Medical Assistance Fee Schedule Revisions in the OBRA Waiver and the Act 150 Program and Availability of Amendment to the Office of Long-Term Living's Home and Community-Based OBRA Waiver
[52 Pa.B. 7049]
[Saturday, November 12, 2022]
This notice announces the Department of Human Services' (Department) addition of the following revisions to the Medical Assistance (MA) fee schedule for the OBRA Waiver and the Act 150 Program: Personal Assistance Service (PAS) (Agency with Choice) and Respite (Agency with Choice).
The Department also proposes to amend the OBRA Waiver and make available for public review and comment the Office of Long-Term Living's proposed amendment.
The revisions to the fee schedule and the amendment are proposed to take effect April 1, 2023.
Under 55 Pa. Code § 52.45 (relating to fee schedule rates), the Department is to publish fee schedule rates under the MA Program and the Act 150 program as a notice in the Pennsylvania Bulletin.
The Department used the same rate methodology for the fee schedule rates as that used in the public notice published 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.
Whenever substantive changes are made to an approved waiver, the Department must submit an amendment to the Centers for Medicare & Medicaid Services for approval. The Department proposes the following substantive and technical changes to the OBRA Waiver:
• Add Agency with Choice as a Financial Management Services model for the participant-directed services of PAS and Respite.
• Revise the Benefits Counseling service definition.
• Amend the responsibilities of the Fiscal/Employer Agent.
• Update the Quality Improvement Strategy to the current process.
• Add a new performance measure for Agency with Choice.
• Remove a performance measure that is duplicative.
The proposed OBRA Waiver amendment and a summary of all revisions are available for review at https://www.dhs.pa.gov/contact/DHS-Offices/Pages/OLTL-Waiver-Amendments-and-Renewals.aspx or by contacting the Department of Human Services, Office of Long-Term Living at (717) 857-3280.
Fee Schedule Rates
The following table provides the procedure code and rates for PAS (Agency with Choice):
PAS (Agency with Choice)
Region OBRA Waiver
and Act 150
Procedure Code Modifier Rate Unit 1 X W0164 N/A $4.02 15 minutes 2 X W0164 N/A $3.89 15 minutes 3 X W0164 N/A $4.12 15 minutes 4 X W0164 N/A $4.58 15 minutes
The following table provides the procedure code and rates for Respite (Agency with Choice):
Respite (Agency with Choice)
Region OBRA Waiver
and Act 150
Procedure Code Modifier Rate Unit 1 X W0165 N/A $4 15 minutes 2 X W0165 N/A $3.90 15 minutes 3 X W0165 N/A $4.12 15 minutes 4 X W0165 N/A $4.59 15 minutes
The fiscal impact of this change is estimated at $0.147 million ($0.070 million in State funds) for Fiscal Year (FY) 2022-2023 and $0.598 million ($0.278 million in State funds) for FY 2023-2024.
Interested persons are invited to submit written comments regarding these fee schedule rates and the proposed amendment to the Department of Human Services, Office of Long-Term Living, Bureau of Policy Development and Communications Management, Attention: Robyn Kokus, P.O. Box 8025, Harrisburg, PA 17105-8025. Comments can also be sent to RAemail@example.com. Use ''OBRA 2023'' as the subject line. Comments received within 30 days will be considered in subsequent revisions to the fee schedule or for revisions to the proposed amendment.
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-1545. (1) General Fund; (2) Implementing Year 2022-23 is $70,000; (3) 1st Succeeding Year 2023-24 through 5th Succeeding Year 2027-28 are $278,000; (4) 2021-22 Program—$121,346,000; 2020-21 Program—$208,841,000; 2019-20 Program—$470,244,000; (7) Long-Term Living; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 22-1749. Filed for public inspection November 11, 2022, 9:00 a.m.]
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