Temporary Fee Schedule Rates for Community Participation Support and Transportation Trip Services Funded Through the Consolidated, Community Living, Person/Family Directed Support and Adult Autism Waivers and the Community Intellectual Disability Base-Funded Program
[51 Pa.B. 1907]
[Saturday, April 3, 2021]
The Department of Human Services (Department) is implementing temporary increases to the Fee Schedule Rates for Community Participation Support services in the Consolidated, Community Living and Person/Family Directed Support (P/FDS) Waivers and for Transportation Trip services in the Consolidated, Community Living, P/FDS and Adult Autism Waivers. These changes are being made due to impacts on service as a result of the novel coronavirus (COVID-19) pandemic. The temporary increases to existing Fee Schedule Rates are retroactive to January 1, 2021. The temporary increase to the Fee Schedule Rates will end on June 30, 2021.
These temporary increases to the rates will also apply to 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 6100 (relating to services for individuals with an intellectual disability or autism).
The temporary Fee Schedule Rates have been loaded to PROMISeTM and may be billed. The Home and Community Services Information System has also been automatically updated to include the new Community Participation Support and Transportation Trip Fee Schedule Rates and critical revisions to Individual Support Plans will not be necessary to implement the change to the Fee Schedule Rates. Providers should review service authorizations to confirm that they are billing the increased Fee Schedule Rate.
Fee Schedule Rates
The Department used a market-based approach to establish the temporary Fee Schedule Rates for Community Participation Support and Transportation Trip services. To determine the temporary Fee Schedule Rates, the Department decreased the productivity assumptions due to individuals being absent from services as a result of COVID-19. The Department established the temporary increases to the Fee Schedule Rates to fund services provided at a level sufficient to ensure access, encourage provider participation and promote provider choice during the COVID-19 pandemic, while at the same time ensuring cost effectiveness and fiscal accountability. The temporary increases to the Fee Schedule Rates represent the maximum rates that the Department will pay for services.
Fee Schedule Rate for Community Participation Support Services Effective
January 1, 2021, through June 30, 2021
All rates in the table are per 15-minute unit.
Community Participation Support—Facility W7222 1:11 to 1:15 $2.96 $3.27 W7223 1:7 to 1:10 $3.18 $3.61 W7226 1:4 to 1:6 $5.23 $6.01 W7224 1:2 to 1:3 $6.84 $7.90 W7244 1:1 $12.40 $14.50 W9353 1:1 Enhanced $17.27 $20.66 W7269 2:1 $23.77 $27.96 W9356 2:1 Enhanced $28.65 $34.12 Community Participation Support—Community W9351 1:2 to 1:3 $6.98 $8.02 W9352 2:3 $10.43 $13.60 W5996 1:1 $12.81 $14.97 W5997 1:1 Enhanced $17.83 $21.38 W5993 2:1 $24.62 $29.07 W5994 2:1 Enhanced $29.70 $35.43
Fee Schedule Rate for Transportation Trip Services Effective
January 1, 2021, through June 30, 2021
Service Unit of Service Procedure Code Temporary Fee
Transportation Trip Zone 1
(greater than 0 and up to 10 miles)
W7274 $33.83 Zone 2
(greater than 10 miles and up to 30 miles)
W7275 $60.91 Zone 4
(over 30 miles)
It is anticipated that the temporary enhanced rates from January 1, 2021, through June 30, 2021, would cost a total of $18.837 million ($7.836 million in State funds), which includes $16.337 million ($6.796 million in State funds) for Community Participation Support and $2.500 million ($1.040 million in State funds) for Transportation Trip. However, the Department anticipates the decrease in utilized services resulting in a decrease of expenditures, which will offset any increase as a result of the temporary enhanced rates. This should keep expenditures within the current level of funding for Fiscal Year 2020-2021 for all affected programs.
Copies of this notice may be requested by contacting 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, firstname.lastname@example.org.
Interested persons are invited to submit written comments regarding the temporary increases to the Fee Schedule Rates. Comments received within 30 days of publication of this notice will be reviewed and considered for revisions to the rates. Comments should be addressed 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 may also be sent to email@example.com. Use subject header ''PN COVID Fee Schedule.''
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania Hamilton 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).
TERESA D. MILLER,
Fiscal Note: 14-NOT-1431. (1) General Fund;
(7) Autism Intervention and Services; (2) Implementing Year 2020-21 is $10,000; (3) 1st Succeeding Year 2021-22 through 5th Succeeding Year 2025-26 are $0; (4) 2019-20 Program—$25,252,000; 2018-19 Program—$30,842,000; 2017-18 Program—$27,669,000;
(7) Intellectual Disabilities—Community Base Program; (2) Implementing Year 2020-21 is $240,000; (3) 1st Succeeding Year 2021-22 through 5th Succeeding Year 2025-26 are $0; (4) 2019-20 Program—$148,943,000; 2018-19 Program—$149,379,000; 2017-18 Program—$150,734,000;
(7) Intellectual Disabilities—Community Waiver Program; (2) Implementing Year 2020-21 is $7,586,000; (3) 1st Succeeding Year 2021-22 through 5th Succeeding Year 2025-26 are $0; (4) 2019-20 Program—$1,664,000,000; 2018-19 Program—$1,643,000,000; 2017-18 Program—$1,527,000,000;
(8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 21-525. Filed for public inspection April 2, 2021, 9:00 a.m.]
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