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PA Bulletin, Doc. No. 14-1365

NOTICES

Proposed Fee Schedule Rates and Department-Established Fees for Consolidated and Person/Family Directed Support Waivers Services, Targeted Services Management and the Community Intellectual Disability Base-Funded Program

[44 Pa.B. 4045]
[Saturday, June 28, 2014]

 The purpose of this notice is to announce the Department of Public Welfare's (Department) proposed Fee Schedule Rates for select services funded through the Consolidated and Person/Family Directed Support waivers, the Department-established fees for residential ineligible services and fee for Targeted Service Management (TSM) effective July 1, 2014. These proposed Fee Schedule Rates also serve as the Department-established fees under 55 Pa. Code § 4300.115(a) (relating to Department established fees) for base-funded services managed through county programs for individuals with an intellectual disability under the Mental Health and Intellectual Disability Act of 1966 (50 P. S. §§ 4104—4704), 55 Pa. Code Chapter 4300 (relating to county mental health and mental retardation fiscal manual) and 55 Pa. Code Chapter 51 (relating to Office of Developmental Programs home and community-based services).

Fee Schedule Rates

 The Fee Schedule Rates are identified under the following categories: Select Community-Based Services and Agency with Choice/Financial Management Services (AWC/FMS), including benefit allowance and excluding benefit allowance.

 The Select Community-Based Services include behavior support, companion, home and community habilitation unlicensed, homemaker/chore, licensed day habilitation (adult training), prevocational services, therapy (physical, occupational, speech and language, individual behavior therapy, group behavior therapy and visual/mobility), nursing, older adult day, supplemental habilitation, additional individualized staffing, supported employment, supports broker, supports coordination, transitional work and all waiver-funded respite care services, excluding respite camp which is a vendor service.

 AWC/FMS (including and excluding benefit allowance) includes home and community habilitation unlicensed, companion services, unlicensed in-home and out-of-home respite, supported employment, supports broker and homemaker/chore services. There are two separate tables for AWC/FMS, one provides the fee schedule rate including a benefit allowance and the other provides the fee schedule rate excluding a benefit allowance. The benefit allowance is provided as an option for the managing employer to include benefits such as disability insurance, life insurance, retirement savings and paid time off to the support service worker.

 The proposed fee schedule rates should be used to process claims submitted to the Provider Reimbursement and Operations Management Information System (PROMISeTM) in electronic format for services provided until a notice announcing final fee schedule rates is published.

Enhanced Communication Services

 Effective July 1, 2014, the Enhanced Communication Services modifier is available for the following Consolidated Waiver fee schedule services behavioral support, companion, supported employment, transitional work, prevocational services, home and community habilitation unlicensed, licensed day habilitation (adult training), therapy (physical, occupational, speech and language, individual behavior therapy, group behavior therapy and visual/mobility), nursing, older adult day, supplemental habilitation, additional individualized staffing, supports broker and all waiver-funded respite care services, excluding respite camp which is a vendor service.

 Enhanced Communication Services can be provided to individuals who meet all of the following:

 • Enrolled in the Consolidated Waiver.

 • Deaf.

 • Determined to need services that are provided by staff who are proficient in sign language.

 Providers seeking the Enhanced Communication Services Rate will need to submit a request to the Office of Developmental Programs. The request must include documentation that the provider has sign language proficient staff and can meet the communication needs of individuals who are deaf at all times during services. The Office of Developmental Programs will also review the records of each individual that receives Enhanced Communication Services to ensure that he is in need of the service.

Department-Established Fees

 The Department-established fees represent a per-person, per-day net fee based on the size of the home (such as a 1-individual home or 2-individual home) and type of home (defined by licensed, unlicensed or family living home). The 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 proposed Department-established fees should be used to process claims submitted to the PROMISeTM for services provided until a notice announcing final Department-established fees is published.

Geographic Areas

 The geographic areas are as follows:

Area 1: Adams, Cumberland, Dauphin, Delaware, Lancaster, Lebanon, Lehigh, Montgomery, Northampton, Perry, Philadelphia, York

Area 2: Allegheny, Berks, Bucks, Chester, Franklin, Fulton

Area 3: Armstrong, Beaver, Bedford, Blair, Bradford, Butler, Cambria, Cameron, Carbon, Centre, Clarion, Clearfield, Clinton, Columbia, Crawford, Elk, Erie, Fayette, Forest, Greene, Huntingdon, Indiana, Jefferson, Juniata, Lackawanna, Lawrence, Luzerne, Lycoming, McKean, Mercer, Mifflin, Monroe, Montour, Northumberland, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Washington, Wayne, Westmoreland, Wyoming

TSM Fee

 TSM is provided under the State Plan to eligible Medical Assistance (MA) recipients. This service is provided consistent with the supports coordination service definition. The supports coordination MA fee identified in the Fee Schedule rate chart is also applicable to TSM.

