NOTICES
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. 7968]
[Saturday, December 20, 2014]The Department of Human Services (Department) is providing final notice of the Fee Schedule Rates for select services funded through the Consolidated and Person/Family Directed Support (P/FDS) waivers, the Department-established fees for residential ineligible services and fee for Targeted Service Management (TSM) effective July 1, 2014. These 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). The Department published its proposed fee schedule rates, Department-established fees for residential ineligible services and fee for TSM at 44 Pa.B. 4045 (June 28, 2014) and will implement the rates as proposed. There will be a change to the rates for Agency with Choice/Financial Management Services (AWC/FMS) beginning January 1, 2015.
Change to AWC/FMS Fee Schedule Rates
The Department considered as part of the final rate development process the impact the Federal Patient Protection and Affordable Care Act (Pub. L. No. 111-148) (ACA) may have on provider costs to provide services. Under the ACA, employers with 100 or more full-time employees will be required, beginning January 1, 2015, to offer meaningful and affordable health insurance options to full-time employees. The ACA defines a full-time employee as an employee who on average works 30 hours or more per week.
Currently available information indicates that AWC/FMS providers may be subject to the same provisions of the ACA as traditional agency employers. This means that AWC support service workers who work 30 hours or more per week, on average, may be considered ''full-time employees'' of the AWC provider organization. Because the proposed Fee Schedule Rates for AWC services did not include costs associated with employer-paid health care coverage, the Department adjusted the final Fee Schedule Rates for AWC services to include consideration for costs associated with employer-paid health care coverage.
No other adjustments are being made to the proposed rates for AWC/FMS. The proposed Fee Schedule Rates for AWC services published at 44 Pa.B. 4045 will be effective from July 1, 2014, through December 31, 2014.
The final Fee Schedule Rates for AWC services in this notice will be effective beginning January 1, 2015.
Fiscal Impact
It is anticipated that there will be an approximate cost to the Commonwealth of $2.043 million ($0.976 million State funds) in Fiscal Year (FY) 2014-2015 and $2.268 million ($1.084 million State funds) in FY 2015-2016 and subsequent fiscal years. A minimal increase in costs is anticipated for the Base program appropriation, which will be absorbed within existing funding. The Department does not anticipate making any adjustments to county allocations.
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 (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/ID County Program or AE may be found 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 proposed notice to the Department of Human Services, Office Developmental Programs, Division of Provider Assistance and Rate Setting, 4th Floor, Health and Welfare Building, Forster and Commonwealth Avenues, Harrisburg, PA 17120. Comments can also be sent to ra-ratesetting@state.pa.us, use subject header ''PN Fee Schedule.''
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,
SecretaryFiscal Note: 14-NOT-929. (1) General Fund;
(7) ID—Community Waiver Program; (2) Implementing Year 2014-15 is $976,000; (3) 1st Succeeding Year 2015-16 is $1,084,000; 2nd Succeeding Year 2016-17 through 5th Succeeding Year 2019-20 are $0; (4) 2013-14 Program—$1,027,000,000; 2012-13 Program—$932,000,000; 2011-12 Program—$855,000,000;
(7) ID—Community Base Program; (2) Implementing Year 2014-15 is $0; (3) 1st Succeeding Year 2015-16 through 5th Succeeding Year 2019-20 are $0; (4) 2013-14 Program—$151,000,000; 2012-13 Program—$151,000,000; 2011-12 Program—$158,000,000;
