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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 54 Pa.B. 2336 (April 27, 2024).

55 Pa. Code § 6100.571. Fee schedule rates.


§ 6100.571. Fee schedule rates.

 (a)  The Department will establish fee schedule rates, based on the factors in subsection (b), using a market-based approach so that payments are consistent with efficiency, economy and quality of care and sufficient to enlist enough providers so that services are available to at least the extent that such services are available to the general population in the geographic area.

 (b)  In establishing the fee schedule rates in subsection (a), the Department will examine and use data relating to the following factors:

   (1)  The service needs of the individuals.

   (2)  Staff wages, including education, experience, licensure requirements and certification requirements.

   (3)  Staff-related expenses, including benefits, training, recruitment and supervision.

   (4)  Productivity. Productivity is the amount of service delivered relative to the level of staffing provided.

   (5)  Occupancy. Occupancy is the cost related to occupying a space, including rent, taxes, insurance, depreciation and amortization expenses.

   (6)  Direct and indirect program and administration-related expenses.

   (7)  Geographic costs based on the location where the HCBS is provided.

   (8)  Federally-approved HCBS definitions in the waiver and determinations made about cost components that reflect reasonable and necessary costs related to the delivery of each HCBS.

   (9)  The cost of implementing applicable Federal and State statutes and regulations and local ordinances.

   (10)  Other factors that impact costs.

 (c)  The Department will update the data used in subsection (b) at least every 3 years.

 (d)  The Department will publish a description of its rate setting methodology used in subsection (a) as a notice in the Pennsylvania Bulletin for public review and comment. The description will include a discussion of the use of the factors in subsection (b) to establish the fee schedule rates; a discussion of the data and data sources used; and the fee schedule rates.

 (e)  The Department will make available to the public a summary of the public comments received in response to the notice in subsection (d) and the Department’s response to the public comments.

Cross References

   This section cited in 55 Pa. Code §  6100.803 (relating to organized health care delivery system).

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