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PA Bulletin, Doc. No. 12-1220


Medical Assistance Program Fee Schedule for Services in the Adult Autism Waiver

[42 Pa.B. 3819]
[Saturday, June 30, 2012]

 This notice announces the additions to the Department of Public Welfare's (Department) fees for certain services provided to Adult Autism Waiver participants effective July 1, 2012.

Rate-Setting Methodology

 As part of the Department's efforts to continue to align rates and rate-setting methodology across all offices and programs, the Department used a market-based approach to develop the fee schedule rates.

 The Department is adding two new services and is also adding new procedure codes. Unlicensed Respite Care out of Home (Day) and Respite Care Unlicensed Out of Home (15 minute unit) is being added to Respite Care Services. In addition, the current Transitional Work Services procedure codes have been end-dated and new procedure codes have been added for these services.

Fee Schedule Rate Table

 The following procedure codes, modifiers, provider types, specialty code, unit and fees for Adult Autism Waiver services are being added to the MA Program Fee Schedule:

Service Procedure
Modifier Provider
Unit Rate
Respite Unlicensed
Out of Home (Day)
W9495 51 513 Day $166.42
Respite Unlicensed
Out of Home (15 min.)
W9596 51 513 15 min. $4.16
Transitional Work





15 min.


Transitional Work


These two procedure codes have been end-dated effective 6-30-12
and replaced with W0011 and W0012 above.

Fiscal Impact

 The Department anticipates that these changes will not result in significant savings for Fiscal Year 2012-2013 or for the planning years.

Public Comment

 Interested persons are invited to submit written comments regarding this notice to the Department at, use subject header ''PN AAW Fee Schedule,'' or Department of Public Welfare, Office of Developmental Programs, Bureau of Autism Services, 6th Floor, Health and Welfare Building, Forster and Commonwealth Avenues, Harrisburg, PA 17120.

 Comments received will be reviewed and considered for any subsequent revisions to the fee schedule for Adult Autism Waiver services.

 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).


Fiscal Note: 14-NOT-773. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 12-1220. Filed for public inspection June 29, 2012, 9:00 a.m.]

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