(8) recommends adoption. Funds have been included in the budget to cover this increase.
Agency with Choice Financial Management Services, Including Benefit Allowance Effective
January 1, 2015**
**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 Companion, level 3 W1727 54 540 15 min. $3.76 $3.56 $3.33 Supported Employment W7235 54 540 15 min. $6.96 $6.59 $6.16 Unlicensed Habilitation, level 3 W7060 54 540 15 min. $5.66 $5.36 $5.01 Unlicensed Habilitation, level 3, enhanced W7061 TD 54 540 15 min. $8.82 $8.35 $7.81 TE Unlicensed Habilitation, level 4 W7068 54 540 15 min. $11.34 $10.74 $10.04 Unlicensed Habilitation, level 4, enhanced W7069 TD 54 540 15 min. $17.64 $16.70 $15.61 TE Supports Broker W7096 54 540 15 min. $6.41 $6.07 $5.67 Respite—unlicensed, in home, level 2 W7250 54 540 1 day $268.61 $254.35 $237.71 W7258 54 540 15 min. $4.16 $3.94 $3.68 Respite—unlicensed, in home, level 2, enhanced W7251 TD 54 540 1 day $513.63 $486.36 $454.54 TE W7264 TD 54 540 15 min. $7.95 $7.53 $7.04 TE Respite—unlicensed, in home, level 3 W7252 54 540 1 day $537.21 $508.69 $475.41 W7265 54 540 15 min. $8.34 $7.90 $7.38 Respite—unlicensed, in home, level 3, enhanced W7253 TD 54 540 1 day $1,027.25 $972.71 $909.07 TE W7266 TD 54 540 15 min. $15.92 $15.07 $14.09 TE Homemaker/ Chore W7283 UA 54 540 1 hour $16.18 $15.32 $14.32 Respite—unlicensed, out of home, level 2 W8002 54 540 1 day $268.61 $254.35 $237.71 W8012 54 540 15 min. $4.16 $3.94 $3.68 Respite—unlicensed, out of home, level 2, enhanced W8003 TD 54 540 1 day $513.63 $486.36 $454.54 TE W8013 TD 54 540 15 min. $7.95 $7.53 $7.04 TE Respite—unlicensed, out of home, level 3 W8004 54 540 1 day $537.21 $508.69 $475.41 W8014 54 540 15 min. $8.34 $7.90 $7.38 Respite—unlicensed, out of home, level 3, enhanced W8005 TD 54 540 1 day $1,027.25 $972.71 $909.07 TE W8015 TD 54 540 15 min. $15.92 $15.07 $14.09 TE
Enhanced Communication Agency with Choice Financial Management Services, Including Benefit Allowance, Consolidated Waiver Only Effective January 1, 2015—Requires ODP Approval**
**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 Companion, level 3 W1727 U1 54 540 15 min. $4.13 $3.91 $3.66 Supported Employment W7235 U1 54 540 15 min. $7.67 $7.27 $6.79 Unlicensed Habilitation, level 3 W7060 U1 54 540 15 min. $6.26 $5.93 $5.54 Unlicensed Habilitation, level 3, enhanced W7061 U1 54 540 15 min. $9.82 $9.29 $8.70 TD & U1 TE & U1 Unlicensed Habilitation, level 4 W7068 U1 54 540 15 min. $12.56 $11.89 $11.12 Unlicensed Habilitation, level 4, enhanced W7069 U1 54 540 15 min. $19.65 $18.61 $17.39 TD & U1 TE & U1 Supports Broker W7096 U1 54 540 15 min. $7.12 $6.75 $6.30 Respite—unlicensed, in home, level 2 W7250 U1 54 540 1 day $295.74 $280.04 $261.72 W7258 U1 54 540 15 min. $4.58 $4.34 $4.05 Respite—unlicensed, in home, level 2, enhanced W7251 U1 54 540 1 day $571.16 $540.83 $505.45 TD & U1 TE & U1 W7264 U1 54 540 15 min. $8.84 $8.38 $7.83 TD & U1 TE & U1 Respite—unlicensed, in home, level 3 W7252 U1 54 540 1 day $591.47 $560.06 $523.42 W7265 U1 54 540 15 min. $9.19 $8.70 $8.13 Respite—unlicensed, in home, level 3, enhanced W7253 U1 54 540 1 day $1,142.31 $1,081.66 $1,010.90 TD & U1 TE & U1 W7266 U1 54 540 15 min. $17.71 $16.76 $15.67 TD & U1 TE & U1 Respite—unlicensed, out of home, level 2 W8002 U1 54 540 1 day $295.74 $280.04 $261.72 W8012 U1 54 540 15 min. $4.58 $4.34 $4.05 Respite—unlicensed, out of home, level 2, enhanced W8003 U1 54 540 1 day $571.16 $540.83 $505.45 TD & U1 TE & U1 W8013 U1 54 540 15 min. $8.84 $8.38 $7.83 TD & U1 Respite—unlicensed, out of home, level 3 W8004 U1 54 540 1 day $591.47 $560.06 $523.42 W8014 U1 54 540 15 min. $9.19 $8.70 $8.13 Respite—unlicensed, out of home, level 3, enhanced W8005 U1 54 540 1 day $1,142.31 $1,081.66 $1,010.90 TD & U1 TE & U1 W8015 U1 54 540 15 min. $17.71 $16.76 $15.67 TD & U1 TE & U1
Agency with Choice Financial Management Services, Excluding Benefit Allowance Effective
