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PA Bulletin, Doc. No. 14-2641

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, 
Secretary

Fiscal 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 3W17275454015 min.$3.76$3.56$3.33
Supported EmploymentW72355454015 min.$6.96$6.59$6.16
Unlicensed Habilitation, level 3W70605454015 min.$5.66$5.36$5.01
Unlicensed Habilitation, level 3, enhanced W7061TD5454015 min.$8.82$8.35$7.81
TE
Unlicensed Habilitation, level 4 W70685454015 min.$11.34$10.74$10.04
Unlicensed Habilitation, level 4, enhanced W7069TD 54 540 15 min. $17.64 $16.70 $15.61
TE
Supports BrokerW70965454015 min.$6.41$6.07$5.67
Respite—unlicensed, in home, level 2 W7250545401 day$268.61$254.35$237.71
W72585454015 min.$4.16$3.94$3.68
Respite—unlicensed, in home, level 2, enhancedW7251TD545401 day$513.63$486.36$454.54
TE
W7264TD54 540 15 min.$7.95 $7.53 $7.04
TE
Respite—unlicensed, in home, level 3 W7252 545401 day$537.21$508.69$475.41
W72655454015 min.$8.34$7.90$7.38
Respite—unlicensed, in home, level 3, enhanced W7253 TD545401 day$1,027.25$972.71$909.07
TE
W7266TD 5454015 min.$15.92$15.07$14.09
TE
Homemaker/ ChoreW7283UA545401 hour$16.18$15.32$14.32
Respite—unlicensed, out of home, level 2W8002545401 day$268.61$254.35$237.71
W80125454015 min.$4.16$3.94$3.68
Respite—unlicensed, out of home, level 2, enhanced W8003TD545401 day$513.63$486.36$454.54
TE
W8013TD5454015 min.$7.95$7.53$7.04
TE
Respite—unlicensed, out of home, level 3W8004545401 day$537.21$508.69$475.41
W80145454015 min.$8.34$7.90$7.38
Respite—unlicensed, out of home, level 3, enhancedW8005TD545401 day$1,027.25$972.71 $909.07
TE
W8015TD 5454015 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 CodeModifier**Provider TypeSpecialty CodeUnitArea 1Area 2 Area 3
Companion, level 3W1727U15454015 min.$4.13$3.91$3.66
Supported Employment W7235U15454015 min.$7.67$7.27$6.79
Unlicensed Habilitation, level 3W7060U15454015 min.$6.26$5.93$5.54
Unlicensed Habilitation, level 3, enhancedW7061U15454015 min.$9.82$9.29$8.70
TD & U1
TE & U1
Unlicensed Habilitation, level 4W7068U15454015 min.$12.56$11.89$11.12
Unlicensed Habilitation, level 4, enhancedW7069U15454015 min.$19.65$18.61$17.39
TD & U1
TE & U1
Supports BrokerW7096U15454015 min.$7.12$6.75$6.30
Respite—unlicensed, in home, level 2W7250U1545401 day$295.74$280.04$261.72
W7258U15454015 min.$4.58$4.34$4.05
Respite—unlicensed, in home, level 2, enhanced W7251U1545401 day$571.16$540.83$505.45
TD & U1
TE & U1
W7264U15454015 min.$8.84$8.38$7.83
TD & U1
TE & U1
Respite—unlicensed, in home, level 3W7252U1545401 day$591.47$560.06$523.42
W7265U15454015 min.$9.19$8.70$8.13
Respite—unlicensed, in home, level 3, enhancedW7253U1545401 day$1,142.31$1,081.66$1,010.90
TD & U1
TE & U1
W7266U15454015 min.$17.71$16.76$15.67
TD & U1
TE & U1
Respite—unlicensed, out of home, level 2 W8002U1545401 day$295.74$280.04$261.72
W8012U15454015 min.$4.58$4.34$4.05
Respite—unlicensed, out of home, level 2, enhanced W8003U1545401 day$571.16$540.83$505.45
TD & U1
TE & U1
W8013U15454015 min.$8.84$8.38$7.83
TD & U1
Respite—unlicensed, out of home, level 3W8004U1545401 day$591.47$560.06$523.42
W8014U15454015 min.$9.19$8.70$8.13
Respite—unlicensed, out of home, level 3, enhancedW8005U1545401 day$1,142.31$1,081.66$1,010.90
TD & U1
TE & U1
W8015U15454015 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 codeModifier**Provider TypeSpecialty CodeUnitArea 1Area 2 Area 3
Companion, level 3W1727U45454015 min.$3.14$2.97$2.78