Fee Schedule Rates and Department-Established Fees Tables: Effective July 1, 2014

 Modifier ET must be used with applicable procedure codes when billing for temporary Base-funded services.

 The supports coordination MA fee identified as follows and billed with procedure code W7210 is also applicable to TSM and base funded supports coordination.

 Prior authorization must be obtained from the Department for services denoted by (PA) in the service row in the following table.

Fee Schedule Rates

Service Procedure Modifier Provider Specialty Unit Area 1 Area 2 Area 3
CodeType Code
Nursing Services: LPN T2025 TE 05 051 15 min. $11.36 $10.76 $10.05
TE & ET
TE 16 161
TE & ET
Nursing Services: RN T2025 TD 05 051 15 min. $14.72 $13.94 $13.03
TD & ET
TD 16 160
TD & ET
Physical Therapy T2025 GP 17 170 15 min. $21.61 $20.46 $19.12
GP & ET
Occupational Therapy T2025 GO 17 171 15 min. $20.93 $19.82 $18.52
GO & ET
Speech and Language Therapy T2025 GN 17 173 15 min. $19.23 $18.21 $17.02
GN & ET
Individual Behavioral Therapy T2025 HE 19 208 15 min. $25.29 $23.95 $22.38
HE & ET
Group Behavioral Therapy T2025 HE & HQ 19 208 15 min. $8.09 $7.66 $7.16
HE, HQ & ET
Visual/Mobility Therapy W7246 51 517 15 min. $19.23 $18.21 $17.02
ET
Companion, Basic staff support W1724 51 363 15 min. $1.26 $1.19 $1.12
ET
Companion, level 1 W1725 51 363 15 min. $1.46 $1.38 $1.29
ET
Companion, level 2 W1726 51 363 15 min. $2.23 $2.11 $1.97
ET
Companion, level 3 W1727 51 363 15 min. $6.11 $5.79 $5.41
ET
Supplemental Habilitation, 1:1(PA) W7070 52 456, 520, 521 or 522 15 min. $5.41 $5.12 $4.79
ET
Supplemental Habilitation, 2:1(PA) W7084 52 456, 520, 521 or 522 15 min. $10.81 $10.24 $9.57
ET
Additional Individualized Staffing, 1:1(PA) W7085 52 456, 520, 521 or 522 15 min. $5.41 $5.12 $4.79
Additional Individualized Staffing, 2:1(PA) W7086 52 456, 520, 521 or 522 15 min. $10.81 $10.24 $9.57
Older Adult Day Habilitation W7094 51 410 15 min. $2.57 $2.43 $2.27
ET
Behavioral Support W7095 51 510 15 min. $19.42 $18.39 $17.19
ET
Supports Broker W7096 51 510 15 min. $8.65 $8.19 $7.65
Licensed Day-Adult W7072 51 514 15 min. $2.90 $2.75 $2.57
W7073 51 514 15 min. $3.55 $3.36 $3.14
W7074 51 514 15 min. $4.50 $4.26 $3.98
W7075 51 514 15 min. $9.16 $8.67 $8.11
W7076 51 15 min. $13.35 $12.64 $11.81
W7035 15 min. $17.20 $16.29 $15.22
W7036 15 min. $25.57 $24.21 $22.63
Prevocational W7087 15 min. $2.06 $1.95 $1.82
W7088 15 min. $2.43 $2.30 $2.15
W7089 15 min. $3.26 $3.09 $2.88
W7090 15 min. $9.06 $8.58 $8.02
W7091 15 min. $12.59 $11.92 $11.14
W7092 15 min. $17.75 $16.81 $15.71
