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PA Bulletin, Doc. No. 11-1965

NOTICES

Medical Assistance Program Fee Schedule for Select Services in the Consolidated and Person/Family Directed Support Waivers and Community Mental Retardation Base Program; Correction Effective July 1, 2011, through November 14, 2011

[41 Pa.B. 6168]
[Saturday, November 12, 2011]

 The Department of Public Welfare is correcting the Medical Assistance Fee Schedule Tables published at 41 Pa.B. 3292 (June 25, 2011).

 Specifically, payment rates for providers of the Consolidated waiver, Person/Family Directed Support waiver and base funded services for a waiver service location identified as fee schedule services in Fiscal Year (FY) 2010-2011 will continue to have the same payment rates as the FY 2010-2011 final fee schedule payment rate for the period of July 1, 2011, through November 14, 2011.

 The revised Fee Schedule Tables reflect carryover of the FY 2010-2011 fee schedule services for the period July 1, 2011, through November 14, 2011, and are as follows:

Geographic Areas:

Area 1: Bucks, Chester, Delaware, Lehigh, Montgomery, Northampton, Philadelphia

Area 2: Adams, Allegheny, Beaver, Berks, Carbon, Cumberland, Dauphin, Erie, Franklin, Fulton, Greene, Lancaster, Lawrence, Lebanon, Monroe, Perry, Pike, Schuylkill, Washington, York

Area 3: Armstrong, Bradford, Butler, Cameron, Centre, Clarion, Clinton, Columbia, Crawford, Elk, Forest, Indiana, Huntingdon, Juniata, Lackawanna, Luzerne, Lycoming, McKean, Mercer, Mifflin, Montour, Northumberland, Potter, Snyder, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Wayne, Westmoreland, Wyoming

Area 4: Bedford, Blair, Cambria, Clearfield, Fayette, Jefferson, Somerset

Fee Schedule Rates Tables:

Select Community-Based Services*

 * Modifier ET must be used with applicable procedures codes when billing for temporary base-funded services.

 (PA) Prior authorization by the Office of Developmental Programs (ODP) must be obtained for this service.

Service Procedure
Code
Modifier Provider
Type
Specialty
Code
Unit
Area 1
Area 2
Area 3
Area 4
Nursing Services: LPN T2025 TE 05 051 15 min. $11.02 $10.31 $9.78 $8.89
TE & ET
TE 16 161
TE & ET
Nursing Services: RN T2025 TD 05 051 15 min. $16.55 $15.48 $14.68 $13.35
TD & ET
TD 16 160
TD & ET
Physical Therapy T2025 GP 17 170 15 min. $20.20 $18.90 $17.92 $16.29
GP & ET
Occupational Therapy T2025 GO 17 171 15 min. $21.29 $19.92 $18.89 $17.17
GO & ET
Speech and Language Therapy T2025 GN 17 173 15 min. $21.72 $20.32 $19.27 $17.52
GN & ET
Individual Behavioral Therapy T2025 HE 19 208 15 min. $20.79 $19.45 $18.44 $16.77
HE & ET
Group Behavioral Therapy T2025 HE & HQ 19 208 15 min. $5.20 $4.86 $4.61 $4.19
HE, HQ & ET
Visual/Mobility Therapy W7246 51 517 15 min. $21.73 $20.33 $19.28 $17.52
ET
Companion Services, Basic staff support W1724 51 363 15 min. $ .78 $ .73 $ .69 $ .63
ET
Companion Services, level 1 W1725 51 363 15 min. $ .98 $ .92 $.87 $ .79
ET
Companion Services, level 2 W1726 51 363 15 min. $2.07 $1.94 $1.84 $1.67
ET
Companion Services, level 3 W1727 51 363 15 min. $4.65 $4.35 $4.13 $3.75
ET
Supplemental Habilitation, 1:1 (PA) W7070 52 456, 520 521 or 522 15 min. $4.87 $4.56 $4.32 $3.93
ET
Supplemental Habilitation, 2:1 (PA) W7084 52 456, 520 521 or 522 15 min. $9.75 $9.12 $8.65 $7.86
ET
Additional Individualized Staffing, 1:1 (PA) W7085 52 456, 520 521 or 522 15 min. $4.87 $4.56 $4.32 $3.93
Additional Individualized Staffing, 2:1 (PA) W7086 52 456, 520 521 or 522 15 min. $9.75 $9.12 $8.65 $7.86
Older Adult Day Habilitation W7094 51 410 15 min. $2.88 $2.69 $2.55 $2.32
ET
Behavioral Support W7095 51 510 15 min. $21.52 $20.13 $19.09 $17.35
ET
Supports Broker W7096 51 510 15 min. $10.85 $10.15 $9.63 $8.75
Home Finding W7277 51 or 55 571 15 min. $9.94 $9.30 $8.82 $8.02
Homemaker/Chore (permanent) W7283 43 430 1 hour $22.87 $21.39 $20.29 $18.44
51 430 or 431
55 430 or 431
Homemaker/Chore (temporary) W7283 UA 43 430
UA & ET
UA 51 430 or 431
UA & ET
UA 45 430 or 431
UA & ET

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

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

Fiscal Impact

 There is no anticipated fiscal impact to the Commonwealth.

Public Comment

 Copies of this notice may be obtained at the local Mental Health/Mental Retardation (MH/MR) County Program, Administrative Entity (AE) or regional ODP in the corresponding regions:

 • Western region: Piatt Place, Room 4900, 301 5th Avenue, Pittsburgh, PA 15222, (412) 565-5144

 • Northeast region: Room 315, Scranton State Office Building, 100 Lackawanna Avenue, Scranton, PA 18503, (570) 963-4749

 • Southeast region: 801 Market Street, Suite 5071, Philadelphia, PA 19107, (215) 560-2242 or (215) 560-2245

 • Central region: Room 430, Willow Oak Building, P. O. Box 2675, DGS Annex Complex, Harrisburg, PA 17105, (717) 772-6507

 Contact information for the local MH/MR County Program or AE may be accessed at https://www.hcsis.state.pa.us/hcsis-ssd/pgm/asp/PRCNT.ASP or contact the previously referenced regional ODP.

 Interested persons are invited to submit written comments regarding this notice to the Department of Public Welfare, Office of Developmental Programs, Division of Provider Assistance and Rate Setting, 4th Floor, Health and Welfare Building, Forster and Commonwealth Avenues, Harrisburg, PA 17120. E-mail should be sent to ODP's rate-setting mailbox at ra-ratesetting@pa.gov (use ''PN Fee Schedule'' in the subject line).

 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).

GARY D. ALEXANDER, 
Secretary

Fiscal Note: 14-NOT-729. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 11-1965. Filed for public inspection November 11, 2011, 9:00 a.m.]



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