1061 Medical Assistance Program Fee schedule for Services in the Adult Autism Waiver

Medical Assistance Program Fee Schedule for Services in the Adult Autism Waiver

[41 Pa.B. 3300]
[Saturday, June 25, 2011]

 This notice announces the Department of Public Welfare's (Department) fees for certain services provided to Adult Autism Waiver participants effective July 1, 2011.

Rate-Setting Methodology

 As part of the Department's efforts to continue to align rates and rate-setting methodology across all offices and programs, the Department used a market-based approach to develop the fee schedule rates. The Department reviewed the service definitions and determined the allowable cost components. The allowable cost components are the costs that are considered reasonable, necessary and related to the delivery of the service. Costs were determined by evaluating independent data sources (for example, Pennsylvania-specific compensation study) and considering expected expenses for the following major categories of allowable costs:

 • Direct care worker wages and other program staff wages for supervisors and program specialists, when applicable.

 • Employee-related expenses related to health insurance and other benefits, employer taxes, paid time off and training time.

 • Productivity related to the amount of time a direct care staff person is expected to be engaged in direct service program activities.

 • Program indirect expenses.

 • Administration-related expenses.

 The Department also considered provider participation and promotion of provider choice, while at the same time ensuring cost effectiveness and fiscal accountability when it developed the fee schedule rates.

 The Department has made changes in the fees for the following services: Behavioral Specialist Plan Development; Behavioral Specialist-Ongoing; Community Inclusion; Day Habilitation Services; Family Counseling; Family Training; Job Assessment and Finding; Nutritional Consultation; Counseling; Occupational Therapy; Speech Therapy; Residential Habilitation Services; Respite Services; Supports Coordination-Plan Development; Supports Coordination-Ongoing; Supported Employment; Temporary Crisis Services; and Transitional Work Services.

Fee Schedule

 The procedure codes, modifiers, provider types, specialty code, unit and fees for Adult Autism Waiver services are as follows:

Service	Procedure Code	Modifier	Provider Type	Specialty Code	Unit	Rate
Behavioral Specialist Plan  Development  (Behavioral Support  Plan and Crisis  Intervention Plans)	96150		11	420	Plans	$1,469.93
Behavioral  Specialist-Ongoing	96151 96151 96151	HB HC HT	11	420	15 min	$18.37
Community Inclusion	W7201		51	510	15 min	$9.00
Day Habilitation Staffing  Levels: Staffing >1:6 Staffing <1:6 - 1:3.5 Staffing <1:3.5 - >1:1 Staffing 1:1	W7063 W7064 W7065 W7066		51	514	15 min	$2.81 $3.37 $5.14 $9.98
Family Counseling	90846 90847 H0046 H0046 H0046 H0046	SE SE SE SE SE SE	19 19 11 11 11 11	425 425 421 422 423 424	15 min	$19.04
Family Training	W7062		51	535	15 min	$10.61
Job Assessment and  Finding-Assessment	W7071		53	531	Unit	$657.09
Job Assessment and  Finding-Job Finding	W7077		53	530	Job	$1,226.58
Nutritional Consultation	S9470	SE	23	230	15 min	$15.95
Residential Habilitation-  Community Home Light Limited Extensive Intensive Intensive +	W7228 W7229 W7230 W7231 W7232		52	521	Day	$137.89 $165.21 $219.83 $439.66 $519.60
Residential Habilitation-  Family Living Home Staffing Low Staffing High	W7052 W7053		52	522	Day	$101.23 $134.24
Respite Out of Home-Day	W7211		51	513	Day	$216.80
Respite Out of Home	W7212		51	513	15 min	$5.42
Respite In Home	W7213		51	512	15 min	$6.12
Supported Employment	W7200		53	531	15 min	$10.95
Supports Coordination  Plan Development	W7199		21	214	Unit	$818.59
Supports Coordination  Ongoing	T2024		21	214	15 min	$17.05
Temporary Crisis Services	W7236		51	536	15 min	$9.00
Counseling	T2025	HE	19 31 11 11 11 11	425 426 421 422 423 424	15 min	$21.29
Occupational Therapy	T2025	GO U2	17	171	15 min	$19.66
Speech Therapy	T2025	GN U2	17	173	15 min	$15.08
Transitional Work  Services <1:6 - >1:3.5 <1:3.5 - >1:1	W7239 W7241		51	516	15 min	$2.36 $3.98

Fiscal Impact

 It is anticipated that these revisions will result in an increased cost of $0.357 million ($0.160 million in State funds) in the Autism Intervention Program in Fiscal Year 2011-2012.

Public Comment

 Interested persons are invited to submit written comments regarding this notice to the Department at [e-mail], use subject header ''PN AAW Fee Schedule'' or Department of Public Welfare, Office of Developmental Programs, Bureau of Autism Services, 6th Floor, Health and Welfare Building, Forster and Commonwealth Avenues, Harrisburg, PA 17120. Comments received will be reviewed and considered for any subsequent revisions to the fee schedule for Adult Autism Waiver services.

 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).

GARY D. ALEXANDER, 
Acting Secretary

 Fiscal Note: 14-NOT-701. (1) General Fund; (2) Implementing Year 2010-11 is $0; (3) 1st Succeeding Year 2011-12 is $160,000; 2nd Succeeding Year 2012-13 is $0; 3rd Succeeding Year 2013-14 is $0; 4th Succeeding Year 2014-15 is $0; 5th Succeeding Year 2015-16 is $0; (4) 2007-08 Program—$9,955,000; 2008-09 Program—$12,363,000; 2009-10 Program—$9,963,000; (7) Autism Intervention and Services; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 11-1061. Filed for public inspection June 24, 2011, 9:00 a.m.]