W7093 15 min. $24.82 $23.50 $21.96
Supports Coordination W7210 21 218 15 min. $21.70 $20.55 $19.20
Supported Employment W7235 53 530
531
15 min. $17.75 $16.81 $15.71
Transitional Work W7237 51 516 15 min. $2.65 $2.51 $2.35
W7239 51 516 15 min. $3.55 $3.36 $3.14
W7241 51 516 15 min. $4.65 $4.40 $4.12
W7245 51 516 15 min. $11.63 $11.01 $10.29 Unlicensed Home and Community Habilitation W7057 51 510 15 min. $2.54 $2.41 $2.25
W7058 51 510 15 min. $3.52 $3.33 $3.12
W7059 51 510 15 min. $4.47 $4.23 $3.96
W7060 51 510 15 min. $7.21 $6.83 $6.38
W7061 51 510 15 min. $11.09 $10.50 $9.81
TD
TE
W7068 51 510 15 min. $13.96 $13.22 $12.35
W7069 51 510 15 min. $23.97 $22.70 $21.21
TD
TE
In Home Respite—24 hours W7247 51 512 Day $85.20 $80.68 $75.40
W7248 51 512 Day $110.80 $104.92 $98.05
W7250 51 512 Day $241.92 $229.07 $214.09
W7251 51 512 Day $381.84 $361.57 $337.91
W7252 51 512 Day $475.82 $450.56 $421.08
W7253 51 512 Day $755.66 $715.54 $668.73
TD
TE
In Home Respite—15 Minutes W7255 51 512 15 min. $2.13 $2.02 $1.88
W7256 51 512 15 min. $2.77 $2.62 $2.45
W7258 51 512 15 min. $6.11 $5.79 $5.41
W7264 51 512 15 min. $9.55 $9.04 $8.45
W7265 51 512 15 min. $11.90 $11.27 $10.53
W7266 51 512 15 min. $18.89 $17.89 $16.72
TD
TE
Respite—unlicensed out of home—24 hour W8000 51 513 Day $85.20 $80.68 $75.40
W8001 51 513 Day $110.80 $104.92 $98.05
W8002 51 513 Day $241.92 $229.07 $214.09
W8003 51 513 Day $381.84 $361.57 $337.91
W8004 51 513 Day $475.82 $450.56 $421.08
W8005 51 513 Day $755.66 $715.54 $668.73
TD
TE Respite—unlicensed out of home—15 minute W8010 51 513 15 min. $2.13 $2.02 $1.88
W8011 51 513 15 min. $2.77 $2.62 $2.45
W8012 51 513 15 min. $6.11 $5.79 $5.41
W8013 51 513 15 min. $9.55 $9.04 $8.45
TD
TE
W8014 51 513 15 min. $11.90 $11.27 $10.53
W8015 51 513 15 min. $18.89 $17.89 $16.72
TD
TE Respite—licensed out of home—24 hour W7259 51 513 Day $111.11 $105.21 $98.33
U2
W7260 51 513 Day $203.96 $193.13 $180.50
U2
W7262 51 513 Day $269.98 $255.64 $238.92
U2
W7263 51 513 Day $416.51 $394.39 $368.59
U2
W7299 51 513 Day $524.61 $496.75 $464.26
U2
W7300 51 513 Day $817.68 $774.26 $723.61
TD
TE
U2 Respite—licensed out of home—15 minutes W7267 51 513 15 min. $2.78 $2.63 $2.46
W7268 51 513 15 min. $3.68 $3.48 $3.26
W7270 51 513 15 min. $6.75 $6.39 $5.97
W7400 51 513 15 min. $10.41 $9.86 $9.21
TD
TE
W7401 51 513 15 min. $13.12 $12.42 $11.61
W7402 51 513 15 min. $20.44 $19.35 $18.09
TD
TE
Homemaker/Chore (permanent) W7283 43 430 1 hour $19.44 $18.41 $17.20
51 430 or 431
Homemaker/Chore (temporary) W7283 UA 43 430 1 hour $19.44 $18.41 $17.20
UA & ET
UA 51 430 or 431
UA & ET

