Medical Assistance Program Fee Schedule for Services in the Adult Autism Waiver
[41 Pa.B. 3300]
[Saturday, June 25, 2011]
This notice announces the Department of Public Welfare's (Department) fees for certain services provided to Adult Autism Waiver participants effective July 1, 2011.
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 reviewed the service definitions and determined the allowable cost components. The allowable cost components are the costs that are considered reasonable, necessary and related to the delivery of the service. Costs were determined by evaluating independent data sources (for example, Pennsylvania-specific compensation study) and considering expected expenses for the following major categories of allowable costs:
• Direct care worker wages and other program staff wages for supervisors and program specialists, when applicable.
• Employee-related expenses related to health insurance and other benefits, employer taxes, paid time off and training time.
• Productivity related to the amount of time a direct care staff person is expected to be engaged in direct service program activities.
• Program indirect expenses.
• Administration-related expenses.
The Department also considered provider participation and promotion of provider choice, while at the same time ensuring cost effectiveness and fiscal accountability when it developed the fee schedule rates.
The Department has made changes in the fees for the following services: Behavioral Specialist Plan Development; Behavioral Specialist-Ongoing; Community Inclusion; Day Habilitation Services; Family Counseling; Family Training; Job Assessment and Finding; Nutritional Consultation; Counseling; Occupational Therapy; Speech Therapy; Residential Habilitation Services; Respite Services; Supports Coordination-Plan Development; Supports Coordination-Ongoing; Supported Employment; Temporary Crisis Services; and Transitional Work Services.
The procedure codes, modifiers, provider types, specialty code, unit and fees for Adult Autism Waiver services are as follows:
Service Procedure Code Modifier Provider
Specialty Code Unit Rate Behavioral Specialist Plan Development (Behavioral Support Plan and Crisis Intervention Plans) 96150 11 420 Plans $1,469.93 Behavioral Specialist-Ongoing 96151
11 420 15 min $18.37 Community Inclusion W7201 51 510 15 min $9.00 Day Habilitation Staffing Levels:
Staffing <1:6 - 1:3.5
Staffing <1:3.5 - >1:1
51 514 15 min $2.81
Family Counseling 90846
15 min $19.04 Family Training W7062 51 535 15 min $10.61 Job Assessment and Finding-Assessment W7071 53 531 Unit $657.09 Job Assessment and Finding-Job Finding W7077 53 530 Job $1,226.58 Nutritional Consultation S9470 SE 23 230 15 min $15.95 Residential Habilitation- Community Home
52 521 Day $137.89
Residential Habilitation- Family Living Home
52 522 Day $101.23
Respite Out of Home-Day W7211 51 513 Day $216.80 Respite Out of Home W7212 51 513 15 min $5.42 Respite In Home W7213 51 512 15 min $6.12 Supported Employment W7200 53 531 15 min $10.95 Supports Coordination Plan Development W7199 21 214 Unit $818.59 Supports Coordination Ongoing T2024 21 214 15 min $17.05 Temporary Crisis Services W7236 51 536 15 min $9.00 Counseling T2025 HE 19
15 min $21.29 Occupational Therapy T2025 GO U2 17 171 15 min $19.66 Speech Therapy T2025 GN U2 17 173 15 min $15.08 Transitional Work Services
<1:6 - >1:3.5
<1:3.5 - >1:1
51 516 15 min $2.36
It is anticipated that these revisions will result in an increased cost of $0.357 million ($0.160 million in State funds) in the Autism Intervention Program in Fiscal Year 2011-2012.
Interested persons are invited to submit written comments regarding this notice to the Department at firstname.lastname@example.org, 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).
GARY D. ALEXANDER,
Fiscal Note: 14-NOT-701. (1) General Fund; (2) Implementing Year 2010-11 is $0; (3) 1st Succeeding Year 2011-12 is $160,000; 2nd Succeeding Year 2012-13 is $0; 3rd Succeeding Year 2013-14 is $0; 4th Succeeding Year 2014-15 is $0; 5th Succeeding Year 2015-16 is $0; (4) 2007-08 Program—$9,955,000; 2008-09 Program—$12,363,000; 2009-10 Program—$9,963,000; (7) Autism Intervention and Services; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 11-1061. Filed for public inspection June 24, 2011, 9:00 a.m.]
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