1099 Proposed fee schedule rates and Department-established fees for consolidated and person/family directed support waivers services, targeted service management and the Community Intellectual Disability Base-Funded Program
Proposed Fee Schedule Rates and Department-Established Fees for Consolidated and Person/Family Directed Support Waivers Services, Targeted Service Management and the Community Intellectual Disability Base-Funded Program [46 Pa.B. 3373]
[Saturday, June 25, 2016]The purpose of this notice is to announce the Department of Human Services (Department) proposed Fee Schedule Rates for Targeted Service Management and select services funded through the Consolidated and Person/Family Directed Support (P/FDS) waivers as well as the Department-established fees for residential ineligible services effective July 1, 2016. These proposed 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 intellectual disability fiscal manual) and 55 Pa. Code Chapter 51 (relating to Office of Developmental Programs home and community-based services). The proposed Fee Schedule Rates and Department-established fees effective July 1, 2016, are unchanged from the final rates established for Fiscal Year (FY) 2015-2016.
Fee Schedule Rates
The Fee Schedule Rates are identified under the following categories: Select Community-Based Services and Agency with Choice/Financial Management Services (AWC/FMS), including benefit allowance and excluding benefit allowance.
The Select Community-Based Services include behavior support, companion, home and community habilitation unlicensed, homemaker/chore, licensed day habilitation (adult training), prevocational services, therapy (physical, occupational, speech and language, individual behavior, group behavior and orientation, mobility and vision), nursing, older adult day, supplemental habilitation, additional individualized staffing, supported employment, supports broker, supports coordination, targeted service management, transitional work and all waiver-funded respite care services, excluding respite camp which is a vendor service.
AWC/FMS (including and excluding benefit allowance) include home and community habilitation unlicensed, companion services, unlicensed in-home and out-of-home respite, supported employment, supports broker and homemaker/chore services. There are two separate tables for AWC/FMS—one provides the Fee Schedule Rate including a benefit allowance and the other provides the Fee Schedule Rate excluding a benefit allowance. The benefit allowance is provided as an option for the Managing Employer to include benefits such as disability insurance, life insurance, retirement savings and paid time off to the support service worker.
The Office of Developmental Programs (ODP) will be using the proposed Fee Schedule Rates to support claims processing in the Provider Reimbursement and Operations Management Information System in electronic format (PROMISeTM). A notice will be published announcing the Final Fee Schedule rates once a budget bill is passed and enacted for FY 2016-2017.
Enhanced Communication Services
The Enhanced Communication Services modifier, U1, is available for the following Consolidated Waiver fee schedule services: behavioral support; companion; supported employment; transitional work; prevocational services; home and community habilitation unlicensed; licensed day habilitation (adult training); therapy (physical, occupational, speech and language, individual behavior, group behavior and orientation, mobility and vision); nursing; older adult day; supplemental habilitation; additional individualized staffing; supports broker and all waiver-funded respite care services; excluding respite camp which is a vendor service.
Enhanced Communication Services can be provided to individuals who meet all of the following:
• Enrolled in the Consolidated Waiver.
• Deaf.
• Determined to need services that are provided by staff who are proficient in sign language.
Providers who wish to receive the Enhanced Communication Services Rate must be approved to do so by the Department. Requests for enhanced rates should be directed to the Deaf Services Coordinator at RA-ODPDeafServices@pa.gov.
Department-Established Fees
The Department-established fees represent a per-person, per-day net fee based on the size of the home (such as a one-individual home or two-individual home) and type of home (defined by licensed, unlicensed or family living home). The fee does not include consideration for payment by the participant, as it is the provider's responsibility to collect that portion of payment from the participant.
The ODP will be using the proposed Department-established fees to support claims processing in PROMISeTM. A notice will be published announcing the final Department-established fees once a budget bill is passed and enacted for FY 2016-2017.
