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PA Bulletin, Doc. No. 10-71

NOTICES

DEPARTMENT OF
PUBLIC WELFARE

Medical Assistance Program Fee Schedule for Select Services in the Consolidated and Person/Family Directed Support Waivers and Community Mental Retardation Base Program; Correction

Purpose

[40 Pa.B. 359]
[Saturday, January 9, 2010]

 The Department of Public Welfare (Department) is correcting the Fee Schedule Tables published at 39 Pa.B. 3238 (June 27, 2009). Specifically, some of the provider types, specialty codes, modifiers, selected services and rates of the Fee Schedule Tables are corrected.

 The published notice did not include the Supported Employment service on the Agency with Choice Financial Management Services, including Benefits Fee Schedule Table. Therefore, Supported Employment has been included on the updated table. In addition, the published notice provided an incorrect Area 2 rate for Unlicensed Habilitation, level 4 enhanced on the same table. The published notice incorrectly stated ''$19.83'' as the Area 2 rate for Unlicensed Habilitation, level 4 enhanced. Instead of ''$19.83'' the notice should have stated ''$19.86'' for the Area 2 rate for that service.

 The revised Fee Schedule Tables with the corrected provider types, specialty codes, modifiers, selected services and rates are as follows:

Fee Schedule Table: Select Community-Based Services

Service Procedure Code Modifier Provider Type Specialty Code Unit Area 1 Area 2 Area 3 Area 4
Nursing Services: LPN T2025 TE 05
______
16		051
______
161		15 minutes $11.02 $10.31 $9.78 $8.89
Nursing Services: RN T2025 TD 05
______
16		051
______
160		15 minutes $16.55 $15.48 $14.68 $13.35
Physical Therapy T2025 GP 17 170 15 minutes $15.64 $14.63 $13.87 $12.61
Occupational Therapy T2025 GO 17 171 15 minutes $17.12 $16.02 $15.19 $13.81
Speech/
Language Therapy 		T2025 GN 17 173 15 minutes $18.73 $17.52 $16.62 $15.10
Individual Behavioral Therapy T2025 HE 19 208 15 minutes $16.50 $15.44 $14.64 $13.31
Group Behavioral Therapy T2025 HE & HQ 19 208 15 minutes $4.12 $3.85 $3.65 $3.32
Visual/Mobility Therapy W7246 51 517 15 minutes $18.73 $17.52 $16.62 $15.10
Companion Services, Basic Staff Support W1724 51 363 15 minutes $ .79 $ .74 $ .70 $ .64
Companion Services,
Level 1 		W1725 51 363 15 minutes $ .99 $ .93 $ .88 $ .80
Companion Services,
Level 2 		W1726 51 363 15 minutes $2.09 $1.96 $1.85 $1.69
Companion Services,
Level 3 		W1727 51 363 15 minutes $4.69 $4.39 $4.16 $3.78
Behavioral Support W7095 51 510 15 minutes $17.96 $16.80 $15.93 $14.48
Supports Broker W7096 51 510 15 minutes $10.85 $10.15 $9.63 $8.75
Home Finding W7277 51 or 55 571 15 minutes $9.99 $9.35 $8.86 $8.06
Homemaker/
Chore 		W7283 51
______
55
______
43		430 or 431
______
430 or 431
______
430		Hour $22.87 $21.39 $20.29 $18.44
UA 51
______
55
______
43		430 or 431
______
430 or 431
______
430

Fee Schedule Table: Unlicensed Out-of-Home Respite and Respite Camp Ineligible Services
(Room and Board)

