Medical Assistance Program Fee Schedule; Peer Support Services [36 Pa.B. 6604]
[Saturday, October 28, 2006]This notice announces that the Department of Public Welfare (Department) will add Peer Support Services for Medical Assistance (MA) recipients 18 years of age and older to the MA Program Fee Schedule effective November 1, 2006.
Description of Service
Peer Support Services are person-centered and recovery-focused services for individuals with serious and persistent mental illness. The services are provided by individuals who have utilized services in the behavioral health system. These individuals are trained and certified to offer support and assistance to help others in the recovery and community integration process. The services are designed to promote empowerment, self-determination, understanding and coping skills through mentoring and service coordination supports that allow individuals with severe and persistent mental illness to achieve personal wellness and cope with the stressors and barriers encountered when recovering from their disabilities. The service is multifaceted and includes activities such as advocacy, education, development of natural supports, support of work or other meaningful activity of the person's choosing, crisis management, effective utilization of the service delivery system and coordination of and linkage to other service providers. The purpose of Peer Support Services is to inspire hope in individuals that recovery from mental illness and co-occurring substance abuse is not only possible, but probable.
Peer Support Services must be provided by an agency or entity approved by the Department.
The procedure code for Peer Support Services is H00038--Self Help/peer services. The fee schedule rate is $10 per 15-minute unit. The maximum number of units that may be billed for 1 day is 16 per individual served.
Fiscal Impact
The fiscal impact is anticipated to be an annual savings $1.412 million in the MA Program. Savings in Fiscal Year 2006-2007 are estimated at $0.886 million in total funds ($0.403 million in State funds).
Public Comment
The Department received and considered input from a wide variety of stakeholders, including the MA Advisory Committee and the Advisory Committee for the Office of Mental Health and Substance Abuse Services, in developing Peer Support Services. Interested persons may submit written comments regarding this notice to the Department of Public Welfare, Office of Mental Health and Substance Abuse Services, Bureau of Policy and Program Development, Attention: Division Chief, P. O. Box 2675, Beechmont Building, 2d Floor, Harrisburg, PA 17105. Comments received within 30 days of publication of this notice will be considered in any subsequent revisions to the service requirements or fee schedule.
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-NOT-489. No fiscal impact; (8) recommends adoption. Enactment of this notice is expected to save $44,000 in Medical Assistance--Outpatient program; $326,000 in the Medical Assistance--Capitation program; and $33,000 in the Medical Assistance--Inpatient program in Fiscal Year 2006-07.
[Pa.B. Doc. No. 06-2126. Filed for public inspection October 27, 2006, 9:00 a.m.]