Enhanced Communication Services for Consolidated Waiver—Requires ODP Approval

Service Procedure Modifier Provider Specialty Unit Area 1 Area 2 Area 3
CodeType Code
Nursing Services: LPN T2025 TE & U1 5 51 15 min. $12.56 $11.89 $11.12
TE & U1 16 161
Nursing Services: RN T2025 TD & U1 5 51 15 min. $16.33 $15.46 $14.45
TD & U1 16 160
Physical Therapy T2025 GP & U1 17 170 15 min. $23.82 $22.56 $21.08
Occupational Therapy T2025 GO & U1 17 171 15 min. $23.06 $21.84 $20.41
Speech and Language Therapy T2025 GN & U1 17 173 15 min. $21.15 $20.03 $18.72
Individual Behavioral Therapy T2025 HE & U1 19 208 15 min. $27.96 $26.48 $24.74
Group Behavioral Therapy T2025 HE & HQ & U1 19 208 15 min. $9.41 $8.91 $8.33
Visual/Mobility Therapy W7246 U1 51 517 15 min. $21.15 $20.03 $18.72
Companion, Basic staff support W1724 U1 51 363 15 min. $1.46 $1.38 $1.29
Companion, level 1 W1725 U1 51 363 15 min. $1.68 $1.59 $1.49
Companion, level 2 W1726 U1 51 363 15 min. $2.61 $2.47 $2.31
Companion, level 3 W1727 U1 51 363 15 min. $6.67 $6.32 $5.90
Supplemental Habilitation, 1:1(PA) W7070 U1 52 456, 520, 521 or 522 15 min. $5.96 $5.64 $5.27
Supplemental Habilitation, 2:1(PA) W7084 U1 52 456, 520, 521 or 522 15 min. $11.92 $11.29 $10.55
Additional Individualized Staffing, 1:1(PA) W7085 U1 52 456, 520, 521 or 522 15 min. $5.96 $5.64 $5.27
Additional Individualized Staffing, 2:1(PA) W7086 U1 52 456, 520, 521 or 522 15 min. $11.92 $11.29 $10.55
Older Adult Day Habilitation W7094 U1 51 410 15 min. $2.81 $2.66 $2.49
Behavioral Support W7095 U1 51 510 15 min. $21.36 $20.23 $18.90
Supports Broker W7096 U1 51 510 15 min. $9.57 $9.06 $8.47 Licensed Day—Adult W7072 U1 51 514 15 min. $3.18 $3.01 $2.81
W7073 U1 51 514 15 min. $3.94 $3.73 $3.49
W7074 U1 51 514 15 min. $5.08 $4.81 $4.50
W7075 U1 51 514 15 min. $9.86 $9.34 $8.73
W7076 U1 51 514 15 min. $14.56 $13.79 $12.88
TD & U1
TE & U1
W7035 U1 51 514 15 min. $18.59 $17.60 $16.45
W7036 U1 51 514 15 min. $28.00 $26.51 $24.78
TD & U1
TE & U1 Prevocational W7087 U1 51 515 15 min. $2.27 $2.15 $2.01
W7088 U1 51 515 15 min. $2.73 $2.59 $2.42
W7089 U1 51 515 15 min. $3.76 $3.56 $3.33
W7090 U1 51 515 15 min. $9.84 $9.32 $8.71
W7091 U1 51 515 15 min. $13.81 $13.08 $12.22
TD & U1
TE & U1
W7092 U1 51 515 15 min. $19.30 $18.28 $17.08
W7093 U1 51 515 15 min. $27.25 $25.80 $24.12
TD & U1
TE & U1
Supported Employment W7235 U1 53 530 or 531 15 min. $19.31 $18.28 $17.09
Transitional Work W7237 U1 51 516 15 min. $3.10 $2.94 $2.74
W7239 U1 51 516 15 min. $4.17 $3.95 $3.69
