NOTICES
DEPARTMENT OF
HUMAN SERVICES
Availability of Amendments to the Office of Developmental Programs' Consolidated, Community Living, Person/Family Directed Support and Adult Autism Waivers as well as Rate Setting Methodology and Proposed Fee Schedule Rates for Select Services Funded Through the Office of Developmental Programs' Waivers
[53 Pa.B. 2902]
[Saturday, May 27, 2023]The Department of Human Services (Department) is making available for public review and comment, the Office of Developmental Programs' proposed amendments to the Consolidated, Person/Family Directed Support (P/FDS), Community Living and Adult Autism waivers, which will be effective November 1, 2023. The Department is also making available for public review and comment the rate setting methodology and proposed Fee Schedule Rates for services in the waivers that are impacted by the proposed amendments and additional Fee Schedule Rates for Needs Group 5 Residential Habilitation services and for Life Sharing Without Day services. In addition, the Department is making available for public review and comment, the Fee Schedule Rates for Community Participation Support services and for Transportation Trip services which will be in effect 6 months after the expiration of the Federal novel coronavirus (COVID-19) public health emergency.
Background
Whenever substantive changes are made to an approved waiver, the Department must submit an amendment to the Centers for Medicare & Medicaid Services (CMS) for approval.
The Department proposes the following substantive amendments to all four waivers effective November 1, 2023:
• Increase community participation and create administrative efficiencies by removing the requirement for a variance to be requested for each individual who spends less than 25% of their time during the provision of Community Participation Support or Day Habilitation services participating in integrated community activities. Providers of Community Participation Support or Day Habilitation services will instead be required to include in their quality management plans required by 55 Pa. Code § 6100.45 (relating to quality management) provider performance improvement targets and strategies that ensure opportunities for access to the community for service locations where individuals' participation in integrated community activities is low as defined in the waivers.
• Improve quality of services provided by adding additional provider qualification standards that address financial preparedness and experience rendering services.
• Prevent individuals from losing services due to changes in Community Participation Support or Transportation Trip rates by allowing exceptions to annual service limits in the P/FDS and Adult Autism waivers.
• Increase employment of individuals by allowing Community Participation Support, Day Habilitation, Career Planning and Supported Employment services to assist individuals with contacting relevant agencies and obtaining documents needed to access employment supports and services that educate participants on the impact of employment on current benefits and adding a timeframe for when providers must complete a plan for decreasing an individual's need for Job Coaching and Support.
• Improve quality and support provider innovation through inclusion of supplemental payments for activities that promote recovery and expansion of services impacted by the COVID-19 pandemic and technology that enhance services and for staff training, credentialing and business associates programs for employment.
The Department proposes the following substantive amendments to the Consolidated, Community Living and P/FDS waivers effective November 1, 2023:
• Promote the health, wellness and safety of individuals receiving services by allowing for group Music Therapy, Art Therapy and Equine Assisted Therapy and adding a Specialty Health Assessment and Coordination service.
• Support individuals with complex needs by clarifying what must be in the risk mitigation policy for Life Sharing providers when serving individuals with a medically complex condition.
Rates
Additional Fee Schedule Rates are being added for:
• Group Music Therapy, Art Therapy and Equine Assisted Therapy services provided through the Consolidated, Community Living and P/FDS waivers.
• Needs Group 5 Residential Habilitation services provided through the Consolidated Waiver and Life Sharing Without Day services provided through the Consolidated and Community Living waivers.
The new Specialty Health Assessment and Coordination service in the Consolidated, Community Living and P/FDS waivers will be reimbursed monthly as a vendor service based on the cost that the provider charges to the general public.
In addition, on April 3, 2021, the Department provided notification at 51 Pa. B. 1907 (April 3, 2021) that it had implemented temporary increases to the Fee Schedule Rates for Community Participation Support services provided through the Consolidated, Community Living and P/FDS Waivers and Transportation Trip services provided through the Consolidated, Community Living, P/FDS and Adult Autism Waivers retroactive to January 1, 2021. The Department intended to end the temporary increases to the Fee Schedule Rates and Department-Established Fees on June 30, 2021.
On March 11, 2021, President Joe Biden signed the American Rescue Plan Act (ARPA) of 2021 (Pub.L. No. 117-2). Section 9817 of the ARPA provides the Commonwealth with a temporary 10 percentage point increase to the Federal medical assistance percentage for certain Medicaid expenditures for home and community-based services provided the Department maintains provider payments at a rate no less than those in place on April 1, 2021, through the end of the spending period required by section 9817. On February 26, 2022, the Department provided notification at 52 Pa.B. 1328 (February 26, 2022) that new Fee Schedule Rates for Community Participation Support services provided through the Consolidated, Community Living and P/FDS waivers will be effective 6 months after the expiration of the Federal COVID-19 public health emergency. The Department no longer intends to implement the rates for Community Participation Support services announced in the February 26, 2022, notice and will instead continue to use the rates announced in the April 3, 2021, notice.
