2449 Fee schedule rates and Department-established fees for consolidated and person/family directed support waivers services, targeted services management and the Community Intellectual Disability Base-Funded Program
DEPARTMENT OF
PUBLIC WELFAREFee Schedule Rates and Department-Established Fees for Consolidated and Person/Family Directed Support Waivers Services, Targeted Services Management and the Community Intellectual Disability Base-Funded Program [43 Pa.B. 7598]
[Saturday, December 28, 2013]The Department of Public Welfare (Department) is providing final notice of the Fee Schedule Rates for select services funded through the Consolidated and Person/Family Directed Support waivers, the Department-established fees for residential ineligible services and fee for Targeted Service Management (TSM) effective July 1, 2013. These Fee Schedule Rates also serve as the Department-established fees under 55 Pa. Code § 4300.115(a) (relating to Department established fees) for base-funded services managed through county programs for individuals with an intellectual disability under the Mental Health and Intellectual Disability Act of 1966 (50 P. S. §§ 4104—4704), 55 Pa. Code Chapter 4300 (relating to county mental health and mental retardation fiscal manual) and 55 Pa. Code Chapter 51 (relating to Office of Developmental Programs home and community-based services). The Department published its proposed fee schedule rates, Department-established fees for residential ineligible services and fee for TSM at 43 Pa.B. 3588 (June 29, 2013) and will implement the rates as proposed with the exception of the rates for Agency with Choice/Financial Management Services (AWC/FMS).
Change to AWC/FMS Fee Schedule Rates
When developing the proposed rates for AWC/FMS (including and excluding benefit allowance), the Department considered as part of the rate development process the impact the Federal Patient Protection and Affordable Care Act (ACA) (Pub. L. No. 111-148) may have on provider costs to provide services. At the time of the publication of the proposed Fee Schedule Rates, the ACA required employers with 50 or more full-time employees to offer meaningful and affordable health insurance options to full-time employees beginning January 1, 2014. The ACA defines a full-time employee as an employee who on average works 30 or more hours per week. The Department determined that AWC/FMS providers would be subject to the same provisions of the ACA as traditional agency employers. Because the Fee Schedule Rates for AWC services did not include costs associated with employer-paid health care coverage, the Department adjusted the proposed Fee Schedule Rates for AWC services to include consideration for costs associated with employer-paid health care coverage.
On July 2, 2013, the United States Department of Treasury announced that the requirement to provide meaningful and affordable health insurance options to full-time employees was being postponed a year and would be effective January 1, 2015. For this reason, the Department is removing costs associated with employer-paid health care coverage from the proposed rates for AWC/FMS.
No other adjustments are being made to the proposed rates for AWC/FMS. The proposed Fee Schedule Rates for AWC services published at 43 Pa.B. 3588 will be effective from July 1, 2013, through December 31, 2013.
The final Fee Schedule Rates for AWC services in this notice will be effective beginning January 1, 2014.
Fiscal Impact
It is anticipated there will be an approximate cost to the Commonwealth of $21.126 million ($10.118 million State funds) in Fiscal Year (FY) 2013-2014 and $20.801 million ($10.263 million State funds) in FY 2014-2015.
Public Comment
Copies of this notice may be obtained at the local Mental Health/Intellectual Disability (MH/ID) County Program, Administrative Entity (AE) or regional Office of Developmental Programs (ODP) 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
Contact information for the local MH/ID County Program or AE may be found through a link at https://www.hcsis.state.pa.us/hcsis-ssd/pgm/asp/PRCNT.ASP, or contact the previously referenced regional ODP.
Interested persons are invited to submit written comments regarding this notice to the Department to the ODP rate-setting mailbox at ra-ratesetting@state.pa.us, use subject header ''PN Fee Schedule.'' Written comments may be mailed to Department of Public Welfare, Office of Developmental Programs, Division of Provider Assistance and Rate Setting, 4th Floor, Health and Welfare Building, Forster and Commonwealth Avenues, 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 (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
AWC/FMS Fee Schedule Rate Tables: Effective January 1, 2014 Agency with Choice Financial Management Services, Including Benefit Allowance***
