344,000; (4) 2020-21 Program—$1,622,000,000; 2019-20 Program—$1,644,000,000; 2018-19 Program—$1,644,000,000;
(7) ID—Community Base Program; (2) Implementing Year 2021-22 is $4,766,000; (3) 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 Program—$149,379,000;
(8) recommends adoption. Funds have been included in the budget.
[Pa.B. Doc. No. 22-329. Filed for public inspection February 25, 2022, 9:00 a.m.]
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