Geographic Areas
The geographic areas are as follows:
Area 1: Adams, Cumberland, Dauphin, Delaware, Lancaster, Lebanon, Lehigh, Montgomery, Northampton, Perry, Philadelphia, York
Area 2: Allegheny, Berks, Bucks, Chester, Franklin, Fulton
Area 3: Armstrong, Beaver, Bedford, Blair, Bradford, Butler, Cambria, Cameron, Carbon, Centre, Clarion, Clearfield, Clinton, Columbia, Crawford, Elk, Erie, Fayette, Forest, Greene, Huntingdon, Indiana, Jefferson, Juniata, Lackawanna, Lawrence, Luzerne, Lycoming, McKean, Mercer, Mifflin, Monroe, Montour, Northumberland, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Washington, Wayne, Westmoreland, Wyoming
Fee Schedule Rates and Department-Established Fees Tables: Effective July 1, 2016 Modifier ET must be used with applicable procedure codes when billing for temporary Base-funded services.
The Supports Coordination fee identified as follows and billed with procedure code W7210 is also applicable to base funded supports coordination.
Prior authorization must be obtained from the Department for services denoted by (PA) in the service row in the following table.
Fee Schedule Rates Service Procedure Code Modifier Provider Type Specialty Code Unit Area 1 Area 2 Area 3 Nursing Services: LPN T2025 TE 05 051 15 min. $11.36 $10.76 $10.05 TE & ET TE 16 161 TE & ET Nursing Services: RN T2025 TD 05 051 15 min. $14.72 $13.94 $13.03 TD & ET TD 16 160 TD & ET Physical Therapy T2025 GP 17 170 15 min. $21.61 $20.46 $19.12 GP & ET Occupational Therapy T2025 GO 17 171 15 min. $20.93 $19.82 $18.52 GO & ET Speech and Language Therapy T2025 GN 17 173 15 min. $19.23 $18.21 $17.02 GN & ET Individual Behavioral Therapy T2025 HE 19 208 15 min. $25.29 $23.95 $22.38 HE & ET Group Behavioral Therapy T2025 HE & HQ 19 208 15 min. $8.09 $7.66 $7.16 HE, HQ & ET Visual/Mobility Therapy W7246 51 517 15 min. $19.23 $18.21 $17.02 ET Companion, Basic staff support W1724 51 363 15 min. $1.26 $1.19 $1.12 ET Companion, level 1 W1725 51 363 15 min. $1.46 $1.38 $1.29 ET Companion, level 2 W1726 51 363 15 min. $2.23 $2.11 $1.97 ET Companion, level 3 W1727 51 363 15 min. $6.11 $5.79 $5.41 ET Supplemental Habilitation, 1:1(PA) W7070 52 456, 520, 521 or 522 15 min. $5.41 $5.12 $4.79 ET Supplemental Habilitation, 2:1(PA) W7084 52 456, 520, 521 or 522 15 min. $10.81 $10.24 $9.57 ET Additional Individualized Staffing, 1:1(PA) W7085 52 456, 520, 521 or 522 15 min. $5.41 $5.12 $4.79 Additional Individualized Staffing, 2:1(PA) W7086 52 456, 520, 521 or 522 15 min. $10.81 $10.24 $9.57 Older Adult Day Habilitation W7094 51 410 15 min. $2.57 $2.43 $2.27 ET Behavioral Support W7095 51 510 15 min. $19.42 $18.39 $17.19 ET Supports Broker W7096 51 510 15 min. $8.65 $8.19 $7.65 Licensed Day—Adult W7072 51 514 15 min. $2.90 $2.75 $2.57 W7073 51 514 15 min. $3.55 $3.36 $3.14 W7074 51 514 15 min. $4.50 $4.26 $3.98 W7075 51 514 15 min. $9.16 $8.67 $8.11 W7076 51 15 min. $13.35 $12.64 $11.81 W7035 