W7241 U1 51 516 15 min. $5.46 $5.17 $4.83
W7245 U1 51 516 15 min. $12.67 $12.00 $11.21 Unlicensed Home and Community Habilitation W7057 U1 51 510 15 min. $2.93 $2.77 $2.59
W7058 U1 51 510 15 min. $4.08 $3.86 $3.61
W7059 U1 51 510 15 min. $5.21 $4.93 $4.61
W7060 U1 51 510 15 min. $7.86 $7.44 $6.96
W7061 U1 51 510 15 min. $12.22 $11.57 $10.81
TD & U1
TE & U1
W7068 U1 51 510 15 min. $15.25 $14.44 $13.50
W7069 U1 51 510 15 min. $26.44 $25.04 $23.40
TD & U1
TE & U1 In Home Respite—24 hours W7247 U1 51 512 Day $99.69 $94.40 $88.22
W7248 U1 51 512 Day $130.23 $123.32 $115.25
W7250 U1 51 512 Day $264.17 $250.14 $233.78
W7251 U1 51 512 Day $421.55 $399.17 $373.05
TD & U1
TE & U1
W7252 U1 51 512 Day $520.29 $492.66 $460.43
W7253 U1 51 512 Day $835.06 $790.72 $738.99
TD & U1
TE & U1 In Home Respite—15 Minutes W7255 U1 51 512 15 min. $2.50 $2.37 $2.21
W7256 U1 51 512 15 min. $3.27 $3.10 $2.89
W7258 U1 51 512 15 min. $6.67 $6.32 $5.90
W7264 U1 51 512 15 min. $10.55 $9.99 $9.34
TD & U1
TE & U1
W7265 U1 51 512 15 min. $13.02 $12.33 $11.52
W7266 U1 51 512 15 min. $20.88 $19.77 $18.48
TD & U1
TE & U1 Respite—unlicensed out of home—24 hour W8000 U1 51 513 Day $99.66 $94.37 $88.19
W8001 U1 51 513 Day $130.20 $123.29 $115.22
W8002 U1 51 513 Day $264.15 $250.12 $233.76
W8003 U1 51 513 Day $421.56 $399.18 $373.06
TD & U1
TE & U1
W8004 U1 51 513 Day $520.28 $492.65 $460.42
W8005 U1 51 513 Day $835.09 $790.75 $739.02
TD & U1
TE & U1 Respite—unlicensed out of home—15 minute W8010 U1 51 513 15 min. $2.49 $2.36 $2.20
W8011 U1 51 513 15 min. $3.26 $3.09 $2.88
W8012 U1 51 513 15 min. $6.67 $6.32 $5.90
W8013 U1 51 513 15 min. $10.54 $9.98 $9.33
TD & U1
TE & U1
W8014 U1 51 513 15 min. $13.01 $12.32 $11.51
W8015 U1 51 513 15 min. $20.88 $19.77 $18.48
TD & U1
TE & U1 Respite—licensed out of home—24 hour W7259 U1 51 513 Day $128.51 $121.69 $113.73
U2 & U1
W7260 U1 51 513 Day $238.74 $226.06 $211.27
U2 & U1
W7262 U1 51 513 Day $294.29 $278.66 $260.43
U2 & U1
W7263 U1 51 513 Day $459.13 $434.75 $406.31
TD & U1
TE & U1
U2 & U1
TD & U2 & U1
TE & U2 & U1
W7299 U1 51 513 Day $573.22 $542.78 $507.27
U2 & U1
W7300 U1 51 513 Day $902.92 $854.98 $799.04
TD & U1
TE & U1
U2 & U1
TD & U2 & U1
TE & U2 & U1 Respite—licensed out of home—15 minutes W7267 U1 51 513 15 min. $3.22 $3.05 $2.85
W7268 U1 51 513 15 min. $4.29 $4.06 $3.80
W7270 U1 51 513 15 min. $7.36 $6.97 $6.51
W7400 U1 51 513 15 min. $11.48 $10.87 $10.16
TD & U1
TE & U1
W7401 U1 51 513 15 min. $14.33 $13.57 $12.68
W7402 U1 51 513 15 min. $22.57 $21.37 $19.97
TD & U1
TE & U1

