NOTICES
DEPARTMENT OF
HUMAN SERVICES
Updates to Pediatric Shift Care Services for Beneficiaries under 21 Years of Age
[53 Pa.B. 5673]
[Saturday, September 9, 2023]In accordance with 55 Pa. Code § 1150.61(a) (relating to guidelines for fee schedule changes), the Department of Human Services (Department) announces the following changes to the Medical Assistance (MA) Program Fee Schedule for the provision of pediatric home health aide services provided through home health agencies rendered to MA beneficiaries under 21 years of age.
Background
On February 3, 2023, the Centers for Medicare & Medicaid Services (CMS) provided guidance that personal care services provided by a qualified parent or other legally responsible relative (LRR) under the home health benefit, as described in 42 CFR 440.70 (relating to home health services), is allowable if the parent or LRR meets the Federal and State requirements for the provision of those services. In response to CMS' guidance, the Department will cover personal care services provided to MA beneficiaries under 21 years of age under the home health services benefit effective with dates of service on and after October 1, 2023.
To facilitate this change, the Department is adding modifiers to procedure code G0156 to the MA Program Fee Schedule, effective October 1, 2023. Procedure code G0156 with modifier U7 is for pediatric home health aide services by a non-LRR and procedure code G0156 with modifiers U7 and SC is for pediatric home health aide services by an LRR.
Additionally, the Department is end-dating personal care services procedure codes S9122 and T1019, effective September 30, 2023.
New Procedure Code Modifiers
The Department is adding the following modifiers to procedure code G0156 to the MA Program Fee Schedule for the coverage of pediatric home health aide services, effective October 1, 2023.
Procedure Code Modifiers Code Description Fee Unit
LimitAge
LimitG0156 U7 Services of home health/hospice aide in home health or hospice settings, each 15 minutes $6.84
per unit96 per day Age 0—20 G0156 U7, SC Services of home health/hospice aide in home health or hospice settings, legally responsible relative, each 15 minutes $6.84
per unit96 per day Age 0—20 End-dated Procedure Codes
The Department is end-dating the following procedure codes on the MA Program Fee Schedule for the coverage of personal care services, effective September 30, 2023.
Procedure
CodeCode Description Fee Unit
LimitAge
LimitS9122 Home health aide or certified nurse assistant, providing care in the home; per hour $27.36
per unit24 per day Age 0—20 T1019 Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, ICF/MR or IMD, part of the individualized plan of treatment $6.84
per unit96 per day Age 0—20
Prior Authorization Requirements
Procedure code G0156 will require prior authorization, as authorized under section 443.6(b)(7) of the Human Services Code (62 P.S. § 443.6(b)(7)), regarding reimbursement of certain medical assistance items and services.
Providers that received authorizations for procedure codes S9122 or T1019 before October 1, 2023, will continue to use those procedure codes for dates of service through September 30, 2023. The Department will manually adjust those prior authorization requests with new coding and modifiers for dates of service on and after October 1, 2023.
Providers requesting pediatric home health aide services for dates of service beginning on or after October 1, 2023, must use procedure code G0156 and the appropriate modifiers in their submitted requests.
Fiscal Impact
The Department does not anticipate any fiscal impact related to the previously listed updates, as these services are already rendered to MA beneficiaries under 21 years of age.
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, RA-PWMAProgComments@pa.gov. Comments received within 30 days will be reviewed and considered for any subsequent revision 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 (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
VALERIE A. ARKOOSH,
SecretaryFiscal Note: 14-NOT-1589. No fiscal impact; recommends adoption.
[Pa.B. Doc. No. 23-1221. Filed for public inspection September 8, 2023, 9:00 a.m.]
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