Service Procedure Code Provider Type Specialty Code Unit Areas 1 through 4
Respite— Unlicensed out of home, ineligible W6066 51 513 15 minutes $4.00/unit, max
of 3 units per day
W6067 51 513 15 minutes $4.00/unit, max
of 3 units per day
W6068 51
______
54		513
______
540 or 541		15 minutes $4.00/unit, max
of 3 units per day
W6069 51
______
54		513
______
540 or 541		15 minutes $4.00/unit, max
of 3 units per day
W6070 51
______
54		513
______
540 or 541 		15 minutes $4.00/unit, max
of 3 units per day
W6071 51
______
54 		513
______
540 or 541 		15 minutes $4.00/unit, max
of 3 units per day
W6060 51 513 Day $12.00/unit, max
of 1 unit per day
W6061 51 513 Day $12.00/unit, max
of 1 unit per day
W6062 51
______
54 		513
______
540 or 541 		Day $12.00/unit, max
of 1 unit per day
W6063 51
______
54 		513
______
540 or 541 		Day $12.00/unit, max
of 1 unit per day
W6064 51
______
54 		513
______
540 or 541 		Day $12.00/unit, max
of 1 unit per day
W6065 51
______
54 		513
______
540 or 541 		Day $12.00/unit, max
of 1 unit per day
Respite—Camp, Ineligible W8400 51
______
55
______
54 		555
______
555
______
540 or 541 		15 minutes $4.00/unit, max
of 3 units per day
W8401 51
______
55
______
54 		554
______
554
______
540 or 541 		Day $12.00/unit, max
of 1 unit per day

Fee Schedule Table: Agency with Choice Financial Management Services, Excluding Benefits*

 * Modifier U4 must be used with all procedures codes when billing for services excluding benefits.

Service Procedure code Modifier Provider Type Specialty Code Unit Area 1 Area 2 Area 3 Area 4
Companion,
Level 3 		W1727 U4 54 540 15 minutes $3.06 $2.87 $2.72 $2.47
Unlicensed Habilitation, Level 3 W7060 U4 54 540 15 minutes $5.07 $4.74 $4.50 $4.09
Unlicensed Habilitation, Level 3 enhanced W7061 U4
______
TD & U4
______
TE & U4 		54 540 15 minutes $8.39 $7.85 $7.44 $6.77
Unlicensed Habilitation,
Level 4 		W7068 U4 54 540 15 minutes $10.13 $9.48 $8.99 $8.17
Unlicensed Habilitation,
Level 4 enhanced 		W7069 U4
______
TD & U4
______
TE & U4 		54 540 15 minutes $16.77 $15.69 $14.88 $13.52
Supports Broker W7096 U4 54 540 15 minutes $6.15 $5.76 $5.46 $4.96
Supported Employment W7235 U4 54 540 15 minutes $6.12 $5.73 $5.43 $4.94
Respite—
Unlicensed in home,
Level 2 		W7250 U4 54 540 Day $223.14 $208.74 $197.94 $179.95
W7258 U4 54 540 15 minutes $3.48 $3.26 $3.09 $2.81
Respite— Unlicensed in home,
Level 2 enhanced 		W7251 U4
______
TD & U4
______
TE & U4 		54 540 Day $478.66 $447.77 $424.61 $386.01
W7264 U4
______
TD & U4
______
TE & U4 		54 540 15 minutes $7.48 $7.00 $6.64 $6.03
Respite— Unlicensed in home,
Level 3 		W7252 U4 54 540 Day $446.27 $417.48 $395.89 $359.90
W7265 U4 54 540 15 minutes $6.97 $6.52 $6.19 $5.62
Respite— Unlicensed in home,
Level 3 enhanced 		W7253 U4
______
TD & U4
______
TE & U4 		54 540 Day $957.31 $895.55 $849.23 $772.02
W7266 U4
______
TD & U4
______
TE & U4 		54 540 15 minutes $14.95 $13.99 $13.26 $12.06
Homemaker/
Chore 		W7283 U4
______
UA & U4 		54 540 Hour $13.42 $12.55 $11.91 $10.82
Respite—
Unlicensed out of home,
Level 2 		W8002 U4 54 540 Day $223.14 $208.74 $197.94 $179.95
W8012 U4 54 540 15 minutes $3.48 $3.26 $3.09 $2.81
Respite—
Unlicensed out of home,
Level 2 enhanced 		W8003 U4
______
TD & U4
______
TE & U4 		54 540 Day $478.66 $447.77 $424.61 $386.01
W8013 U4
______
TD & U4
______
TE & U4 		54 540 15 minutes $7.48 $7.00 $6.64 $6.03
Respite—
Unlicensed out of home,
Level 3 		W8004 U4 54 540 Day $446.27 $417.48 $395.89 $359.90
W8014 U4 54 540 15 minutes $6.97 $6.52 $6.19 $5.62
Respite—
Unlicensed out of home,
Level 3 enhanced 		W8005 U4
______
TD & U4
______
TE & U4 		54 540 Day $957.31 $895.55 $849.23 $772.02
W8015 U4
______
TD & U4
______
TE & U4 		54 540 15 minutes $14.95 $13.99 $13.26 $12.06

