Availability of the Proposed Rate Setting Methodology, Fee Schedule Rates and Department-Established Fees for Services Funded Through the Office of Developmental Programs' Adult Autism Waiver
[52 Pa.B. 98]
[Saturday, January 1, 2022]
The Department of Human Services (Department) is making available for public review and comment the rate setting methodology used to develop the proposed Fee Schedule Rates for services funded through the Adult Autism Waiver and the proposed Department-Established Fees for residential ineligible services. The rates are effective July 1, 2021. The Department will not be implementing the proposed rates published at 51 Pa.B. 2882 (May 22, 2021).
Under 55 Pa. Code § 6100.571 (relating to fee schedule rates), which was effective October 5, 2019, the Department is required to update the data used in establishing the fee schedule rates at least every 3 years. The Department has reviewed and revised its rates for Adult Autism Waiver services to comply with this requirement as well as to comply with the requirement in the Home and Community-Based Waiver Instructions, Technical Guide and Review Criteria to ensure at a minimum of every 5 years that rates are adequate to maintain an ample provider base and ensure quality of services.
Rate-Setting Methodology for Fee Schedule Rates and Department-Established Fees:
The proposed Fee Schedule Rates and Department-Established Fees were developed using a market-based approach. The process for the development of the Fee Schedule Rates and Department-Established Fees included a review of the Adult Autism Waiver service definitions and a determination of allowable cost components which reflected costs that are reasonable, necessary and related to the service, as defined in the Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Awards (OMB Circular Uniform Guidance, December 26, 2014). The Department established the Fee Schedule Rates and Department-Established Fees to fund services at a level sufficient to ensure access, encourage provider participation and promote provider choice, while at the same time ensuring cost effectiveness and fiscal accountability. The Fee Schedule Rates and Department-Established Fees represent the maximum rates that the Department will pay for each service.
In developing the proposed Fee Schedule Rates and Department-Established fees for each service, the Department evaluated and used various independent data sources, such as a Commonwealth-specific compensation study, to ensure the rates reflect the expected expenses for the delivery of the service under the Adult Autism Waiver.
As required by 55 Pa. Code § 6100.571(b), to establish the Fee Schedule Rates the Department examined and used data relating to the following factors:
• The service needs of the individuals.
• Staff wages.
• Staff-related expenses.
• Program and administration-related expenses.
• Geographic costs based on the location where the service is provided.
• Proposed service definitions in the Adult Autism Waiver and determinations made about allowable cost components that reflect reasonable and necessary costs related to the delivery of each service.
• Cost of implementing applicable Federal and State statutes and regulations and local ordinances.
As required by 55 Pa. Code § 6100.711(c) (relating to fee for the ineligible portion of residential service), to establish the Department-Established Fees the Department examined and used data relating to the following factors:
• Meals for staff persons.
• Custodial and maintenance expenses.
• Geographic costs based on the location where the service is provided.
Because Life Sharing is provided in a private home, the factors listed previously do not apply to the development of rates for the Life Sharing service, and therefore, the Department did not develop Department-Established Fees for the Life Sharing service. Life Sharing providers are responsible for complying with 55 Pa. Code §§ 6100.681—6100.694 and collecting room and board payment from the participant.
The proposed Fee Schedule Rates and the proposed Department-Established Fees for each service are included in the following tables. The assumption logs used to develop the Fee Schedule Rates and Department-Established fees are available at https://www.dhs.pa.gov/Services/Disabilities-Aging/Pages/Adult-Autism-Waiver-Renewal.aspx.
A notice will be published announcing the final Fee Schedule Rates and Department-Established Fees after the public comment period.
FEE SCHEDULE RATES FOR ADULT AUTISM WAIVER SERVICES EFFECTIVE JULY 1, 2021
Rates in the table are per 15-minute unit unless otherwise noted.