15 min. $17.20 $16.29 $15.22 W7036 15 min. $25.57 $24.21 $22.63 Prevocational W7087 15 min. $2.06 $1.95 $1.82 W7088 15 min. $2.43 $2.30 $2.15 W7089 15 min. $3.26 $3.09 $2.88 W7090 15 min. $9.06 $8.58 $8.02 W7091 15 min. $12.59 $11.92 $11.14 W7092 15 min. $17.75 $16.81 $15.71 W7093 15 min. $24.82 $23.50 $21.96 Supports Coordination W7210 21 218 15 min. $21.70 $20.55 $19.20 Targeted Services Management T1017 21 218 15 min. $21.70 $20.55 $19.20 Supported Employment W7235 53 530
53115 min. $17.75 $16.81 $15.71 Transitional Work W7237 51 516 15 min. $2.65 $2.51 $2.35 W7239 51 516 15 min. $3.55 $3.36 $3.14 W7241 51 516 15 min. $4.65 $4.40 $4.12 W7245 51 516 15 min. $11.63 $11.01 $10.29 W7057 51 510 15 min. $2.54 $2.41 $2.25 W7058 51 510 15 min. $3.52 $3.33 $3.12 W7059 51 510 15 min. $4.47 $4.23 $3.96 W7060 51 510 15 min. $7.21 $6.83 $6.38 W7061 51 510 15 min. $11.09 $10.50 $9.81 TD TE W7068 51 510 15 min. $13.96 $13.22 $12.35 W7069 51 510 15 min. $23.97 $22.70 $21.21 TD TE In Home Respite—
24 hoursW7247 51 512 Day $85.20 $80.68 $75.40 W7248 51 512 Day $110.80 $104.92 $98.05 W7250 51 512 Day $241.92 $229.07 $214.09 W7251 51 512 Day $381.84 $361.57 $337.91 W7252 51 512 Day $475.82 $450.56 $421.08 W7253 51 512 Day $755.66 $715.54 $668.73 TD TE In Home Respite—
15 minutesW7255 51 512 15 min. $2.13 $2.02 $1.88 W7256 51 512 15 min. $2.77 $2.62 $2.45 W7258 51 512 15 min. $6.11 $5.79 $5.41 W7264 51 512 15 min. $9.55 $9.04 $8.45 W7265 51 512 15 min. $11.90 $11.27 $10.53 W7266 51 512 15 min. $18.89 $17.89 $16.72 TD TE Respite—unlicensed out of home—24 hour W8000 51 513 Day $85.20 $80.68 $75.40 W8001 51 513 Day $110.80 $104.92 $98.05 W8002 51 513 Day $241.92 $229.07 $214.09 W8003 51 513 Day $381.84 $361.57 $337.91 W8004 51 513 Day $475.82 $450.56 $421.08 W8005 51 513 Day $755.66 $715.54 $668.73 TD TE W8010 51 513 15 min. $2.13 $2.02 $1.88 W8011 51 513 15 min. $2.77 $2.62 $2.45 W8012 51 513 15 min. $6.11 $5.79 $5.41 W8013 51 513 15 min. $9.55 $9.04 $8.45 TD TE W8014 51 513 15 min. $11.90 $11.27 $10.53 W8015 51 513 15 min. $18.89 $17.89 $16.72 TD TE W7259 51 513 Day $111.11 $105.21 $98.33 U2 W7260 51 513 Day $203.96 $193.13 $180.50 U2 W7262 51 513 Day $269.98 $255.64 $238.92 U2 W7263 51 513 Day $416.51 $394.39 $368.59 U2 W7299 51 513 Day $524.61 $496.75 $464.26 U2 W7300 51 513 Day $817.68 $774.26 $723.61 TD TE U2 W7267 51 513 15 min. $2.78 $2.63 $2.46 W7268 51 513 15 min. $3.68 $3.48 $3.26 W7270 51 513 15 min. $6.75 $6.39 $5.97 W7400 51 513 15 min. $10.41 $9.86 $9.21 TD TE W7401 51 513 15 min. $13.12 $12.42 $11.61 W7402 51 513 15 min. $20.44 $19.35 $18.09 TD TE Homemaker/Chore (permanent) W7283 43 430 1 hour $19.44 $18.41 $17.20 51 430 or 431 Homemaker/Chore (temporary) W7283 UA 43 430 1 hour $19.44 $18.41 $17.20 UA & ET UA 51 430 or 431 UA & ET Enhanced Communication Services for Consolidated Waiver—Requires ODP Approval Service Procedure Code Modifier Provider Type Specialty Code Unit