The proposed Fee Schedule Rates discussed in this notice 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).
Rate Setting Methodology:
The proposed Fee Schedule Rates for Life Sharing Without Day services, Residential Habilitation Needs Group 5 and group Music Therapy, Art Therapy and Equine Assisted Therapy were developed using a market-based approach. The process for the development of the Fee Schedule included a review of the 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 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 represent the maximum rates that the Department will pay for each service.
In developing the proposed Fee Schedule Rates for Life Sharing Without Day Services, Residential Habilitation Needs Group 5 and group Music Therapy, Art Therapy and Equine Assisted Therapy, 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 services.
As required by 55 Pa. Code § 6100.571(b) (relating to fee schedule rates), 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.
• Productivity.
• Occupancy.
• Program and administration-related expenses.
• Geographic costs based on the location where the service is provided.
• Service definitions in the Consolidated, Community Living and P/FDS waivers 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.
The Department also used the previously-described methodology to determine that the rates for Community Participation Support and Transportation Trip services implemented January 1, 2021, continue to reflect the expected expenses for the delivery of Community Participation Support and Transportation Trip services. Therefore, the Department intends to continue to use the Fee Schedule Rates for Community Participation Support and Transportation Trip services implemented on January 1, 2021.
The proposed Fee Schedule Rates, which are also the proposed Department-Established Fees under 55 Pa. Code § 4300.115(a), 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/2023-Proposed-Waiver-Amendments.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 Community Participation Support Services Effective 6 Months after the Expiration of the Federal COVID-19 Public Health EmergencyThe rates in the table are per 15-minute unit.
Service Procedure
CodeStaff to
Individual
RatioFee Schedule
RateFee Schedule
Rate for
Enhanced
CommunicationCommunity 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 Rates for Transportation Trip Services Effective 6 Months after the Expiration of the
Federal COVID-19 Public Health Emergency
Service Unit of Service Procedure
CodeFee Schedule
RateTransportation 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 3
(over 30 miles)W7276 $69.19
Fee Schedule Rates for Life Sharing, Residential Habilitation Services and Group Music Therapy,
Art Therapy and Equine Assisted Therapy Effective January 1, 2024
Service Name Needs
GroupProgram Capacity or Staffing Level Procedure
CodeStatewide
FeeEnhanced
Communication
Statewide FeeLicensed Residential Habilitation With Day Needs Group 5 1 person TBD $1,265.90
(per day unit)$1,519.08
(per day unit)2 person TBD $1,146.38
(per day unit)$1,375.66
(per day unit)3 person TBD $788.17
(per day unit)$945.80
(per day unit)4 person TBD $606.45
(per day unit)$727.74
(per day unit)5—8 person TBD $546.93
(per day unit)$656.32
(per day unit)Licensed Residential Habilitation Without Day Needs Group 5 1 person TBD $1,655.20
(per day unit)$1,986.24
(per day unit)2 person TBD $1,238.27
(per day unit)$1,485.92
(per day unit)3 person TBD $947.47
(per day unit)$1,136.96
(per day unit)4 person TBD $722.91
(per day unit)$867.49
(per day unit)5—8 person TBD $644.85
(per day unit)$773.82
(per day unit)Life Sharing Without Day—Over 30 Hours Per Week on Average Needs Group 1 1 person TBD $279.64
(per day unit)$286.76
(per day unit)2 person TBD $229.06
(per day unit)$233.52
(per day unit)Needs Group 2 1 person TBD $317.42
(per day unit)$329.17
(per day unit)2 person TBD $257.96
(per day unit)$264.99
(per day unit)Needs Group 3 1 person TBD $389.74
(per day unit)$418.88
(per day unit)2 person TBD $307.22
(per day unit)$325.02
(per day unit)Needs Group 4 1 person TBD $470.86
(per day unit)$522.88
(per day unit)2 person TBD $360.46
(per day unit)$391.25
(per day unit)Medically Complex Life Sharing Without Day Needs Group 4 1 person TBD $494.40
(per day unit)$549.02
(per day unit)2 person TBD $378.48 $410.81 Music Therapy N/A 1:2 to 1:4 TBD $9.58
(per 15-minute unit)$12.11
(per 15-minute unit)Art Therapy N/A 1:2 to 1:4 TBD $9.58
(per 15-minute unit)$12.11
(per 15-minute unit)Equine Assisted Therapy N/A 1:2 to 1:4 TBD $6.67
(per 15-minute unit)$8.13
(per 15-minute unit)Copies of this notice and documents containing the proposed amendments to the Consolidated, Community Living, P/FDS and Adult Autism waivers may be obtained by contacting Julie Mochon, Department of Human Services, Office of Developmental Programs, 625 Forster Street, Room 510, Harrisburg, PA 17120, RA-odpcomment@pa.gov.