Department-Established Fees

Service Procedure Modifier Provider Specialty Unit Area 1 Area 2 Area 3
CodeType Code
Licensed Community Homes—Ineligible W6091 Day $72.71 $67.93 $62.35
W6093 $38.64 $35.67 $32.20
W6095 $27.32 $24.95 $22.18
W6097 $21.22 $19.17 $16.78
W6099 $16.78 $14.97 $12.86
Licensed Child Residential Services—Ineligible W7011 Day $72.71 $67.93 $62.35
W7013 $38.64 $35.67 $32.20
W7015 $27.32 $24.95 $22.18
W7017 $21.22 $19.17 $16.78
W7019 $16.78 $14.97 $12.86
Licensed Community Residential Rehabilitation Services—Ineligible W7021 Day $72.71 $67.93 $62.35
W7023 $38.64 $35.67 $32.20
W7025 $27.32 $24.95 $22.18
W7027 $21.22 $19.17 $16.78
W7029 $16.78 $14.97 $12.86
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

Agency with Choice Financial Management Services, Including Benefit Allowance***

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

Service Procedure Modifier Provider Specialty Unit Area 1 Area 2 Area 3
CodeType Code
Companion level 3 W1727 54 540 15 min. $3.84 $3.64 $3.40
Supported Employment W7235 54 540 15 min. $6.52 $6.17 $5.77
Unlicensed Habilitation, level 3 W7060 54 540 15 min. $5.77 $5.46 $5.11
Unlicensed Habilitation, level 3, enhanced W7061 54 540 15 min. $8.92 $8.45 $7.89
TD
TE
Unlicensed Habilitation, level 4 W7068 54 540 15 min. $11.54 $10.93 $10.21
Unlicensed Habilitation, level 4, enhanced W7069 54 540 15 min. $17.84 $16.89 $15.79
TD
TE
Supports Broker W7096 54 540 15 min. $6.50 $6.15 $5.75
Respite—unlicensed, in home, level 2 W7250 54 540 1 day $273.69 $259.16 $242.20
W7258 54 540 15 min. $4.28 $4.05 $3.79
Respite—unlicensed, in home, level 2, enhanced W7251 54 540 1 day $516.87 $489.43 $457.41
TD
TE
W7264 54 540 15 min. $8.05 $7.62 $7.12
TD
TE
Respite—unlicensed, in home, level 3 W7252 54 540 1 day $547.39 $518.33 $484.42
W7265 54 540 15 min. $8.55 $8.10 $7.57
Respite—unlicensed, in home, level 3, enhanced W7253 54 540 1 day $1033.74 $978.85 $914.81
TD
TE
W7266 54 540 15 min. $16.09 $15.24 $14.24
TD
TE
Homemaker/ Chore W7283 54 540 1 hour $16.43 $15.56 $14.54
UA
Respite—unlicensed, out of home, level 2 W8002 54 540 1 day $273.69 $259.16 $242.20
W8012 54 540 15 min. $4.28 $4.05 $3.79
Respite—unlicensed, out of home, level 2, enhanced W8003 54 540 1 day $516.87 $489.43 $457.41
TD
TE
W8013 54 540 15 min. $8.05 $7.62 $7.12
TD
TE
Respite—unlicensed, out of home, level 3 W8004 54 540 1 day $547.39 $518.33 $484.42
W8014 54 540 15 min. $8.55 $8.10 $7.57
Respite—unlicensed, out of home, level 3, enhanced W8005 54 540 1 day $1033.74 $978.85 $914.81
TD
TE
W8015 54 540 15 min. $16.09 $15.24 $14.24
TD
TE

Enhanced Communication Agency with Choice Financial Management Services, Including Benefit Allowance, Consolidated Waiver Only***—Requires ODP Approval

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

Service Procedure Modifier** Provider Specialty Unit Area 1 Area 2 Area 3
CodeType Code
Companion, level 3 W1727 U1 54 540 15 min. $4.21 $3.99 $3.73
Supported Employment W7235 U1 54 540 15 min. $7.23 $6.85 $6.40
Unlicensed Habilitation, level 3 W7060 U1 54 540 15 min. $6.37 $6.03 $5.64
Unlicensed Habilitation, level 3, enhanced W7061 U1 54 540 15 min. $9.92 $9.39 $8.78
TD & U1
TE & U1
Unlicensed Habilitation, level 4 W7068 U1 54 540 15 min. $12.76 $12.08 $11.29
Unlicensed Habilitation, level 4, enhanced W7069 U1 54 540 15 min. $19.85 $18.80 $17.57
TD & U1
TE & U1
Supports Broker W7096 U1 54 540 15 min. $7.21 $6.83 $6.38
Respite—unlicensed, in home, level 2 W7250 U1 54 540 1 day $300.82 $284.85 $266.21
W7258 U1 54 540 15 min. $4.70 $4.45 $4.16
Respite—unlicensed, in home, level 2, enhanced W7251 U1 54 540 1 day $574.40 $543.90 $508.32
TD & U1
TE & U1
W7264 U1 54 540 15 min. $8.94 $8.47 $7.91
TD & U1
TE & U1
Respite—unlicensed, in home, level 3 W7252 U1 54 540 1 day $601.65 $569.70 $532.43
W7265 U1 54 540 15 min. $9.40 $8.90 $8.32
Respite—unlicensed, in home, level 3, enhanced W7253 U1 54 540 1 day $1,148.80 $1,087.80 $1,016.64
TD & U1
TE & U1
W7266 U1 54 540 15 min. $17.88 $16.93 $15.82
TD & U1
TE & U1
Respite—unlicensed, out of home, level 2 W8002 U1 54 540 1 day $300.82 $284.85 $266.21
W8012 U1 54 540 15 min. $4.70 $4.45 $4.16
Respite—unlicensed, out of home, level 2, enhanced W8003 U1 54 540 1 day $574.40 $543.90 $508.32
TD & U1
TE & U1
W8013 U1 54 540 15 min. $8.94 $8.47 $7.91
TD & U1
Respite—unlicensed, out of home, level 3 W8004 U1 54 540 1 day $601.65 $569.70 $532.43
W8014 U1 54 540 15 min. $9.40 $8.90 $8.32
Respite—unlicensed, out of home, level 3, enhanced W8005 U1 54 540 1 day $1,148.80 $1,087.80 $1,016.64
TD & U1
TE & U1
W8015 U1 54 540 15 min. $17.88 $16.93 $15.82
TD & U1
TE & U1