Area 1 Area 2 Area 3 Nursing Services: LPN T2025 TE & U1 5 51 15 min. $12.56 $11.89 $11.12 TE & U1 16 161 Nursing Services: RN T2025 TD & U1 5 51 15 min. $16.33 $15.46 $14.45 TD & U1 16 160 Physical Therapy T2025 GP & U1 17 170 15 min. $23.82 $22.56 $21.08 Occupational Therapy T2025 GO & U1 17 171 15 min. $23.06 $21.84 $20.41 Speech and Language Therapy T2025 GN & U1 17 173 15 min. $21.15 $20.03 $18.72 Individual Behavioral Therapy T2025 HE & U1 19 208 15 min. $27.96 $26.48 $24.74 Group Behavioral Therapy T2025 HE & HQ & U1 19 208 15 min. $9.41 $8.91 $8.33 Visual/Mobility Therapy W7246 U1 51 517 15 min. $21.15 $20.03 $18.72 Companion, Basic staff support W1724 U1 51 363 15 min. $1.46 $1.38 $1.29 Companion, level 1 W1725 U1 51 363 15 min. $1.68 $1.59 $1.49 Companion, level 2 W1726 U1 51 363 15 min. $2.61 $2.47 $2.31 Companion, level 3 W1727 U1 51 363 15 min. $6.67 $6.32 $5.90 Supplemental Habilitation, 1:1(PA) W7070 U1 52 456, 520, 521 or 522 15 min. $5.96 $5.64 $5.27 Supplemental Habilitation, 2:1(PA) W7084 U1 52 456, 520, 521 or 522 15 min. $11.92 $11.29 $10.55 Additional Individualized Staffing, 1:1(PA) W7085 U1 52 456, 520, 521 or 522 15 min. $5.96 $5.64 $5.27 Additional Individualized Staffing, 2:1(PA) W7086 U1 52 456, 520, 521 or 522 15 min. $11.92 $11.29 $10.55 Older Adult Day Habilitation W7094 U1 51 410 15 min. $2.81 $2.66 $2.49 Behavioral Support W7095 U1 51 510 15 min. $21.36 $20.23 $18.90 Supports Broker W7096 U1 51 510 15 min. $9.57 $9.06 $8.47 W7072 U1 51 514 15 min. $3.18 $3.01 $2.81 W7073 U1 51 514 15 min. $3.94 $3.73 $3.49 W7074 U1 51 514 15 min. $5.08 $4.81 $4.50 W7075 U1 51 514 15 min. $9.86 $9.34 $8.73 W7076 U1 51 514 15 min. $14.56 $13.79 $12.88 TD & U1 TE & U1 W7035 U1 51 514 15 min. $18.59 $17.60 $16.45 W7036 U1 51 514 15 min. $28.00 $26.51 $24.78 TD & U1 TE & U1 W7087 U1 51 515 15 min. $2.27 $2.15 $2.01 W7088 U1 51 515 15 min. $2.73 $2.59 $2.42 W7089 U1 51 515 15 min. $3.76 $3.56 $3.33 W7090 U1 51 515 15 min. $9.84 $9.32 $8.71 W7091 U1 51 515 15 min. $13.81 $13.08 $12.22 TD & U1 TE & U1 W7092 U1 51 515 15 min. $19.30 $18.28 $17.08 W7093 U1 51 515 15 min. $27.25 $25.80 $24.12 TD & U1 TE & U1 Supported Employment W7235 U1 53 530 or 531 15 min. $19.31 $18.28 $17.09 Transitional Work W7237 U1 51 516 15 min. $3.10 $2.94 $2.74 W7239 U1 51 516 15 min. $4.17 $3.95 $3.69 W7241 U1 51 516 15 min. $5.46 $5.17 $4.83 W7245 U1 51 516 15 min. $12.67 $12.00 $11.21 W7057 U1 51 510 15 min. $2.93 $2.77 $2.59 W7058 U1 51 510 15 min. $4.08 $3.86 $3.61 W7059 U1 51 510 15 min. $5.21 $4.93 $4.61 W7060 U1 51 510 15 min. $7.86 $7.44 $6.96 W7061 U1 51 510 15 min. $12.22 $11.57 $10.81 TD & U1 TE & U1 W7068 U1 51 510 15 min. $15.25 $14.44 $13.50 W7069 U1 51 510 15 min. $26.44 $25.04 $23.40 TD & U1 TE & U1
24 hoursW7247 U1 51 512 Day $99.69 $94.40 $88.22 W7248 U1 51 512 Day $130.23 $123.32 $115.25 W7250 U1 51 512 Day $264.17 $250.14 $233.78 W7251 U1 51 512 Day $421.55 $399.17 $373.05 TD & U1 TE & U1 W7252 U1 51 512 Day $520.29 $492.66 $460.43 W7253 U1 51 512 Day $835.06 $790.72 $738.99 TD & U1 TE & U1
