2109 Department-established fees for the ineligible portion of payment for respite services provided at waiver service locations ?
Title 55—PUBLIC WELFARE DEPARTMENT OF PUBLIC WELFARE [ 55 PA. CODE CH. 4300 ] Department-Established Fees for the Ineligible Portion of Payment for Respite Services Provided at Waiver Service Locations [41 Pa.B. 6681]
[Saturday, December 10, 2011]Scope
This statement of policy applies to Administrative Entity (AE) administrators or directors, County Mental Health and Mental Retardation (MH/MR) Program administrators or directors, Supports Coordination Organization directors and providers of services.
Purpose
The purpose of this statement of policy is to provide the Department of Public Welfare (Department) established fees for the ineligible portion of payment for respite services. For waiver funding, only a portion of payment for specific respite services is eligible for Federal reimbursement. Therefore, the Department-established fees cover the ineligible portion of these respite services. These Department-established fees are for service locations that serve both waiver individuals under the Consolidated and Person/Family Directed Support (P/FDS) waivers and based-funded individuals. The Department-established fees are effective July 1, 2011.
Discussion
This statement of policy interprets § 4300.115(a) (relating to Department established fees) to apply to fees for reimbursement of the ineligible portion of payment for respite services. These services are funded from State-only funds for individuals enrolled in the Consolidated and P/FDS waivers.
In addition, these Department-established fees for the ineligible portion of payment for services apply to an individual receiving a base-funded service in a waiver-funded service location as the ineligible portion of the total rate.
The Department-established fees for the ineligible portion of payment for respite services in a waiver service location are as follows:
Service Procedure Code Provider Type Specialty Unit Area 1 Area 2 Area 3 Area 4 Respite—
Unlicensed Out of
Home, 24 hours—
IneligibleW6060 51 513 day $12.00 $12.00 $12.00 $12.00 W6061 51 513 day $12.00 $12.00 $12.00 $12.00 W6062 51 513 day $12.00 $12.00 $12.00 $12.00 54 540 or 541 W6063 51 513 day $12.00 $12.00 $12.00 $12.00 54 540 or 541 W6064 51 513 day $12.00 $12.00 $12.00 $12.00 54 540 or 541 W6065 51 513 day $12.00 $12.00 $12.00 $12.00 54 540 or 541 Respite—
Unlicensed Out of Home, 15 minutes—
Ineligible
Ineligible units depend on number of eligible unitsW6066 51 513 15 min $4.00 $4.00 $4.00 $4.00 W6067 51 513 15 min $4.00 $4.00 $4.00 $4.00 0-4 hours eligible = 1 ineligible unit W6068 51 513 15 min $4.00 $4.00 $4.00 $4.00 54 540 or 541 4-8 hour eligible = 2 ineligible units W6069 51 513 15 min $4.00 $4.00 $4.00 $4.00 54 540 or 541 More than 8 hours eligible = 3 eligible units
W6070 51 513 15 min $4.00 $4.00 $4.00 $4.00 54 540 or 541 W6071 51 513 15 min $4.00 $4.00 $4.00 $4.00 54 540 or 541 Respite Camp—Ineligible W8400 55 555 15 min $4.00 $4.00 $4.00 $4.00 54 540 or 541 W8401 55 554 day $12.00 $12.00 $12.00 $12.00 These fees are also available through a link titled ''Respite Ineligible Fees'' at http://www.dpw.state.pa.us/provider/doingbusinesswithdpw/developmentalprograms/index.htm
Effective Date
This statement of policy is effective July 1, 2011.
Contact Person
Questions about this statement of policy should be directed to the Regional Program Manager at the following appropriate regional office. Copies of this statement of policy may be obtained at the local MH/MR County Program, AE or regional office in the corresponding regions:
Western region: Piatt Place, Room 4900, 301 5th Avenue, Pittsburgh, PA 15222, (412) 565-5144
Northeast region: Room 315, Scranton State Office Building, 100 Lackawanna Avenue, Scranton, PA 18503, (570) 963-4749
Southeast region: 801 Market Street, Suite 5071, Philadelphia, PA 19107, (215) 560-2242 or (215) 560-2245
Central region: Room 430, Willow Oak Building, P. O. Box 2675, DGS Annex Complex, Harrisburg, PA 17105, (717) 772-6507
GARY D. ALEXANDER,
Secretary(Editor's Note: Title 55 of the Pennsylvania Code is amended by adding a statement of policy in § 4300.115a to read as set forth in Annex A.)
Fiscal Note: 14-BUL-96. No fiscal impact; (8) recommends adoption.
Annex A TITLE 55. PUBLIC WELFARE PART VI. MENTAL HEALTH/MENTAL RETARDATION MANUAL Subpart C. ADMINISTRATION AND FISCAL MANAGEMENT CHAPTER 4300. COUNTY MENTAL HEALTH AND MENTAL RETARDATION FISCAL MANUAL UNIT OF SERVICE FUNDING § 4300.115a. Department-established fees for the ineligible portion of payment for respite services provided at waiver service locations—statement of policy.
(a) Section 4300.115(a) (relating to Department established fees) applies to fees for reimbursement of the ineligible portion of payment for respite services funded with State-only funds for participants enrolled in the Consolidated and Person/Family Directed Support waivers.
(b) The Department-established fees under subsection (a) also apply to an individual receiving a base-funded service in a waiver-funded service location as the ineligible portion of a provider's total rate.
(c) The Department-established fees for the ineligible portion of payment for respite services are available on the Department's web site.
[Pa.B. Doc. No. 11-2109. Filed for public inspection December 9, 2011, 9:00 a.m.]
