Medical Assistance Fee Schedule Revisions in the OBRA Waiver and the Act 150 Program
[51 Pa.B. 7001]
[Saturday, November 6, 2021]
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 in the Medical Assistance (MA) OBRA Waiver and the Act 150 Program 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, 2022.
The Department's rate methodology for the fee schedule rates was published in a public notice in the Pennsylvania Bulletin 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), PAS (CSLA), PAS (Consumer) and PAS (Consumer Overtime), procedure codes W1793, W1793 TT, W1792 and W1792 TU, are increased with the intent to provide for a wage increase for direct care workers providing agency-directed and participant-directed PAS. The Department intends to use funds available through the Federal American Rescue Plan Act of 2021 (ARP) to fund this increase. ARP provides funds to states to enhance home and community-based services. This increase is dependent on approval by the Centers for Medicare & Medicaid Services, including approval of the Department's ARP spending plan and approval of an amendment to the OBRA Waiver.
Fee Schedule Rates
The following tables provide the rates for PAS procedure codes W1793, W1793 TT, W1792 and W1792 TU:
Region OBRA Waiver and Act 150 Procedure Code Rate Unit 1 X W1793 $4.83 15 minutes 2 X W1793 $5.37 15 minutes 3 X W1793 $5.05 15 minutes 4 X W1793 $5.38 15 minutes
Region OBRA Waiver only Procedure Code Rate Unit 1 X W1793 TT $4.91 15 minutes 2 X W1793 TT $5.46 15 minutes 3 X W1793 TT $5.15 15 minutes 4 X W1793 TT $5.48 15 minutes
Region OBRA Waiver and Act 150 Procedure Code Rate Unit 1 X W1792 $3.76 15 minutes 2 X W1792 $3.60 15 minutes 3 X W1792 $3.93 15 minutes 4 X W1792 $4.41 15 minutes
PAS (Consumer Overtime)
Region OBRA Waiver and Act 150 Procedure Code Rate Unit 1 X W1792 TU $5.64 15 minutes 2 X W1792 TU $5.39 15 minutes 3 X W1792 TU $5.90 15 minutes 4 X W1792 TU $6.61 15 minutes
The fiscal impact of this change is estimated at $1.033 million ($0.869 million in State funds) for Fiscal Year (FY) 2021-2022 and $2.068 million ($1.739 million in State funds) for FY 2022-2023.
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: Danielle Cyphert, 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 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).
Fiscal Note: 14-NOT-1470. (1) General Fund; (2) Implementing Year 2021-22 is $869,000; (3) 1st Succeeding Year 2022-23 through 5th Succeeding Year 2026-27 are $1,739,000; (4) 2020-21 Program—$208,841,000; 2019-20 Program—$470,244,000; 2018-19 Program—$850,149,000; (7) Long-Term Living; (8) recommends adoption. The Long-Term Living appropriation is able to absorb this increase.
[Pa.B. Doc. No. 21-1849. Filed for public inspection November 5, 2021, 9:00 a.m.]
No part of the information on this site may be reproduced for profit or sold for profit.
This material has been drawn directly from the official Pennsylvania Bulletin full text database. Due to the limitations of HTML or differences in display capabilities of different browsers, this version may differ slightly from the official printed version.