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PA Bulletin, Doc. No. 12-1228


Rate-Setting Methodology for Department-Established Fees for Ineligible Residential Habilitation Services for the Consolidated and Adult Autism Waiver- and Base-Funded Services for Individuals Participating in the Office of Developmental Programs Service System

[42 Pa.B. 3828]
[Saturday, June 30, 2012]

 Effective July 1, 2012, the Department of Public Welfare (Department) has determined that ineligible residential habilitation services will transition from a cost report rate to a Department established fee for the Consolidated Waiver and Base-funded services. Residential habilitation ineligible fees will also remain a Department-established fee for the Adult Autism Waiver for individuals participating in the Office of Developmental Programs Service System.


 Since 2009, the Department has continued to evaluate and address differences in provider rates through the cost report review process and will continue to move in a direction to align rates and rate-setting methodologies across programs.

Methodology for Department Established Ineligible Residential Habilitation Services

 Fees for the Ineligible Residential Habilitation services were developed using a market-based pricing methodology. This process includes a determination of allowable residential occupancy cost components which reflect costs that are reasonable and necessary to deliver the service.

 The Department evaluated information from the United States Bureau of Labor Statistics, United States Department of Agriculture, United States Department of Housing and Urban Development, data from approved cost reports and other independent data sources. Expected occupancy-related expenses for the following major allowable cost categories were considered:

 • Operating-related costs including occupancy and utility expenses.

 • Maintenance and service agreement related costs.

 • Food and other individual-related occupancy expenses, such as household consumables.

 • Administration-related expenses.

 The Department established fees represent a per-person, per-day net fee based on the size of home (such as a one-individual home or two-individual home) and type of home (defined by licensed, unlicensed or family living home). The net fee does not include consideration for payment by the participant, as it is the provider's responsibility to collect that portion of payment from the participant.

 The Department used the following process to develop the per-person, per-day net fees:

 1. Established gross fees (such that the fees do include consideration for participant contribution toward room and board) based on home size and type of home.

 2. Applied a standardized 97% vacancy factor to the gross fees to reflect that providers will no longer bill for vacant days, effective July 1, 2012.

 3. Adjusted the resulting gross fees by geographical area factors to reflect consideration for differences in costs observed across this Commonwealth (Consolidated and Base-funded services only).

 4. Adjusted the area-specific gross fees to reflect consideration for participant contribution toward room and board. The participant contribution amount removed from the area-specific gross fees was equal to 72% of the sum of the maximum Supplemental Security Income amount for 2012 and the Commonwealth supplemental payment, converted to a daily amount (Consolidated and Base-Funded services only).

 The methodology for the Adult Autism Waiver Department established ineligible residential habilitation fees did not include adjustments based on geographical area factors.

 The Department established fees for ineligible residential habilitation services for the Consolidated Waiver and Base-funded services effective July 1, 2012, are as follows:

Service Procedure
Modifier Provider
Unit Area 1 Area 2 Area 3
Licensed Community Homes—Ineligible W6091 Day $70.80 $66.13 $60.69
W6093 $37.56 $34.66 $31.28
W6095 $26.51 $24.19 $21.50
W6097 $20.56 $18.56 $16.23
W6099 $16.23 $14.46 $12.40
Licensed Child Residential Services— Ineligible W7011 Day $70.80 $66.13 $60.69
W7013 $37.56 $34.66 $31.28
W7015 $26.51 $24.19 $21.50
W7017 $20.56 $18.56 $16.23
W7019 $16.23 $14.46 $12.40
Licensed Community Residential Rehabilitation Services—Ineligible W7021 Day $70.80 $66.13 $60.69
W7023 $37.56 $34.66 $31.28
W7025 $26.51 $24.19 $21.50
W7027 $20.56 $18.56 $16.23
W7029 $16.23 $14.46 $12.40
Unlicensed Residential Services—Ineligible W7079 Day $15.28 $13.56 $11.56
W7081 $6.14 $4.90 $3.47
W7083 $5.46 $4.26 $2.87
Unlicensed Family Living Home—Ineligible W7038 Day $2.70 $1.65 $0.43
W7040 $1.31 $0.34 $0.00
Licensed Adult Family Living Home—Ineligible W7292 Day $2.70 $1.65 $0.43
W7294 $1.31 $0.34 $0.00
Licensed Child Family Living Home—Ineligible W7296 Day $2.70 $1.65 $0.43
W7298 $1.31 $0.34 $0.00

 The Department established fees for ineligible residential habilitation services for the Adult Autism Waiver effective July 1, 2012, are as follows:

Service Procedure
Modifier Provider
Unit Rate
Residential Hab. Community Home— Ineligible (State funded only room and board) W7233 52 521 Day $32.04
Residential Hab. Family Living Home—Ineligible (State funded only room and board) W7234 52 521 Day $2.70

Fiscal Impact

 It is anticipated that there will be an approximate cost to the Commonwealth of $4.471 million in State funds in Fiscal Year (FY) 2012-2013 and subsequent fiscal years. The Adult Autism Waiver ineligible residential habilitation services remain on a Department established fee and is cost neutral.

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 Office of Developmental Programs (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 found at 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 at the Office of Developmental Programs' rate-setting mailbox at, use subject header ''PN PPS Methodology,'' or 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.

 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-774. (1) General Fund:

(2) Implementing Year 2012-13 is $4,471,000
(3) 1st Succeeding Year 2013-14 is $4,471,000
2nd Succeeding Year 2014-15 is $4,471,000
3rd Succeeding Year 2015-16 is $4,471,000
4th Succeeding Year 2016-17 is $4,471,000
5th Succeeding Year 2017-18 is $4,471,000
ID—Community ID—Community Autism Intervention Human Services
Waiver Program Base Program and Services Development Fund
(4) 2011-12 Program— $854,863,000 $166,520,000 $13,549,000 $14,956,000
   2010-11 Program— $672,376,000 $155,958,000 $10,503,000 $23,243,000
  2009-10 Program— $622,849,000 $156,619,000 $9,963,000 $33,346,000
Prior to FY 2012-13, ID—Community Base Services were provided through the ID—Community Base Program appropriation. Beginning in FY 2012-13, ID—Community Base Services are provided through the Human Services Development Fund.
(7) ID—Community Waiver Program; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 12-1228. Filed for public inspection June 29, 2012, 9:00 a.m.]

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