Service Name Staffing Level Procedure Code Statewide Fee Day Habilitation >1:6 W7063 $3.34 <1:6 —1:3.5 W7064 $4.04 <1:3.5 —>1: 1 W7065 $6.30 1:1 W7066 $12.39 Residential Habilitation Community Home Light W7228 $153.52
Limited W7229 $215.54
Extensive W7230 $281.34
Intensive W7231 $546.13
Intensive + W7232 $644.82
Life Sharing Low W7052 $165.06
Medium W7054 $200.44
High W7053 $235.81
Specialized Skill Development Behavioral Specialist (Plan Development) 1:1 96156 $1,750.61
Behavioral Specialist (Consult) 1:1 96171 $21.88 Behavioral Specialist (Direct) 1:1 96159 $21.88 Systematic Skill Building (Plan Development) 1:1 W7214 $610.82
Systematic Skill Building (Consult) 1:1 W7216 $17.61 Systematic Skill Building (Direct) 1:1 W7215 $17.61 Community Support 1:1 W7201 $11.54 1:2 W7204 $6.23 1:3 W7205 $4.46 Small Group Employment < 1:6 to > 1:3.5 W0012 $3.11 < 1:3.5 to > 1:1 W0011 $4.55 Supported Employment Intensive Job Coaching (Direct) 1:1 W7200 $18.64 Intensive Job Coaching (Indirect) 1:1 W7207 $18.64 Extended Employment Supports (Direct) 1:1 W7206 $18.64 Extended Employment Supports (Indirect) 1:1 W7202 $18.64 Career Planning Vocational Assessment 1:1 W7071 $18.64 Job Finding 1:1 W7077 $18.64 Therapies Counseling 1:1 T2025 $22.38 Speech/Language 1:1 T2025 $23.56 Nutritional Consultation 1:1 S9470 $17.48 Family Support 1:1 without participant present 90846 $19.49 1:1 with participant present 90847 $19.49 Other H0046 $19.49 Day unit Respite Licensed Out-of-Home All staffing levels W7211 $280.06
Unlicensed Out-of-Home All staffing levels W9495 $214.64
15-minute unit Respite In-Home 1:1 W7213 $9.60 Licensed Out-of-Home All staffing levels W7212 $7.00 Unlicensed Out-of-Home All staffing levels W9596 $5.37 Supports Coordination Plan Development 1:1 W7199 $1,107.67
Ongoing 1:1 T2024 $23.77 Transportation—Trip Zone 1 W7274 $18.83 Zone 2 W7275 $33.85 Zone 3 W7276 $50.46 Temporary Supplemental Services 1:1 W7236 $11.82
DEPARTMENT-ESTABLISHED FEES FOR RESIDENTIAL HABILITATION SERVICES THROUGH THE ADULT AUTISM WAIVER EFFECTIVE JULY 1, 2021
Rates in the table are per day.
Service Staffing Level Procedure Code Statewide Fee Licensed Residential Habilitation
All staffing levels W7233 $35.06
It is anticipated that there will be a total cost to the Commonwealth in Fiscal Year (FY) 2021-2022 of $9.378 million ($4.013 million in State funds). In FY 2022-2023, the cost is $9.378 million ($4.485 million in State funds). For FY 2023-2024 and subsequent years the total cost is $9.378 million ($4.501 million in State funds).
Copies of this notice may be obtained by contacting the Bureau of Supports for Autism and Special Populations at P.O. Box 2675, Harrisburg, PA 17105, RAemail@example.com.
Comments received within 30 days of publication of this notice will be reviewed and considered for revisions to the proposed Fee Schedule Rates and Department-Established Fees. Written comments should be addressed to Laura Cipriani, Department of Human Services, Office of Developmental Programs, 625 Forster Street, Room 510, Harrisburg, PA 17120. Comments may also be submitted to the Department at RAfirstname.lastname@example.org using subject header ''AAW Rates.''
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-1479. (1) General Fund; (2) Implementing Year 2021-22 is $4,013,000; (3) 1st Succeeding Year 2022-23 is $4,485,000; 2nd Succeeding Year 2023-24 through 5th Succeeding Year 2026-27 are $4,501,000; (4) 2020-21 Program—$27,262,000; 2019-20 Program—$25,252,000; 2018-19 Program—$30,842,000; (7) Autism Intervention and Services; (8) recommends adoption. Funds have been included in the budget.
[Pa.B. Doc. No. 22-24. Filed for public inspection December 30, 2021, 9:00 a.m.]
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