15 minutesW7255 U1 51 512 15 min. $2.50 $2.37 $2.21 W7256 U1 51 512 15 min. $3.27 $3.10 $2.89 W7258 U1 51 512 15 min. $6.67 $6.32 $5.90 W7264 U1 51 512 15 min. $10.55 $9.99 $9.34 TD & U1 TE & U1 W7265 U1 51 512 15 min. $13.02 $12.33 $11.52 W7266 U1 51 512 15 min. $20.88 $19.77 $18.48 TD & U1 TE & U1 W8000 U1 51 513 Day $99.66 $94.37 $88.19 W8001 U1 51 513 Day $130.20 $123.29 $115.22 W8002 U1 51 513 Day $264.15 $250.12 $233.76 W8003 U1 51 513 Day $421.56 $399.18 $373.06 TD & U1 TE & U1 W8004 U1 51 513 Day $520.28 $492.65 $460.42 W8005 U1 51 513 Day $835.09 $790.75 $739.02 TD & U1 TE & U1 W8010 U1 51 513 15 min. $2.49 $2.36 $2.20 W8011 U1 51 513 15 min. $3.26 $3.09 $2.88 W8012 U1 51 513 15 min. $6.67 $6.32 $5.90 W8013 U1 51 513 15 min. $10.54 $9.98 $9.33 TD & U1 TE & U1 W8014 U1 51 513 15 min. $13.01 $12.32 $11.51 W8015 U1 51 513 15 min. $20.88 $19.77 $18.48 TD & U1 TE & U1 W7259 U1 51 513 Day $128.51 $121.69 $113.73 U2 & U1 W7260 U1 51 513 Day $238.74 $226.06 $211.27 U2 & U1 W7262 U1 51 513 Day $294.29 $278.66 $260.43 U2 & U1 W7263 U1 51 513 Day $459.13 $434.75 $406.31 TD & U1 TE & U1 U2 & U1 TD & U2 & U1 TE & U2 & U1 W7299 U1 51 513 Day $573.22 $542.78 $507.27 U2 & U1 W7300 U1 51 513 Day $902.92 $854.98 $799.04 TD & U1 TE & U1 U2 & U1 TD & U2 & U1 TE & U2 & U1 W7267 U1 51 513 15 min. $3.22 $3.05 $2.85 W7268 U1 51 513 15 min. $4.29 $4.06 $3.80 W7270 U1 51 513 15 min. $7.36 $6.97 $6.51 W7400 U1 51 513 15 min. $11.48 $10.87 $10.16 TD & U1 TE & U1 W7401 U1 51 513 15 min. $14.33 $13.57 $12.68 W7402 U1 51 513 15 min. $22.57 $21.37 $19.97 TD & U1 TE & U1 Department-Established Fees Service Procedure Code Modifier Provider Type Specialty Code Unit Area 1 Area 2 Area 3 Licensed Community Homes—Ineligible W6091 Day $72.71 $67.93 $62.35 W6093 $38.64 $35.67 $32.20 W6095 $27.32 $24.95 $22.18 W6097 $21.22 $19.17 $16.78 W6099 $16.78 $14.97 $12.86 Licensed Child Residential Services—Ineligible W7011 Day $72.71 $67.93 $62.35 W7013 $38.64 $35.67 $32.20 W7015 $27.32 $24.95 $22.18 W7017 $21.22 $19.17 $16.78 W7019 $16.78 $14.97 $12.86 Licensed Community Residential Rehabilitation Services—Ineligible W7021 Day $72.71 $67.93 $62.35 W7023 $38.64 $35.67 $32.20 W7025 $27.32 $24.95 $22.18 W7027 $21.22 $19.17 $16.78 W7029 $16.78 $14.97 $12.86 Unlicensed Residential Services—Ineligible W7079 Day $15.28 $13.56 $11.56 W7081 $6.14 $4.90 $3.47 W7083 $5.46 $4.26 $2.87 Unlicensed Family Living Home—Ineligible W7038 Day $2.70 $1.65 $0.43 W7040 $1.31 $0.34 $0.00 Licensed Adult Family Living Home—Ineligible W7292 Day $2.70 $1.65 $0.43 W7294 $1.31 $0.34 $0.00 Licensed Child Family Living Home—Ineligible W7296 Day $2.70 $1.65 $0.43 W7298 $1.31 $0.34 $0.00 Agency with Choice Financial Management Services, Including Benefit Allowance** **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 