***No modifier is needed to indicate the benefit allowance is included.
Service Procedure Modifier Provider Specialty Unit Area 1 Area 2 Area 3 Code Type Code Companion, level 3 W1727 54 540 15 min. $3.84 $3.64 $3.40 Supported Employment W7235 54 540 15 min. $6.52 $6.17 $5.77 Unlicensed Habilitation, level 3 W7060 54 540 15 min. $5.77 $5.46 $5.11 Unlicensed Habilitation, level 3, enhanced W7061 54 540 15 min. $8.92 $8.45 $7.89 TD TE Unlicensed Habilitation, level 4 W7068 54 540 15 min. $11.54 $10.93 $10.21 Unlicensed Habilitation, level 4, enhanced W7069 54 540 15 min. $17.84 $16.89 $15.79 TD TE Supports Broker W7096 54 540 15 min. $6.50 $6.15 $5.75 Respite—unlicensed, in home, level 2 W7250 54 540 1 day $273.69 $259.16 $242.20 W7258 54 540 15 min. $4.28 $4.05 $3.79 Respite—unlicensed, in home, level 2, enhanced W7251 54 540 1 day $516.87 $489.43 $457.41 TD TE W7264 54 540 15 min. $8.05 $7.62 $7.12 TD TE Respite—unlicensed, in home, level 3 W7252 54 540 1 day $547.39 $518.33 $484.42 W7265 54 540 15 min. $8.55 $8.10 $7.57 Respite—unlicensed, in home, level 3, enhanced W7253 54 540 1 day $1,033.74 $978.85 $914.81 TD TE W7266 54 540 15 min. $16.09 $15.24 $14.24 TD TE Homemaker/ Chore W7283 54 540 1 hour $16.43 $15.56 $14.54 UA Respite—unlicensed, out of home, level 2 W8002 54 540 1 day $273.69 $259.16 $242.20 W8012 54 540 15 min. $4.28 $4.05 $3.79 Respite—unlicensed, out of home, level 2, enhanced W8003 54 540 1 day $516.87 $489.43 $457.41 TD TE W8013 54 540 15 min. $8.05 $7.62 $7.12 TD TE Respite—unlicensed, out of home, level 3 W8004 54 540 1 day $547.39 $518.33 $484.42 W8014 54 540 15 min. $8.55 $8.10 $7.57 Respite—unlicensed, out of home, level 3, enhanced W8005 54 540 1 day $1,033.74 $978.85 $914.81 TD TE W8015 54 540 15 min. $16.09 $15.24 $14.24 TD TE Agency with Choice Financial Management Services, Excluding Benefit Allowance**
**Modifier U4 must be used with all procedures codes when billing for services excluding benefit allowance.
Service Procedure Modifier** Provider Specialty Unit Area 1 Area 2 Area 3 Code Type Code Companion, level 3 W1727 U4 54 540 15 min. $2.92 $2.76 $2.58 Supported Employment W7235 U4 54 540 15 min. $5.64 $5.34 $4.99 Unlicensed Habilitation, level 3 W7060 U4 54 540 15 min. $4.84 $4.58 $4.28 Unlicensed Habilitation, level 3, enhanced W7061 U4 54 540 15 min. $8.00 $7.58 $7.08 TD & U4 TE & U4 Unlicensed Habilitation, level 4 W7068 U4 54 540 15 min. $9.68 $9.17 $8.57 Unlicensed Habilitation, level 4, enhanced W7069 U4 54 540 15 min. $15.99 $15.14 $14.15 TD & U4 TE & U4 Supports Broker W7096 U4 54 540 15 min. $5.60 $5.30 $4.96 Respite—unlicensed, in home, level 2 W7250 U4 54 540 1 day $216.81 $205.30 $191.87 W7258 U4 54 540 15 min. $3.35 $3.17 $2.96 Respite—unlicensed, in home, level 2, enhanced W7251 U4 54 540 1 day $459.95 $435.53 $407.04 TD & U4 TE & U4 W7264 U4 54 540 15 min. $7.11 $6.73 $6.29 TD & U4 TE & U4 Respite—unlicensed in home, level 3 W7252 U4 54 540 1 day $433.61 $410.59 $383.73 W7265 U4 54 540 15 min. $6.72 $6.36 $5.95 Respite—unlicensed, in home, level 3, enhanced W7253 U4 54 540 1 day $919.90 $871.06 $814.07 TD & U4 TE & U4 W7266 U4 54 540 15 min. $14.24 $13.48 $12.60 TD & U4 TE & U4 Homemaker/ Chore W7283 U4 54 540 1 hour $12.76 $12.08 $11.29 UA & U4 Respite—unlicensed, out of home, level 2 W8002 U4 54 540 1day $216.81 $205.30 $191.87 W8012 U4 54 540 15 min. $3.35 $3.17 $2.96 Respite—unlicensed, out of home, level 2, enhanced W8003 U4 54 540 1 day $459.95 $435.53 $407.04 TD & U4 TE & U4 W8013 U4 54 540 15 min. $7.11 $6.73 $6.29 TD & U4 TE & U4 Respite—unlicensed, out of home, level 3 W8004 U4 54 540 1 day $433.61 $410.59 $383.73 W8014 U4 54 540 15 min. $6.72 $6.36 $5.95 Respite—unlicensed, out of home, level 3, enhanced W8005 U4 54 540 1 day $919.90 $871.06 $814.07 TD & U4 TE & U4 W8015 U4 54 540 15 min. $14.24 $13.48 $12.60 BEVERLY D. MACKERETH,
SecretaryFiscal Note: 14-NOT-850. (1) General Fund;
(7) Intellectual Disabilities—Community Waiver Program; (2) Implementing Year 2013-14 is $9,814,000; (3) 1st Succeeding Year 2014-15 is $9,952,000; 2nd Succeeding Year 2015-16 through 5th Succeeding Year 2018-19 are $10,036,000; (4) 2012-13 Program—$931,885,000; 2011-12 Program—$854,863,000; 2010-11 Program—$672,376,000;
(7) Intellectual Disabilities—Community Base Program; (2) Implementing Year 2013-14 is $304,000; (3) 1st Succeeding Year 2014-15 is $311,000; 2nd Succeeding Year 2015-16 through 5th Succeeding Year 2018-19 are $313,000; (4) 2012-13 Program—$151,223,000; 2011-12 Program—$158,194,000; 2010-11 Program—$155,958,000;
(8) recommends adoption. Funds have been included in the budget to cover this increase. The additional costs identified for the Base Program will be absorbed within existing funding levels.
[Pa.B. Doc. No. 13-2449. Filed for public inspection December 27, 2013, 9:00 a.m.]
