71 Medical Assistance Program fee schedule for select services in the Consolidated and Person/Family Directed Support Waivers and Community Mental Retardation Base Program; correction

DEPARTMENT OF
PUBLIC WELFARE

Medical Assistance Program Fee Schedule for Select Services in the Consolidated and Person/Family Directed Support Waivers and Community Mental Retardation Base Program; Correction

Purpose

[40 Pa.B. 359]
[Saturday, January 9, 2010]

 The Department of Public Welfare (Department) is correcting the Fee Schedule Tables published at 39 Pa.B. 3238 (June 27, 2009). Specifically, some of the provider types, specialty codes, modifiers, selected services and rates of the Fee Schedule Tables are corrected.

 The published notice did not include the Supported Employment service on the Agency with Choice Financial Management Services, including Benefits Fee Schedule Table. Therefore, Supported Employment has been included on the updated table. In addition, the published notice provided an incorrect Area 2 rate for Unlicensed Habilitation, level 4 enhanced on the same table. The published notice incorrectly stated ''$19.83'' as the Area 2 rate for Unlicensed Habilitation, level 4 enhanced. Instead of ''$19.83'' the notice should have stated ''$19.86'' for the Area 2 rate for that service.

 The revised Fee Schedule Tables with the corrected provider types, specialty codes, modifiers, selected services and rates are as follows:

Fee Schedule Table: Select Community-Based Services

Service	Procedure Code	Modifier	Provider Type	Specialty Code	Unit	Area 1	Area 2	Area 3	Area 4
Nursing Services: LPN	T2025	TE	05 ______ 16	051 ______ 161	15 minutes	$11.02	$10.31	$9.78	$8.89
Nursing Services: RN	T2025	TD	05 ______ 16	051 ______ 160	15 minutes	$16.55	$15.48	$14.68	$13.35
Physical Therapy	T2025	GP	17	170	15 minutes	$15.64	$14.63	$13.87	$12.61
Occupational Therapy	T2025	GO	17	171	15 minutes	$17.12	$16.02	$15.19	$13.81
Speech/ Language Therapy	T2025	GN	17	173	15 minutes	$18.73	$17.52	$16.62	$15.10
Individual Behavioral Therapy	T2025	HE	19	208	15 minutes	$16.50	$15.44	$14.64	$13.31
Group Behavioral Therapy	T2025	HE & HQ	19	208	15 minutes	$4.12	$3.85	$3.65	$3.32
Visual/Mobility Therapy	W7246		51	517	15 minutes	$18.73	$17.52	$16.62	$15.10
Companion Services, Basic Staff Support	W1724		51	363	15 minutes	$ .79	$ .74	$ .70	$ .64
Companion Services, Level 1	W1725		51	363	15 minutes	$ .99	$ .93	$ .88	$ .80
Companion Services, Level 2	W1726		51	363	15 minutes	$2.09	$1.96	$1.85	$1.69
Companion Services, Level 3	W1727		51	363	15 minutes	$4.69	$4.39	$4.16	$3.78
Behavioral Support	W7095		51	510	15 minutes	$17.96	$16.80	$15.93	$14.48
Supports Broker	W7096		51	510	15 minutes	$10.85	$10.15	$9.63	$8.75
Home Finding	W7277		51 or 55	571	15 minutes	$9.99	$9.35	$8.86	$8.06
Homemaker/ Chore	W7283		51 ______ 55 ______ 43	430 or 431 ______ 430 or 431 ______ 430	Hour	$22.87	$21.39	$20.29	$18.44
		UA	51 ______ 55 ______ 43	430 or 431 ______ 430 or 431 ______ 430

Fee Schedule Table: Unlicensed Out-of-Home Respite and Respite Camp Ineligible Services
(Room and Board)