Companion, level 3 W1727 54 540 15 min. $3.76 $3.56 $3.33 Supported Employment W7235 54 540 15 min. $6.96 $6.59 $6.16 Unlicensed Habilitation, level 3 W7060 54 540 15 min. $5.66 $5.36 $5.01 Unlicensed Habilitation, level 3, enhanced W7061 54 540 15 min. $8.82 $8.35 $7.81 TD TE Unlicensed Habilitation, level 4 W7068 54 540 15 min. $11.34 $10.74 $10.04 Unlicensed Habilitation, level 4, enhanced W7069 54 540 15 min. $17.64 $16.70 $15.61 TD TE Supports Broker W7096 54 540 15 min. $6.41 $6.07 $5.67 Respite—unlicensed, in home, level 2 W7250 54 540 1 day $268.61 $254.35 $237.71 W7258 54 540 15 min. $4.16 $3.94 $3.68 Respite—unlicensed, in home, level 2, enhanced W7251 54 540 1 day $513.63 $486.36 $454.54 TD TE W7264 54 540 15 min. $7.95 $7.53 $7.04 TD TE Respite—unlicensed, in home, level 3 W7252 54 540 1 day $537.21 $508.69 $475.41 W7265 54 540 15 min. $8.34 $7.90 $7.38 Respite—unlicensed, in home, level 3, enhanced W7253 54 540 1 day $1,027.25 $972.71 $909.07 TD TE W7266 54 540 15 min. $15.92 $15.07 $14.09 TD TE Homemaker/Chore W7283 54 540 1 hour $16.18 $15.32 $14.32 UA Respite—unlicensed, out of home, level 2 W8002 54 540 1 day $268.61 $254.35 $237.71 W8012 54 540 15 min. $4.16 $3.94 $3.68 Respite—unlicensed, out of home, level 2, enhanced W8003 54 540 1 day $513.63 $486.36 $454.54 TD TE W8013 54 540 15 min. $7.95 $7.53 $7.04 TD TE Respite—unlicensed, out of home, level 3 W8004 54 540 1 day $537.21 $508.69 $475.41 W8014 54 540 15 min. $8.34 $7.90 $7.38 Respite—unlicensed, out of home, level 3, enhanced W8005 54 540 1 day $1,027.25 $972.71 $909.07 TD TE W8015 54 540 15 min. $15.92 $15.07 $14.09 TD TE Enhanced Communication Agency with Choice Financial Management Services, Including Benefit Allowance, Consolidated Waiver Only—Requires ODP Approval** **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 Companion, level 3 W1727 U1 54 540 15 min. $4.13 $3.91 $3.66 Supported Employment W7235 U1 54 540 15 min. $7.67 $7.27 $6.79 Unlicensed Habilitation, level 3 W7060 U1 54 540 15 min. $6.26 $5.93 $5.54 Unlicensed Habilitation, level 3, enhanced W7061 U1 54 540 15 min. $9.82 $9.29 $8.70 TD & U1 TE & U1 Unlicensed Habilitation, level 4 W7068 U1 54 540 15 min. $12.56 $11.89 $11.12 Unlicensed Habilitation, level 4, enhanced W7069 U1 54 540 15 min. $19.65 $18.61 $17.39 TD & U1 TE & U1 Supports Broker W7096 U1 54 540 15 min. $7.12 $6.75 $6.30 Respite—unlicensed, in home, level 2 W7250 U1 54 540 1 day $295.74 $280.04 $261.72 W7258 U1 54 540 15 min. $4.58 $4.34 $4.05 Respite—unlicensed, in home, level 2, enhanced W7251 U1 54 540 1 day $571.16 $540.83 $505.45 TD & U1 TE & U1 W7264 U1 54 540 15 min. $8.84 $8.38 $7.83 TD & U1 TE & U1 Respite—unlicensed, in home, level 3 W7252 U1 54 540 1 day $591.47 $560.06 $523.42 W7265 U1 54 540 15 min. $9.19 $8.70 $8.13 Respite—unlicensed, in home, level 3, enhanced W7253 U1 54 540 1 day $1,142.31 $1,081.66 $1,010.90 TD & U1 TE & U1 W7266 U1 54 540 