Agency with Choice Financial Management Services, Excluding Benefit Allowance**

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

Service Procedure Modifier** Provider Specialty Unit Area 1 Area 2 Area 3
CodeType Code
Companion, level 3 W1727 U4 54 540 15 min. $2.92 $2.76 $2.58
Supported Employment W7235 U4 54 540 15 min. $5.64 $5.34 $4.99
Unlicensed Habilitation, level 3 W7060 U4 54 540 15 min. $4.84 $4.58 $4.28
Unlicensed Habilitation, level 3, enhanced W7061 U4 54 540 15 min. $8.00 $7.58 $7.08
TD & U4
TE & U4
Unlicensed Habilitation, level 4 W7068 U4 54 540 15 min. $9.68 $9.17 $8.57
Unlicensed Habilitation, level 4, enhanced W7069 U4 54 540 15 min. $15.99 $15.14 $14.15
TD & U4
TE & U4
Supports Broker W7096 U4 54 540 15 min. $5.60 $5.30 $4.96
Respite—unlicensed, in home, level 2 W7250 U4 54 540 1 day $216.81 $205.30 $191.87
W7258 U4 54 540 15 min. $3.35 $3.17 $2.96
Respite—unlicensed, in home, level 2, enhanced W7251 U4 54 540 1 day $459.95 $435.53 $407.04
TD & U4
TE & U4
W7264 U4 54 540 15 min. $7.11 $6.73 $6.29
TD & U4
TE & U4
Respite—unlicensed in home, level 3 W7252 U4 54 540 1 day $433.61 $410.59 $383.73
W7265 U4 54 540 15 min. $6.72 $6.36 $5.95
Respite—unlicensed, in home, level 3, enhanced W7253 U4 54 540 1 day $919.90 $871.06 $814.07
TD & U4
TE & U4
W7266 U4 54 540 15 min. $14.24 $13.48 $12.60
TD & U4
TE & U4
Homemaker/ Chore W7283 U4 54 540 1 hour $12.76 $12.08 $11.29
UA & U4
Respite—unlicensed, out of home, level 2 W8002 U4 54 540 1 day $216.81 $205.30 $191.87
W8012 U4 54 540 15 min. $3.35 $3.17 $2.96
Respite—unlicensed, out of home, level 2, enhanced W8003 U4 54 540 1 day $459.95 $435.53 $407.04
TD & U4
TE & U4
W8013 U4 54 540 15 min. $7.11 $6.73 $6.29
TD & U4
TE & U4
Respite—unlicensed, out of home, level 3 W8004 U4 54 540 1 day $433.61 $410.59 $383.73
W8014 U4 54 540 15 min. $6.72 $6.36 $5.95
Respite—unlicensed, out of home, level 3, enhanced W8005 U4 54 540 1 day $919.90 $871.06 $814.07
TD & U4
TE & U4
W8015 U4 54 540 15 min. $14.24 $13.48 $12.60

Enhanced Communication Agency with Choice Financial Management Services, Excluding Benefit Allowance, Consolidated Waiver Only**—Requires ODP Approval

