Medical Assistance Fee Schedule Revisions in the Aging, COMMCARE, Independence and OBRA Waivers [46 Pa.B. 107]
[Saturday, January 2, 2016]This notice announces the Department of Human Services' (Department) addition of Adult Daily Living Services Enhanced Half Day in the Medical Assistance (MA) Aging, COMMCARE, Independence and OBRA waivers under 55 Pa. Code § 52.45(a) and (b) (relating to fee schedule rates). In addition, the Department is announcing changes to the vendor goods and services on the fee schedule under 55 Pa. Code § 52.51 (relating to vendor good or service payment).
The following vendor goods and services are being removed: Accessibility Adaptations (<$6,000), Accessibility Adaptations (>$6,000) and Durable Medical Equipment and Supplies. These vendor goods and services are being replaced with the following: Assistive Technology, Home Adaptations (<$6,000), Home Adaptations (>$6,000) and Specialized Medical Equipment and Supplies in the MA Aging, COMMCARE, Independence and OBRA waivers and Vehicle Modifications in the MA COMMCARE, Independence and OBRA waivers.
Finally, the vendor service Non-Medical Transportation will change from a per month unit to a per one-way trip/per item unit in the MA Aging, COMMCARE, Independence and OBRA waivers.
The rate and changes to the fee schedule are effective October 28, 2015.
Rate-Setting Methodology
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.
Fee Schedule Rates
The following table provides the procedure code and rates for Adult Daily Living Services Enhanced Half Day service:
Adult Daily Living Services Enhanced Half Day Region Aging Attendant Care Act 150 CC IW OW Procedure Code Modifier Rate Unit 1 X N/A N/A X X X S5102 U3 37.51 1/2 day 2 X N/A N/A X X X S5102 U3 35.90 1/2 day 3 X N/A N/A X X X S5102 U3 34.21 1/2 day 4 X N/A N/A X X X S5102 U3 37.51 1/2 day CC = COMMCARE
IW = Independence OW = OBRA Vendor Goods and Services
The following table provides new procedure codes and units for vendor goods and services:
Service Aging Attendant Care Act 150 CC IW OW Procedure Code Region Unit Assistive Technology X N/A N/A X X X W0138 N/A Per Purchase Home Adaptations <$6,000 X N/A N/A X X X W0140 N/A Per Purchase Home Adaptations >$6000 X N/A N/A X X X W0141 N/A Per Purchase Specialized Medical Equipment and Supplies X N/A N/A X X X W0137 N/A Per Purchase Vehicle Modifications N/A N/A N/A X X X W0139 N/A Per Purchase CC = COMMCARE IW = Independence OW = OBRA The following table provides the revised unit for Non-Medical Transportation, an existing vendor service:
Service Aging Attendant Care Act 150 CC IW OW Procedure Code Region Unit Non-Medical Transportation X N/A N/A X X X W6110 N/A Per One-
Way Trip/
Per ItemCC = COMMCARE IW = Independence OW = OBRA
Fiscal Impact
There is a minimal fiscal impact associated with these changes.
Public Comment
Interested persons are invited to submit written comments regarding this notice to the Department of Human Services, Office of Long-Term Living, Bureau of Policy and Regulatory Management, Attention: Elaine Smith, P. O. Box 8025, Harrisburg, PA 17105-8025. Comments can also be sent to RA-waiverstandard@pa.gov. 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 AT&T Relay Service by calling (800) 654-5984 (TDD users) or (800) 654-5988 (Voice users).
THEODORE DALLAS,
SecretaryFiscal Year: 14-NOT-984. No fiscal impact. (8) recommends adoption.
[Pa.B. Doc. No. 16-24. Filed for public inspection December 31, 2015, 9:00 a.m.]