Fee Schedule Table: Agency with Choice Financial Management Services, Including Benefits**

 ** No modifier is needed to indicate the benefit allowance is included.

Service Procedure code Modifier Provider Type Specialty Code Unit Area 1 Area 2 Area 3 Area 4
Companion
Level 3 		W1727 54 540 15 minutes $3.88 $3.63 $3.44 $3.13
Unlicensed Habilitation,
Level 3 		W7060 54 540 15 minutes $6.42 $6.01 $5.70 $5.18
Unlicensed Habilitation,
Level 3 enhanced 		W7061  
______
TD
______
TE 		54 540 15 minutes $10.62 $9.93 $9.42 $8.56
Unlicensed Habilitation,
Level 4 		W7068 54 540 15 minutes $12.83 $12.00 $11.38 $10.35
Unlicensed Habilitation,
Level 4 enhanced 		W7069  
______
TD
______
TE		54 540 15 minutes $21.23 $19.86 $18.83 $17.12
Supports Broker W7096 54 540 15 minutes $7.79 $7.29 $6.91 $6.28
Supported Employment W7235 54 540 15 minutes $7.75 $7.25 $6.88 $6.25
Respite—
Unlicensed in home,
Level 2 		W7250 54 540 Day $282.49 $264.26 $250.60 $227.81
W7258 54 540 15 minutes $4.41 $4.13 $3.91 $3.56
Respite—
Unlicensed in home,
Level 2 enhanced 		W7251  
______
TD
______
TE 		54 540 Day $605.98 $566.88 $537.56 $488.69
W7264  
______
TD
______
TE 		54 540 15 minutes $9.47 $8.86 $8.40 $7.64
Respite—
Unlicensed in home, Level 3 		W7252 54 540 Day $564.98 $528.53 $501.19 $455.63
W7265 54 540 15 minutes $8.83 $8.26 $7.83 $7.12
Respite—
Unlicensed in home,
Level 3 enhanced 		W7253  
______
TD
______
TE 		54 540 Day $1,211.96 $1,133.76 $1,075.12 $977.38
W7266  
______
TD
______
TE 		54 540 15 minutes $18.93 $17.71 $16.79 $15.27
Homemaker/
Chore 		W7283  
______
UA		54 540 Hour $16.99 $15.89 $15.07 $13.70
Respite—
Unlicensed out of home,
Level 2 		W8002 54 540 Day $282.49 $264.26 $250.60 $227.81
W8012 54 540 15 minutes $4.41 $4.13 $3.91 $3.56
Respite—
Unlicensed out of home,
Level 2 enhanced 		W8003  
______
TD
______
TE 		54 540 Day $605.98 $566.88 $537.56 $488.69
W8013  
______
TD
______
TE 		54 540 15 minutes $9.47 $8.86 $8.40 $7.64
Respite—
Unlicensed out of home,
Level 3 		W8004 54 540 Day $564.98 $528.53 $501.19 $455.63
W8014 54 540 15 minutes $8.83 $8.26 $7.83 $7.12
Respite—
Unlicensed out of home,
Level 3 enhanced 		W8005  
______
TD
______
TE 		54 540 Day $1,211.96 $1,133.76 $1,075.12 $977.38
W8015  
______
TD
______
TE 		54 540 15 minutes $18.93 $17.71 $16.79 $15.27

Fiscal Impact

 There is no anticipated fiscal impact.

Public Comment

 Comments received within 30 days will be reviewed and considered for any subsequent revisions to the fee schedules. Interested persons are invited to submit written comments regarding this notice to the Department at the following address:

By E-mail:

 Use subject header ''PN Fee Schedule; Correction'' to the Office of Developmental Programs rate setting mailbox at: ra-ratesetting@state.pa.us.

By postal mail:

 Department of Public Welfare
Office of Developmental Programs
Division of Provider Assistance and Rate Setting
4th Floor, Health and Welfare Building
Harrisburg, PA 17120

 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).

ESTELLE B. RICHMAN 
Secretary

 Fiscal Note: 14-NOT-628. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 10-71. Filed for public inspection January 8, 2010, 9:00 a.m.]


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