The proposed amendments to the Consolidated, Community Living, P/FDS and Adult Autism waivers, effective November 1, 2023, are also available at https://www.dhs.pa.gov/Services/Disabilities-Aging/Pages/2023-Proposed-Waiver-Amendments.aspx.
Fiscal Impact
In Fiscal Year 2023-2024 the anticipated cost for the Intellectual Disabilities (ID)—Community Waiver Programs' expansion of life sharing of $7.500 million ($3.441 million in State funds).
In Fiscal Year 2023-2024 the anticipated cost for the ID—Community Waiver Programs' specialty health assessment and coordination initiative is $1.400 million ($0.700 million in State funds). For the Medical Assistance (MA)—Capitation Program there is an anticipated saving of $2.500 million ($1.134 million in State funds).
The amount of funding available is dependent upon the funds appropriated by the General Assembly for the forthcoming year. Therefore, the fiscal impact is dependent on approval by the General Assembly.
Public Comment
Interested persons are invited to submit written comments regarding the proposed amendments to the waivers and proposed Fee Schedule Rates. Comments should be addressed to Julie Mochon, Department of Human Services, Office of Developmental Programs, 625 Forster Street, Room 510, Harrisburg, PA 17120. Comments may be submitted to the Department at RA-odpcomment@pa.gov using the subject header ''Waiver and Rate Comments.''
Comments received within 30 days of publication of this notice will be reviewed and considered for revisions to the proposed amendments to the waivers and proposed Fee Schedule Rates.
The Department will also hold three webinars to receive comments on the proposed amendments to the waivers: two webinars for the Consolidated, Community Living and P/FDS waivers and one for the Adult Autism waiver. The date, time and link for registration to attend the webinars for the Consolidated, Community Living and P/FDS Waivers are as follows:
June 9, 2023
2 p.m. to 3:30 p.m.
https://attendee.gotowebinar.com/register/9086430493386490975June 14, 2023
10 a.m. to 11:30 a.m.
https://attendee.gotowebinar.com/register/412826365048911710The date, time and link for registration to attend the webinar for the Adult Autism Waiver is as follows:
June 15, 2023
1 p.m. to 2:30 p.m.
https://attendee.gotowebinar.com/register/3649989807848063576Participants who are interested in participating in the webinars may do so by phone but will need a computer to provide comments during the webinars. To assist the Department in accurately capturing comments provided during the webinars, individuals are asked to submit a written copy of their comments by e-mail or mail to the previously provided address.
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).
VALERIE A. ARKOOSH,
Acting SecretaryFiscal Note: 14-NOT-1579. Under section 612 of The Administrative Code of 1929 (71 P.S. § 232), (1) General Fund;
(7) Intellectual Disabilities—Community Waiver Program; (2) Implementing Year 2022-23 is $0; (3) 1st Succeeding Year 2023-24 is $4,141,000; 2nd Succeeding Year 2024-25 is $4,900,000; 3rd Succeeding Year 2025-26 through 5th Succeeding Year 2027-28 are $1,918,000; (4) 2021-22 Program—$1,799,000,000; 2020-21 Program—$1,622,000,000; 2019-20 Program—$1,664,000,000;
(7) Autism Intervention and Services; (2) Implementing Year 2022-23 is $0; (3) 1st Succeeding Year 2023-24 through 5th Succeeding Year 2027-28 are $0; (4) 2021-22 Program—$27,493,000; 2020-21 Program—$27,262,000; 2019-20 Program—$27,062,000;
(7) Medical Assistance—Capitation; (2) Implementing Year 2022-23 is $0; (3) 1st Succeeding Year 2023-24 is -$1,134,000; 2nd Succeeding Year 2024-25 is -$1,789,000; 3rd Succeeding Year is -$2,202,000; 4th Succeeding Year is -$2,2661,000; 5th Succeeding Year 2027-28 is -$3,487,000; (4) 2021-22 Program—$4,557,000,000; 2020-21 Program—$3,060,000,000; 2019-20 Program—$2,508,000,000;
(8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 23-701. Filed for public inspection May 26, 2023, 9:00 a.m.]
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