January 1, 2015**
**Modifier U4 must be used with all procedures codes when billing for services excluding benefit allowance.
Service Procedure code Modifier** Provider Type Specialty Code Unit Area 1 Area 2 Area 3 Companion, level 3 W1727 U4 54 540 15 min. $3.14 $2.97 $2.78 Supported Employment W7235 U4 54 540 15 min. $6.34 $6.00 $5.61 Unlicensed Habilitation, level 3 W7060 U4 54 540 15 min. $5.04 $4.77 $4.46 Unlicensed Habilitation, level 3, enhanced W7061 U4 54 540 15 min. $8.20 $7.76 $7.26 TD & U4 TE & U4 Unlicensed Habilitation, level 4 W7068 U4 54 540 15 min. $10.10 $9.56 $8.94 Unlicensed Habilitation, level 4, enhanced W7069 U4 54 540 15 min. $16.40 $15.53 $14.51 TD & U4 TE & U4 Supports Broker W7096 U4 54 540 15 min. $5.79 $5.48 $5.12 Respite—unlicensed, in home, level 2 W7250 U4 54 540 1 day $228.95 $216.79 $202.61 W7258 U4 54 540 15 min. $3.54 $3.35 $3.13 Respite—unlicensed, in home, level 2, enhanced W7251 U4 54 540 1 day $473.97 $448.80 $419.44 TD & U4 TE & U4 W7264 U4 54 540 15 min. $7.33 $6.94 $6.49 TD & U4 TE & U4 Respite—unlicensed in home, level 3 W7252 U4 54 540 1 day $457.89 $433.58 $405.21 W7265 U4 54 540 15 min. $7.10 $6.72 $6.28 Respite—unlicensed, in home, level 3, enhanced W7253 U4 54 540 1 day $947.93 $897.60 $838.88 TD & U4 TE & U4 W7266 U4 54 540 15 min. $14.68 $13.90 $12.99 TD & U4 TE & U4 Homemaker/Chore W7283 U4 54 540 1 hour $13.70 $12.97 $12.12 UA & U4 Respite—unlicensed, out of home, level 2 W8002 U4 54 540 1 day $228.95 $216.79 $202.61 W8012 U4 54 540 15 min. $3.54 $3.35 $3.13 Respite—unlicensed, out of home, level 2, enhanced W8003 U4 54 540 1 day $473.97 $448.80 $419.44 TD & U4 TE & U4 W8013 U4 54 540 15 min. $7.33 $6.94 $6.49 TD & U4 TE & U4 Respite—unlicensed, out of home, level 3 W8004 U4 54 540 1 day $457.89 $433.58 $405.21 W8014 U4 54 540 15 min. $7.10 $6.72 $6.28 Respite—unlicensed, out of home, level 3, enhanced W8005 U4 54 540 1 day $947.93 $897.60 $838.88 TD & U4 TE & U4 W8015 U4 54 540 15 min. $14.68 $13.90 $12.99
Enhanced Communication Agency with Choice Financial Management Services, Excluding Benefit Allowance, Consolidated Waiver Only Effective January 1, 2015—Requires ODP Approval**
**Modifier U4 must be used with all procedures codes when billing for services excluding benefit allowance.
Service Procedure Code Modifier** Provider Type Specialty Code Unit Area 1 Area 2 Area 3 Companion, level 3 W1727 U4 & U1 54 540 15 min. $3.50 $3.32 $3.10 Supported Employment W7235 U4 & U1 54 540 15 min. $7.04 $6.66 $6.23 Unlicensed Habilitation, level 3 W7060 U4 & U1 54 540 15 min. $5.65 $5.35 $5.00 Unlicensed Habilitation, level 3, enhanced W7061 U4 & U1 54 540 15 min. $9.20 $8.70 $8.14 TD & U4 & U1 TE & U4 & U1 Unlicensed Habilitation, level 4 W7068 U4 & U1 54 540 15 min. $11.31 $10.70 $10.01 Unlicensed Habilitation, level 4, enhanced W7069 U4 & U1 54 540 15 min. $18.40 $17.42 $16.28 TD & U4 & U1 Supports Broker W7096 U4 & U1 54 540 15 min. $6.49 $6.15 $5.74 Respite—unlicensed, in home, level 2 W7250 U4 & U1 54 540 1 day $256.05 $242.45 $226.59 W7258 U4 & U1 54 540 15 min. $3.96 $3.75 $3.51 Respite—unlicensed, in home, level 2, enhanced W7251 U4 & U1 54 540 1 day $531.47 $503.24 $470.32 TD & U4 & U1 TE & U4 & U1 W7264 U4 & U1 54 540 15 min. $8.22 $7.79 $7.28 TD & U4 & U1 TE & U4 & U1 Respite—unlicensed in home, level 3 W7252 U4 & U1 54 540 1 day $512.09 $484.90 $453.17 W7265 U4 & U1 54 540 15 min. $7.94 $7.52 $7.02 Respite—unlicensed, in home, level 3, enhanced W7253 U4 & U1 54 540 1 day $1,062.91 $1,006.47 $940.63 TD & U4 & U1 TE & U4 & U1 W7266 U4 & U1 54 540 15 min. $16.46 $15.59 $14.57 TE & U4 & U1 Respite—unlicensed, out of home, level 2 W8002 U4 & U1 54 540 1 day $256.05 $242.45 $226.59 W8012 U4 & U1 54 540 15 min. $3.96 $3.75 $3.51 Respite—unlicensed, out of home, level 2, enhanced W8003 U4 & U1 54 540 1 day $531.47 $503.24 $470.32 TD & U4 & U1 TE & U4 & U1 W8013 U4 & U1 54 540 15 min. $8.22 $7.79 $7.28 TD & U4 & U1 TE & U4 & U1 Respite—unlicensed, out of home, level 3 W8004 U4 & U1 54 540 1 day $512.09 $484.90 $453.17 W8014 U4 & U1 54 540 15 min. $7.94 $7.52 $7.02 Respite—unlicensed, out of home, level 3, enhanced W8005 U4 & U1 54 540 1 day $1,062.91 $1,006.47 $940.63 TD & U4 & U1 TE & U4 & U1 W8015 U4 & U1 54 540 15 min. $16.46 $15.59 $14.57 TD & U4 & U1 TE & U4 & U1
[Pa.B. Doc. No. 14-2641. Filed for public inspection December 19, 2014, 9:00 a.m.]
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