Service	Procedure Code	Provider Type	Specialty Code	Unit	Areas 1 through 4
Respite— Unlicensed out of home, ineligible	W6066	51	513	15 minutes	$4.00/unit, max of 3 units per day
	W6067	51	513	15 minutes	$4.00/unit, max of 3 units per day
	W6068	51 ______ 54	513 ______ 540 or 541	15 minutes	$4.00/unit, max of 3 units per day
	W6069	51 ______ 54	513 ______ 540 or 541	15 minutes	$4.00/unit, max of 3 units per day
	W6070	51 ______ 54	513 ______ 540 or 541	15 minutes	$4.00/unit, max of 3 units per day
	W6071	51 ______ 54	513 ______ 540 or 541	15 minutes	$4.00/unit, max of 3 units per day
	W6060	51	513	Day	$12.00/unit, max of 1 unit per day
	W6061	51	513	Day	$12.00/unit, max of 1 unit per day
	W6062	51 ______ 54	513 ______ 540 or 541	Day	$12.00/unit, max of 1 unit per day
	W6063	51 ______ 54	513 ______ 540 or 541	Day	$12.00/unit, max of 1 unit per day
	W6064	51 ______ 54	513 ______ 540 or 541	Day	$12.00/unit, max of 1 unit per day
	W6065	51 ______ 54	513 ______ 540 or 541	Day	$12.00/unit, max of 1 unit per day
Respite—Camp, Ineligible	W8400	51 ______ 55 ______ 54	555 ______ 555 ______ 540 or 541	15 minutes	$4.00/unit, max of 3 units per day
	W8401	51 ______ 55 ______ 54	554 ______ 554 ______ 540 or 541	Day	$12.00/unit, max of 1 unit per day

Fee Schedule Table: Agency with Choice Financial Management Services, Excluding Benefits*

 * Modifier U4 must be used with all procedures codes when billing for services excluding benefits.

Service	Procedure code	Modifier	Provider Type	Specialty Code	Unit	Area 1	Area 2	Area 3	Area 4
Companion, Level 3	W1727	U4	54	540	15 minutes	$3.06	$2.87	$2.72	$2.47
Unlicensed Habilitation, Level 3	W7060	U4	54	540	15 minutes	$5.07	$4.74	$4.50	$4.09
Unlicensed Habilitation, Level 3 enhanced	W7061	U4 ______ TD & U4 ______ TE & U4	54	540	15 minutes	$8.39	$7.85	$7.44	$6.77
Unlicensed Habilitation, Level 4	W7068	U4	54	540	15 minutes	$10.13	$9.48	$8.99	$8.17
Unlicensed Habilitation, Level 4 enhanced	W7069	U4 ______ TD & U4 ______ TE & U4	54	540	15 minutes	$16.77	$15.69	$14.88	$13.52
Supports Broker	W7096	U4	54	540	15 minutes	$6.15	$5.76	$5.46	$4.96
Supported Employment	W7235	U4	54	540	15 minutes	$6.12	$5.73	$5.43	$4.94
Respite— Unlicensed in home, Level 2	W7250	U4	54	540	Day	$223.14	$208.74	$197.94	$179.95
W7258	U4	54	540	15 minutes	$3.48	$3.26	$3.09	$2.81
Respite— Unlicensed in home, Level 2 enhanced	W7251	U4 ______ TD & U4 ______ TE & U4	54	540	Day	$478.66	$447.77	$424.61	$386.01
W7264	U4 ______ TD & U4 ______ TE & U4	54	540	15 minutes	$7.48	$7.00	$6.64	$6.03
Respite— Unlicensed in home, Level 3	W7252	U4	54	540	Day	$446.27	$417.48	$395.89	$359.90
W7265	U4	54	540	15 minutes	$6.97	$6.52	$6.19	$5.62
Respite— Unlicensed in home, Level 3 enhanced	W7253	U4 ______ TD & U4 ______ TE & U4	54	540	Day	$957.31	$895.55	$849.23	$772.02
W7266	U4 ______ TD & U4 ______ TE & U4	54	540	15 minutes	$14.95	$13.99	$13.26	$12.06
Homemaker/ Chore	W7283	U4 ______ UA & U4	54	540	Hour	$13.42	$12.55	$11.91	$10.82
Respite— Unlicensed out of home, Level 2	W8002	U4	54	540	Day	$223.14	$208.74	$197.94	$179.95
W8012	U4	54	540	15 minutes	$3.48	$3.26	$3.09	$2.81
Respite— Unlicensed out of home, Level 2 enhanced	W8003	U4 ______ TD & U4 ______ TE & U4	54	540	Day	$478.66	$447.77	$424.61	$386.01
W8013	U4 ______ TD & U4 ______ TE & U4	54	540	15 minutes	$7.48	$7.00	$6.64	$6.03
Respite— Unlicensed out of home, Level 3	W8004	U4	54	540	Day	$446.27	$417.48	$395.89	$359.90
W8014	U4	54	540	15 minutes	$6.97	$6.52	$6.19	$5.62
Respite— Unlicensed out of home, Level 3 enhanced	W8005	U4 ______ TD & U4 ______ TE & U4	54	540	Day	$957.31	$895.55	$849.23	$772.02
W8015	U4 ______ TD & U4 ______ TE & U4	54	540	15 minutes	$14.95	$13.99	$13.26	$12.06

