Fee Schedule Rates and Department-Established Fees for Consolidated, Community Living and Person/Family Directed Support Waivers Services, Targeted Support Management and the Community Intellectual Disability Base-Funded Program
[48 Pa.B. 7716]
[Saturday, December 15, 2018]
The Department of Human Services (Department) is providing final notice of the Fee Schedule Rates for Targeted Support Management and select services funded through the Consolidated, Community Living and Person/Family Directed Support waivers and Department-established fees for residential habilitation ineligible services.
The 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. §§ 4101—4704), 55 Pa. Code Chapter 4300 (relating to county mental health and intellectual disability 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 were developed in accordance with 55 Pa. Code Chapter 51 using a market-based approach. The Fee Schedule Rates represent the maximum rates that the Department will pay for each service.
There have been no changes to the Fee Schedule Rates, which were effective July 1, 2018, since the rates were published as final in the Pennsylvania Bulletin, 48 Pa.B. 688 (January 27, 2018). The Fee Schedule Rates can be accessed on the Department's web site at http://www.dhs.pa.gov/provider/developmentalprograms/feeschedulerates/index.htm.
The Department-established fees for residential habilitation ineligible services represent a per-person, per-day net fee based on the size of the home (such as a one-individual home or two-individual home) and type of home (defined as licensed or unlicensed residential habilitation).
There have been no changes to the Department-established fees that have been in effect July 1, 2018, through December 31, 2018, since the fees were published as final in the Pennsylvania Bulletin, 48 Pa.B. 688. The Department-established fees effective July 1, 2018, through December 31, 2018, can be viewed on the Department's web site at http://www.dhs.pa.gov/provider/developmentalprograms/feeschedulerates/index.htm.
The Department has examined current Federal housing data across this Commonwealth and determined that a differential of approximately 10% exists between the costs in the following counties and those in the rest of this Commonwealth. Unlike wage costs, which are typically standardized across multiple counties through use of a single wage scale across counties, housing costs tend to be specific to a particular county and are therefore difficult to standardize across counties. For these reasons, the Department has decided that the differential in housing costs warrants an increase to the Department-established fees, comparable to the cost differential, for residential habilitation ineligible services provided in the following counties, effective January 1, 2019:
The Federal housing data can be found at https://www.huduser.gov/portal/datasets/fmr/fmrs/FY2017_code/2017state_summary.odn.
The Department will adjust the Department-established fees for residential habilitation ineligible services for these counties as specified in the following table, effective January 1, 2019. The fee table designates these counties as Area 1. For providers with licensed and unlicensed residential habilitation ineligible service locations with addresses in the counties identified as Area 1, the fees and Individual Support Plans (ISP) will be updated automatically. The new fees will be automatically reflected in each impacted individual's ISP. The fees for Area 2 are the same fees that were published at 48 Pa.B. 688.
Department-Established Fees Effective January 1, 2019
Service Procedure Code Unit Approved Program Capacity Area 1
(Bucks, Carbon, Chester, Delaware, Lehigh, Monroe, Montgomery, Northampton, Philadelphia and Pike)
(Remaining counties in Pennsylvania)
Licensed Residential Habilitation—
W9001 Day 1 Person $92.57 $84.15 W9030 Day 2 People $50.47 $45.88 W9046 Day 3 People $33.65 $30.59 W9048 Day 4 People $25.33 $23.03 W9065 Day 5—8 People $18.50 $16.82 Unlicensed Residential Habilitation—
W7079 Day 1 Person $22.63 $20.57 W7081 Day 2 People $13.63 $12.39 W7083 Day 3 People $7.00 $6.36
Copies of this notice and the rates 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: 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/ServicesSupportDirectory/CountyContacts or contact the previously referenced regional ODP.
Interested persons are invited to submit written comments within 30 days regarding the final Fee Schedule Rates and Department-established fees to the Department of Human Services, Office of Developmental Programs, Division of Provider Assistance and Rate Setting, 4th Floor, Health and Welfare Building, 625 Forster Street, Harrisburg, PA 17120. Comments can also be sent to email@example.com. Use subject header ''PN Fee Schedule.'' The Department will consider comments received within 30 days in reviewing future adjustments to the Fee Schedule Rates and the Department-established rates.
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service by dialing 711 or by using one of the toll free numbers: (800) 654-5984 (TDD users), (800) 654-5988 (voice users), (844) 308-9292 (Speech-to-Speech) or (844) 308-9291 (Spanish).
It is anticipated that there will be no increase or decrease in costs associated with the final fee schedule rates effective July 1, 2018. However, it is anticipated that there will be a cost of approximately $2.650 million in State Funds to the Commonwealth in Fiscal Year (FY) 2018-2019 and an annualized cost of $5.300 million in state funds in FY 2019-2020 and subsequent years to implement the Department-established fees for residential habilitation ineligible services, effective January 1, 2019.
TERESA D. MILLER,
Fiscal Note: 14-NOT-1304. (1) General Fund;
(7) ID—Community Waiver Program; (2) Implementing Year 2018-19 is $2,650,000; (3) 1st Succeeding Year 2019-20 through 5th Succeeding Year 2023-24 are $5,300,000; 2017-18 Program—$1,528,000,000; 2016-17 Program—$1,349,000,000; 2015-16 Program—$1,203,000,000;
(7) ID—Community Base Program; (2) Implementing Year 2018-19 is $0; (3) 1st Succeeding Year 2019-20 through 5th Succeeding Year 2023-24 are $0; 2017-18 Program—$150,734,000; 2016-17 Program—$149,950,000; 2015-16 Program—$148,229,000;
(8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 18-1946. Filed for public inspection December 14, 2018, 9:00 a.m.]
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