Medical Assistance Fee Schedule Revisions in the OBRA Waiver
[49 Pa.B. 4913]
[Saturday, August 24, 2019]
The Department of Human Services (Department) is announcing a change in the fee schedule rates for Personal Assistance Services (PAS) procedure codes W1793, W1793 TT, W1792 and W1792 TU, and for Residential Habilitation procedure codes W0100 and W0102 in the Medical Assistance (MA) OBRA waiver under 55 Pa. Code § 52.45(a) and (b) (relating to fee schedule rates).
The changes in the fee schedule rates for these services will be effective January 1, 2020.
The Department's rate methodology for the fee schedule rates was published in a public notice at 42 Pa.B. 3343 (June 9, 2012). Fee schedule rates were developed using a standardized market-based rate setting methodology. Relevant market-based information used to determine the fee schedule rates included Commonwealth-specific wage information from the Center for Workforce Information and Analysis, Occupational Wages by County, Bureau of Labor Statistics Employer Costs, cost surveys from providers, Medicare rate information and MA State Plan Fee Schedules.
The existing fee schedule rates for PAS (Agency) and PAS (CSLA), procedure codes W1793 and W1793 TT, are increased by 2%. The intent of the increase is to provide for a wage increase for direct care workers providing agency-directed personal assistance services. This increase is under section 1729-J of the act of April 9, 1929 (P.L. 343, No. 176), also known as the Fiscal Code, added June 28, 2019 (P.L. 173, No. 20). The Department is also increasing the PAS (Consumer) and PAS (Consumer Overtime) rates, procedure codes W1792, and W1792 TU, to maintain equity in all the PAS rates in the OBRA waiver.
In addition, the existing fee schedule rates for Residential Habilitation procedure codes W0100 and W0102 are increased to include a 3% vacancy factor. A vacancy factor had not previously been included in the rate methodology; however, the Department recognizes that providers may not always deliver services to participants at full capacity. Therefore, a 3% vacancy factor will be applied to adjust the rates to account for the days the residential provider did not provide services to the participant. The provider cannot bill for days the participant did not receive services, but rather is paid a higher rate for days the participant received services. A vacancy factor of 3% was applied to reflect payment to providers for an average number of vacant days.
Fee Schedule Rates
The following tables provide the rates for PAS procedure codes W1793, W1793 TT, W1792 and W1792 TU:
Region OBRA Waiver Procedure Code Rate Unit 1 X W1793 $4.47 15 minutes 2 X W1793 $4.97 15 minutes 3 X W1793 $4.68 15 minutes 4 X W1793 $4.98 15 minutes
Region OBRA Waiver Procedure Code Rate Unit 1 X W1793 TT $4.55 15 minutes 2 X W1793 TT $5.06 15 minutes 3 X W1793 TT $4.77 15 minutes 4 X W1793 TT $5.07 15 minutes
Region OBRA Waiver Procedure Code Rate Unit 1 X W1792 $3.48 15 minutes 2 X W1792 $3.33 15 minutes 3 X W1792 $3.64 15 minutes 4 X W1792 $4.08 15 minutes
PAS (Consumer Overtime)
Region OBRA Waiver Procedure Code Rate Unit 1 X W1792 TU $5.22 15 minutes 2 X W1792 TU $5.00 15 minutes 3 X W1792 TU $5.46 15 minutes 4 X W1792 TU $6.12 15 minutes
The following tables provide the rates for Residential Habilitation procedure codes W0100 and W0102:
Residential Habilitation 1—3 Persons
Region OBRA Waiver Procedure Code Rate Unit 1 X W0100 $272.32 1 day 2 X W0100 $272.32 1 day 3 X W0100 $272.32 1 day 4 X W0100 $272.32 1 day
Residential Habilitation 4—8 Persons
Region OBRA Waiver Procedure Code Rate Unit 1 X W0102 $255.33 1 day 2 X W0102 $255.33 1 day 3 X W0102 $255.33 1 day 4 X W0102 $255.33 1 day
The fiscal impact of this change is estimated at $0.220 million ($0.106 million in State funds) for Fiscal Year (FY) 2019-2020 and $0.527 million ($0.253 million in State funds) for FY 2020-2021.
Interested persons are invited to submit written comments regarding these fee schedule rates to the Department of Human Services, Office of Long-Term Living, Bureau of Policy Development and Communications Management, Attention: Marilyn Yocum, P.O. Box 8025, Harrisburg, PA 17105-8025. Comments can also be sent to RAemail@example.com. Comments received within 30 days will be considered in subsequent revisions to the fee schedule.
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service by calling (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
TERESA D. MILLER,
Fiscal Note: 14-NOT-1354. (1) General Fund; (2) Implementing Year 2019-20 is $106,000; (3) 1st Succeeding Year 2020-21 through 5th Succeeding Year 2024-25 are $253,000; (4) 2018-19 Program—$354,573,000; 2017-18 Program—$462,436,000; 2016-17 Program—$434,607,000; (7) Services to Persons with Disabilities; (8) recommends adoption. The increase in rates will provide for a wage increase for direct care workers providing agency-directed personal assistance services and will benefit residential habilitation providers.
[Pa.B. Doc. No. 19-1288. Filed for public inspection August 23, 2019, 9:00 a.m.]
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