Fee Schedule Table: Agency with Choice Financial Management Services, Including Benefits**

 ** No modifier is needed to indicate the benefit allowance is included.

Service	Procedure code	Modifier	Provider Type	Specialty Code	Unit	Area 1	Area 2	Area 3	Area 4
Companion Level 3	W1727		54	540	15 minutes	$3.88	$3.63	$3.44	$3.13
Unlicensed Habilitation, Level 3	W7060		54	540	15 minutes	$6.42	$6.01	$5.70	$5.18
Unlicensed Habilitation, Level 3 enhanced	W7061	______ TD ______ TE	54	540	15 minutes	$10.62	$9.93	$9.42	$8.56
Unlicensed Habilitation, Level 4	W7068		54	540	15 minutes	$12.83	$12.00	$11.38	$10.35
Unlicensed Habilitation, Level 4 enhanced	W7069	______ TD ______ TE	54	540	15 minutes	$21.23	$19.86	$18.83	$17.12
Supports Broker	W7096		54	540	15 minutes	$7.79	$7.29	$6.91	$6.28
Supported Employment	W7235		54	540	15 minutes	$7.75	$7.25	$6.88	$6.25
Respite— Unlicensed in home, Level 2	W7250		54	540	Day	$282.49	$264.26	$250.60	$227.81
W7258		54	540	15 minutes	$4.41	$4.13	$3.91	$3.56
Respite— Unlicensed in home, Level 2 enhanced	W7251	______ TD ______ TE	54	540	Day	$605.98	$566.88	$537.56	$488.69
W7264	______ TD ______ TE	54	540	15 minutes	$9.47	$8.86	$8.40	$7.64
Respite— Unlicensed in home, Level 3	W7252		54	540	Day	$564.98	$528.53	$501.19	$455.63
W7265		54	540	15 minutes	$8.83	$8.26	$7.83	$7.12
Respite— Unlicensed in home, Level 3 enhanced	W7253	______ TD ______ TE	54	540	Day	$1,211.96	$1,133.76	$1,075.12	$977.38
W7266	______ TD ______ TE	54	540	15 minutes	$18.93	$17.71	$16.79	$15.27
Homemaker/ Chore	W7283	______ UA	54	540	Hour	$16.99	$15.89	$15.07	$13.70
Respite— Unlicensed out of home, Level 2	W8002		54	540	Day	$282.49	$264.26	$250.60	$227.81
W8012		54	540	15 minutes	$4.41	$4.13	$3.91	$3.56
Respite— Unlicensed out of home, Level 2 enhanced	W8003	______ TD ______ TE	54	540	Day	$605.98	$566.88	$537.56	$488.69
W8013	______ TD ______ TE	54	540	15 minutes	$9.47	$8.86	$8.40	$7.64
Respite— Unlicensed out of home, Level 3	W8004		54	540	Day	$564.98	$528.53	$501.19	$455.63
W8014		54	540	15 minutes	$8.83	$8.26	$7.83	$7.12
Respite— Unlicensed out of home, Level 3 enhanced	W8005	______ TD ______ TE	54	540	Day	$1,211.96	$1,133.76	$1,075.12	$977.38
W8015	______ TD ______ TE	54	540	15 minutes	$18.93	$17.71	$16.79	$15.27

Fiscal Impact

 There is no anticipated fiscal impact.

Public Comment

 Comments received within 30 days will be reviewed and considered for any subsequent revisions to the fee schedules. Interested persons are invited to submit written comments regarding this notice to the Department at the following address:

By E-mail:

 Use subject header ''PN Fee Schedule; Correction'' to the Office of Developmental Programs rate setting mailbox at: [e-mail].

By postal mail:

 Department of Public Welfare
Office of Developmental Programs
Division of Provider Assistance and Rate Setting
4th Floor, Health and Welfare Building
Harrisburg, PA 17120

 Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service at [phone] (TDD users) or [phone] (voice users).

ESTELLE B. RICHMAN 
Secretary

 Fiscal Note: 14-NOT-628. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 10-71. Filed for public inspection January 8, 2010, 9:00 a.m.]