Supported EmploymentW7235U45454015 min.$6.34$6.00$5.61
Unlicensed Habilitation, level 3W7060U45454015 min.$5.04$4.77$4.46
Unlicensed Habilitation, level 3, enhancedW7061U45454015 min.$8.20$7.76$7.26
TD & U4
TE & U4
Unlicensed Habilitation, level 4W7068U45454015 min.$10.10$9.56$8.94
Unlicensed Habilitation, level 4, enhancedW7069U45454015 min.$16.40$15.53$14.51
TD & U4
TE & U4
Supports BrokerW7096U45454015 min.$5.79$5.48$5.12
Respite—unlicensed, in home, level 2W7250U4545401 day$228.95$216.79$202.61
W7258U45454015 min.$3.54$3.35$3.13
Respite—unlicensed, in home, level 2, enhancedW7251U4545401 day$473.97$448.80$419.44
TD & U4
TE & U4
W7264U45454015 min.$7.33$6.94$6.49
TD & U4
TE & U4
Respite—unlicensed in home, level 3W7252U4545401 day$457.89$433.58$405.21
W7265U45454015 min.$7.10$6.72$6.28
Respite—unlicensed, in home, level 3, enhancedW7253U4545401 day$947.93$897.60$838.88
TD & U4
TE & U4
W7266U45454015 min.$14.68$13.90$12.99
TD & U4
TE & U4
Homemaker/Chore W7283U4545401 hour$13.70$12.97$12.12
UA & U4
Respite—unlicensed, out of home, level 2 W8002U4545401 day$228.95$216.79$202.61
W8012U45454015 min.$3.54$3.35$3.13
Respite—unlicensed, out of home, level 2, enhancedW8003U4545401 day$473.97$448.80$419.44
TD & U4
TE & U4
W8013U45454015 min.$7.33$6.94$6.49
TD & U4
TE & U4
Respite—unlicensed, out of home, level 3W8004U4545401 day$457.89$433.58$405.21
W8014U45454015 min.$7.10$6.72$6.28
Respite—unlicensed, out of home, level 3, enhancedW8005U4545401 day$947.93$897.60$838.88
TD & U4
TE & U4
W8015U45454015 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 CodeModifier**Provider TypeSpecialty CodeUnitArea 1Area 2 Area 3
Companion, level 3W1727U4 & U15454015 min.$3.50$3.32$3.10
Supported Employment W7235U4 & U15454015 min.$7.04$6.66$6.23
Unlicensed Habilitation, level 3W7060U4 & U15454015 min.$5.65$5.35$5.00
Unlicensed Habilitation, level 3, enhancedW7061U4 & U15454015 min.$9.20$8.70$8.14
TD & U4 & U1
TE & U4 & U1
Unlicensed Habilitation, level 4 W7068U4 & U15454015 min.$11.31$10.70$10.01
Unlicensed Habilitation, level 4, enhancedW7069U4 & U15454015 min.$18.40$17.42$16.28
TD & U4 & U1
Supports BrokerW7096U4 & U15454015 min.$6.49$6.15$5.74
Respite—unlicensed, in home, level 2W7250U4 & U1545401 day$256.05$242.45$226.59
W7258U4 & U15454015 min.$3.96$3.75$3.51
Respite—unlicensed, in home, level 2, enhanced W7251U4 & U1545401 day$531.47$503.24$470.32
TD & U4 & U1
TE & U4 & U1
W7264U4 & U15454015 min.$8.22$7.79$7.28
TD & U4 & U1
TE & U4 & U1
Respite—unlicensed in home, level 3W7252U4 & U1545401 day$512.09$484.90$453.17
W7265U4 & U15454015 min.$7.94$7.52$7.02
Respite—unlicensed, in home, level 3, enhancedW7253U4 & U1545401 day$1,062.91$1,006.47$940.63
TD & U4 & U1
TE & U4 & U1
W7266U4 & U15454015 min.$16.46$15.59$14.57
TE & U4 & U1
Respite—unlicensed, out of home, level 2W8002U4 & U1545401 day$256.05$242.45$226.59
W8012U4 & U15454015 min.$3.96$3.75$3.51
Respite—unlicensed, out of home, level 2, enhancedW8003U4 & U1545401 day$531.47$503.24$470.32
TD & U4 & U1
TE & U4 & U1
W8013U4 & U15454015 min.$8.22$7.79$7.28
TD & U4 & U1
TE & U4 & U1
Respite—unlicensed, out of home, level 3W8004U4 & U1545401 day$512.09$484.90$453.17
W8014U4 & U15454015 min.$7.94$7.52$7.02
Respite—unlicensed, out of home, level 3, enhancedW8005U4 & U1545401 day$1,062.91$1,006.47$940.63
TD & U4 & U1
TE & U4 & U1
W8015U4 & U15454015 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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