15 min. $17.71 $16.76 $15.67 TD & U1 TE & U1 Respite—unlicensed, out of home, level 2 W8002 U1 54 540 1 day $295.74 $280.04 $261.72 W8012 U1 54 540 15 min. $4.58 $4.34 $4.05 Respite—unlicensed, out of home, level 2, enhanced W8003 U1 54 540 1 day $571.16 $540.83 $505.45 TD & U1 TE & U1 W8013 U1 54 540 15 min. $8.84 $8.38 $7.83 TD & U1 Respite—unlicensed, out of home, level 3 W8004 U1 54 540 1 day $591.47 $560.06 $523.42 W8014 U1 54 540 15 min. $9.19 $8.70 $8.13 Respite—unlicensed, out of home, level 3, enhanced W8005 U1 54 540 1 day $1,142.31 $1,081.66 $1,010.90 TD & U1 TE & U1 W8015 U1 54 540 15 min. $17.71 $16.76 $15.67 TD & U1 TE & U1 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 code Modifier** Provider Type Specialty Code Unit Area 1 Area 2 Area 3 Companion, level 3 W1727 U4 54 540 15 min. $3.14 $2.97 $2.78 Supported Employment W7235 U4 54 540 15 min. $6.34 $6.00 $5.61 Unlicensed Habilitation, level 3 W7060 U4 54 540 15 min. $5.04 $4.77 $4.46 Unlicensed Habilitation, level 3, enhanced W7061 U4 54 540 15 min. $8.20 $7.76 $7.26 TD & U4 TE & U4 Unlicensed Habilitation, level 4 W7068 U4 54 540 15 min. $10.10 $9.56 $8.94 Unlicensed Habilitation, level 4, enhanced W7069 U4 54 540 15 min. $16.40 $15.53 $14.51 TD & U4 TE & U4 Supports Broker W7096 U4 54 540 15 min. $5.79 $5.48 $5.12 Respite—unlicensed, in home, level 2 W7250 U4 54 540 1 day $228.95 $216.79 $202.61 W7258 U4 54 540 15 min. $3.54 $3.35 $3.13 Respite—unlicensed, in home, level 2, enhanced W7251 U4 54 540 1 day $473.97 $448.80 $419.44 TD & U4 TE & U4 W7264 U4 54 540 15 min. $7.33 $6.94 $6.49 TD & U4 TE & U4 Respite—unlicensed in home, level 3 W7252 U4 54 540 1 day $457.89 $433.58 $405.21 W7265 U4 54 540 15 min. $7.10 $6.72 $6.28 Respite—unlicensed, in home, level 3, enhanced W7253 U4 54 540 1 day $947.93 $897.60 $838.88 TD & U4 TE & U4 W7266 U4 54 540 15 min. $14.68 $13.90 $12.99 TD & U4 TE & U4 Homemaker/Chore W7283 U4 54 540 1 hour $13.70 $12.97 $12.12 UA & U4 Respite—unlicensed, out of home, level 2 W8002 U4 54 540 1 day $228.95 $216.79 $202.61 W8012 U4 54 540 15 min. $3.54 $3.35 $3.13 Respite—unlicensed, out of home, level 2, enhanced W8003 U4 54 540 1 day $473.97 $448.80 $419.44 TD & U4 TE & U4 W8013 U4 54 540 15 min. $7.33 $6.94 $6.49 TD & U4 TE & U4 Respite—unlicensed, out of home, level 3 W8004 U4 54 540 1 day $457.89 $433.58 $405.21 W8014 U4 54 540 15 min. $7.10 $6.72 $6.28 Respite—unlicensed, out of home, level 3, enhanced W8005 U4 54 540 1 day $947.93 $897.60 $838.88 TD & U4 TE & U4 W8015 U4 54 540 15 min. $14.68 $13.90 $12.99 Enhanced Communication Agency with Choice Financial Management Services, Excluding Benefit Allowance, Consolidated Waiver Only—Requires ODP Approval** **Modifier U4 must be used with all procedures codes when billing for services excluding benefit allowance. Service Procedure Code Modifier** Provider Type Specialty Code Unit Area 1 Area 2 Area 3 Companion, level 3 W1727 