1799 Finalized rate-setting methodology for the consolidated and person/family directed support waivers and targeted services management for persons with mental retardation?

DEPARTMENT OF
PUBLIC WELFARE

Finalized Rate-Setting Methodology for the Consolidated and Person/Family Directed Support Waivers and Targeted Services Management for Persons with Mental Retardation

[40 Pa.B. 5412]
[Saturday, September 18, 2010]

 The purpose of this notice is to announce the rate-setting methodology used in the Prospective Payment System (PPS) to develop the Fiscal Year (FY) 2010-2011 finalized payment rates for community-based services, including supports coordination, funded through the Consolidated and Person/Family Directed Support waivers (waivers) and for Targeted Service Management not funded by the waivers. The methodology described in this notice to finalize the FY 2010-2011 payment rates in the PPS, excludes payment rates for the select waiver services added to the Medical Assistance program fee schedule.

Rate-Setting Methodology

 The methodologies used to develop the proposed rates for FY 2010-2011 were published in the Pennsylvania Bulletin at 40 Pa.B. 3632 (June 26, 2010). To finalize the FY 2010-2011 payment rates, the Department of Public Welfare (Department) made adjustments to the proposed payment rates as described as follows. The final payment rates are effective for services delivered between July 1, 2010 and June 30, 2011.

 To finalize the FY 2010-2011 payment rates, the Department made the following adjustments to the proposed payment rates:

 • Rates were updated based on the enacted budget.

 • The utilization of services projected for FY 2010-2011 was updated. When the proposed rates were calculated, the projected utilization was based on actual paid claims for services delivered from July 1, 2009, through February 28, 2010. These paid claims were then adjusted to account for a full year of utilization. The final payment rates were calculated using projected utilization based on actual claims paid for services delivered from July 1, 2009, through April 30, 2010, adjusted to account for a full year of utilization.

 • Upward adjustments were made to the payment rates for the following services:

  • W7060, home and community habilitation—unlicensed, level 3.

  • W7075, community habilitation—licensed day habilitation—ATF, level 3.

  • W7235, supported employment.

  • W7258, respite—unlicensed, in home, level 2.

  • W7291, family living, 1—individual home adult.

 The adjustments were made to ensure that assigned rates for these services provided for adequate funding to meet minimum wage standards.

 • Adjustments were made to some outlier costs, where proposed rates for individuals with high needs had been incorrectly reduced.

 • Based on the enacted budget and updated utilization information, the Rate Adjustment Factor (RAF) utilized to calculate the final payment rates was -2.5%. The initial RAF utilized for the proposed payment rates was -4.73%.

Fiscal Impact

 There is no anticipated fiscal impact.

Public Comment

 Copies of this notice may be obtained at the local Mental Health/Mental Retardation (MH/MR) 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, [phone]

 • Northeast region: Room 315, Scranton State Office Building, 100 Lackawanna Avenue, Scranton, PA 18503, [phone]

 • Southeast region: 801 Market Street, Suite 5071, Philadelphia, PA 19107, [phone] or [phone]

 • Central region: Room 430, Willow Oak Building, P. O. Box 2675, DGS Annex Complex, Harrisburg, PA 17105, [phone]

 Contact information for the local MH/MR County Program or AE may be accessed through http://www.dpw. state.pa.us/PartnersProviders/MentalRetardation/00367 9539.htm or contact the previously referenced regional ODP.

 Interested persons are invited to submit written comments regarding this notice to the Department at the following addresses:

By e-mail:

 Use subject header ''PN Final Rates'' to ODP's rate-setting mailbox at [e-mail].

By postal mail:

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 [phone] (TDD users) or 1-800-654-5988 (voice users).

HARRIET DICHTER, 
Secretary

 Fiscal Note: 14-NOT-658. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 10-1799. Filed for public inspection September 17, 2010, 9:00 a.m.]