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

Service Procedure Modifier** Provider Specialty Unit Area 1 Area 2 Area 3
CodeType Code
Companion, level 3 W1727 U4 & U1 54 540 15 min. $3.28 $3.11 $2.90
Supported Employment W7235 U4 & U1 54 540 15 min. $6.34 $6.00 $5.61
Unlicensed Habilitation, level 3 W7060 U4 & U1 54 540 15 min. $5.45 $5.16 $4.82
Unlicensed Habilitation, level 3, enhanced W7061 U4 & U1 54 540 15 min. $9.00 $8.52 $7.96
TD & U4 & U1
TE & U4 & U1
Unlicensed Habilitation, level 4 W7068 U4 & U1 54 540 15 min. $10.89 $10.31 $9.64
Unlicensed Habilitation, level 4, enhanced W7069 U4 & U1 54 540 15 min. $17.99 $17.03 $15.92
TD & U4 & U1
Supports Broker W7096 U4 & U1 54 540 15 min. $6.30 $5.97 $5.58
Respite—unlicensed, in home, level 2 W7250 U4 & U1 54 540 1 day $243.91 $230.96 $215.85
W7258 U4 & U1 54 540 15 min. $3.77 $3.57 $3.34
Respite—unlicensed, in home, level 2, enhanced W7251 U4 & U1 54 540 1 day $517.45 $489.97 $457.92
TD & U4 & U1
TE & U4 & U1
W7264 U4 & U1 54 540 15 min. $8.00 $7.58 $7.08
TD & U4 & U1
TE & U4 & U1
Respite—unlicensed in home, level 3 W7252 U4 & U1 54 540 1 day $487.81 $461.91 $431.69
W7265 U4 & U1 54 540 15 min. $7.56 $7.16 $6.69
Respite—unlicensed, in home, level 3, enhanced W7253 U4 & U1 54 540 1 day $1,034.88 $979.93 $915.82
TD & U4 & U1
TE & U4 & U1
W7266 U4 & U1 54 540 15 min. $16.02 $15.17 $14.18
TE & U4 & U1
Respite—unlicensed, out of home, level 2 W8002 U4 & U1 54 540 1 day $243.91 $230.96 $215.85
W8012 U4 & U1 54 540 15 min. $3.77 $3.57 $3.34
Respite—unlicensed, out of home, level 2, enhanced W8003 U4 & U1 54 540 1 day $517.45 $489.97 $457.92
TD & U4 & U1
TE & U4 & U1
W8013 U4 & U1 54 540 15 min. $8.00 $7.58 $7.08
TD & U4 & U1
TE & U4 & U1
Respite—unlicensed, out of home, level 3 W8004 U4 & U1 54 540 1 day $487.81 $461.91 $431.69
W8014 U4 & U1 54 540 15 min. $7.56 $7.16 $6.69
Respite—unlicensed, out of home, level 3, enhanced W8005 U4 & U1 54 540 1 day $1,034.88 $979.93 $915.82
TD & U4 & U1
TE & U4 & U1
W8015 U4 & U1 TD & U4 & U1 TE & U4 & U1 54 540 15 min. $16.02 $15.17 $14.18

Fiscal Impact

 A new estimated cost for Fiscal Year 2014-15 and subsequent years is the Enhanced Communication Service for individuals enrolled in the Consolidated Waiver. The total amount for Fee Schedule Enhanced Communication Services that was included in the Waiver Appropriation of the Governor's Executive Budget at $1.818 million ($0.868 million State funds). The amount of funding available for this program is dependent upon the funds appropriated by the General Assembly for the forthcoming fiscal year; therefore, until a budget bill is passed and enacted, the fiscal impact associated with this notice is estimated.

Public Comment

 Copies of this notice may be obtained at the local Mental Health/Intellectual Disability (MH/ID) County Program, Administrative Entity (AE) or regional Office of Developmental Programs 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/ID County Program or AE may be found at https://www.hcsis.state.pa.us/hcsis-ssd/pgm/asp/PRCTY.ASP or contact the previously referenced regional Office of Developmental Programs.

 Interested persons are invited to submit written comments regarding this notice to the Department at the Office of Developmental Programs' rate-setting mailbox at ra-ratesetting@state.pa.us, use subject header ''PN Fee Schedule,'' or mail to the Department of Public Welfare, Office of Developmental Programs, Division of Provider Assistance and Rate Setting, 4th Floor, Health and Welfare Building, 625 Forster Street, 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).

BEVERLY D. MACKERETH, 
Secretary

Fiscal Note: 14-NOT-884. (1) General Fund; (2) Implementing Year 2014-15 is $868,000; (3) 1st Succeeding Year 2015-16 through 5th Succeeding Year 2019-20 are $868,000; (4) 2013-14 Program—$1,027,000,000; 2012-13 Program—$931,885,000; 2011-12 Program—$854,863,000; (7) Intellectual Disabilities—Community Waiver Program; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 14-1365. Filed for public inspection June 27, 2014, 9:00 a.m.]



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