U4 & U1 54 540 15 min. $3.50 $3.32 $3.10 Supported Employment W7235 U4 & U1 54 540 15 min. $7.04 $6.66 $6.23 Unlicensed Habilitation, level 3 W7060 U4 & U1 54 540 15 min. $5.65 $5.35 $5.00 Unlicensed Habilitation, level 3, enhanced W7061 U4 & U1 54 540 15 min. $9.20 $8.70 $8.14 TD & U4 & U1 TE & U4 & U1 Unlicensed Habilitation, level 4 W7068 U4 & U1 54 540 15 min. $11.31 $10.70 $10.01 Unlicensed Habilitation, level 4, enhanced W7069 U4 & U1 54 540 15 min. $18.40 $17.42 $16.28 TD & U4 & U1 Supports Broker W7096 U4 & U1 54 540 15 min. $6.49 $6.15 $5.74 Respite—unlicensed, in home, level 2 W7250 U4 & U1 54 540 1 day $256.05 $242.45 $226.59 W7258 U4 & U1 54 540 15 min. $3.96 $3.75 $3.51 Respite—unlicensed, in home, level 2, enhanced W7251 U4 & U1 54 540 1 day $531.47 $503.24 $470.32 TD & U4 & U1 TE & U4 & U1 W7264 U4 & U1 54 540 15 min. $8.22 $7.79 $7.28 TD & U4 & U1 TE & U4 & U1 Respite—unlicensed in home, level 3 W7252 U4 & U1 54 540 1 day $512.09 $484.90 $453.17 W7265 U4 & U1 54 540 15 min. $7.94 $7.52 $7.02 Respite—unlicensed, in home, level 3, enhanced W7253 U4 & U1 54 540 1 day $1,062.91 $1,006.47 $940.63 TD & U4 & U1 TE & U4 & U1 W7266 U4 & U1 54 540 15 min. $16.46 $15.59 $14.57 TE & U4 & U1 Respite—unlicensed, out of home, level 2 W8002 U4 & U1 54 540 1 day $256.05 $242.45 $226.59 W8012 U4 & U1 54 540 15 min. $3.96 $3.75 $3.51 Respite—unlicensed, out of home, level 2, enhanced W8003 U4 & U1 54 540 1 day $531.47 $503.24 $470.32 TD & U4 & U1 TE & U4 & U1 W8013 U4 & U1 54 540 15 min. $8.22 $7.79 $7.28 TD & U4 & U1 TE & U4 & U1 Respite—unlicensed, out of home, level 3 W8004 U4 & U1 54 540 1 day $512.09 $484.90 $453.17 W8014 U4 & U1 54 540 15 min. $7.94 $7.52 $7.02 Respite—unlicensed, out of home, level 3, enhanced W8005 U4 & U1 54 540 1 day $1,062.91 $1,006.47 $940.63 TD & U4 & U1 TE & U4 & U1 W8015 U4 & U1 54 540 15 min. $16.46 $15.59 $14.57 TD & U4 & U1 TE & U4 & U1 Fiscal Impact
There is no additional cost to the Commonwealth anticipated in FY 2016-2017 and subsequent years as a result of this notice.
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 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 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 of Human Services, Office of Developmental Programs, Division of Provider Assistance and Rate Setting, 4th Floor, Health and Welfare Building, 625 Forster Street, Harrisburg, PA 17120. Comments can also be sent to ra-ratesetting@pa.gov or ra-ratesetting@state.pa.us. Use subject header ''PN Fee Schedule.''
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service by dialing 711 or by using one of the following toll free numbers:
(800) 654-5984 (TDD users)
(800) 654-5988 (voice users)
(844) 308-9292 (Speech-to-Speech)
(844) 308-9291 (Spanish)
THEODORE DALLAS,
SecretaryFiscal Note: 14-NOT-1047. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 16-1099. Filed for public inspection June 24, 2016, 9:00 a.m.]
