Changes to the Medical Assistance Fee Schedule
[46 Pa.B. 6939]
[Saturday, October 29, 2016]
This notice announces the Department of Human Services (Department) proposed changes to the Medical Assistance (MA) Fee Schedule for Transition Service Coordination administered through the Aging, Attendant Care, COMMCARE, Independence and OBRA waivers (waivers) effective December 1, 2016.
Currently, pre-transition activities within the Nursing Home Transition (NHT) Program, conducted by the NHT provider, are reimbursed as an administrative function using only State funds. The NHT provider receives four post-transition outcome payments for successful transition and monitoring, totaling $2,500, at specified intervals during the participant's first year in the community. The Department intends to eliminate the four post-transition payments for participants in waivers and increase the MA fee schedule rates for Transition Service Coordination (procedure code W7337). Pre-transition services will be billed as Transition Service Coordination for waiver participants. This will allow the Department to receive Federal Financial Participation for pre-transition services provided to participants in a waiver.
Under 55 Pa. Code § 52.45(a) and (b) (relating to fee schedule rates), the Department proposes to increase the MA fee schedule rate for Transition Service Coordination administered through the waivers.
The Department proposes to increase the Transition Service Coordination rates from the current rate of $10 per unit Statewide to the corresponding rates paid for Service Coordination (procedure code W1011). The Department proposes this increase to encourage participation of service coordinators in its NHT Program and to enhance its efforts to serve additional Pennsylvanians in their homes and communities.
The geographic areas are as follows:
Region 1: Allegheny, Armstrong, Beaver, Fayette, Greene, Washington, Westmoreland
Region 2: Bedford, Blair, Bradford, Butler, Cambria, Cameron, Centre, Clarion, Clearfield, Clinton, Columbia, Crawford, Elk, Erie, Forest, Indiana, Jefferson, Lackawanna, Lawrence, Luzerne, Lycoming, McKean, Mercer, Mifflin, Monroe, Montour, Northumberland, Pike, Potter, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Wayne, Wyoming
Region 3: Adams, Berks, Carbon, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Juniata, Lancaster, Lebanon, Lehigh, Northampton, Perry, Schuylkill
Region 4: Bucks, Chester, Delaware, Montgomery, Philadelphia
Fee schedule rates are set using a standardized market-based rate setting methodology described as follows. Relevant market-based information used to determine the fee schedule rates included Commonwealth-specific wage information from the Center for Workforce Information and Analysis, Occupational Wages by County, Bureau of Labor Statistics Employer Costs, cost surveys from providers, Medicare rate information and MA State Plan Fee Schedules.
Fee Schedule Rates
Proposed Changes to Transition Service Coordination Fee Schedule Rates
Region Aging Attendant
Act 150 CC IW OW Procedure
Rate Unit 1 X X N/A X X X W7337 18.49 15 min 2 X X N/A X X X W7337 20.21 15 min 3 X X N/A X X X W7337 18.78 15 min 4 X X N/A X X X W7337 21.47 15 min CC = COMMCARE
IW = Independence
OW = OBRA
The net fiscal impact is budget neutral. However, costs will shift between appropriations as a result of this change.
Interested persons are invited to submit written comments regarding this notice and the proposed MA Fee Schedule rates to the Department of Human Services, Office of Long-Term Living, Bureau of Policy and Regulatory Management, Attention: HCBS Waiver Rate, P.O. Box 8025, Harrisburg, PA 17105-8025. This notice is available in alternate format and paper copy upon request by calling (717) 783-8412. Comments received within 30 days will be reviewed and considered for any subsequent revision of the notice.
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).
Fiscal Note: 14-NOT-1066. (1) General Fund;
(7) Long-Term Care; (2) Implementing Year 2016-17 is -$459,000; (3) 1st Succeeding Year 2017-18 through 5th Succeeding Year 2021-22 are -$786,000; (4) 2015-16 Program—$968,083,000; 2014-15 Program—$810,545,000; 2013-14 Program—$820,409,000;
(7) Attendant Care; (2) Implementing Year 2016-17 is $13,000; (3) 1st Succeeding Year 2017-18 through 5th Succeeding Year 2021-22 are $22,000; (4) 2015-16 Program—$161,741,000; 2014-15 Program—$137,229,000; 2013-14 Program—$116,084,000;
(7) Services to Persons with Disabilities; (2) Implementing Year 2016-17 is $196,000; (3) 1st Succeeding Year 2017-18 through 5th Succeeding Year 2021-22 are $335,000; (4) 2015-16 Program—$339,077,000; 2014-15 Program—$273,538,000; 2013-14 Program—$233,104,000;
(7) Home and Community-Based Services; (2) Implementing Year 2016-17 is $250,000; (3) 1st Succeeding Year 2017-18 through 5th Succeeding Year 2021-22 are $429,000; (4) 2015-16 Program—$261,945,000; 2014-15 Program—$132,951,000; 2013-14 Program—$225,008,000;
(8) recommends adoption. The net fiscal impact would be budget neutral. Costs would shift between appropriations as a result of this change.
[Pa.B. Doc. No. 16-1879. Filed for public inspection October 28, 2016, 9:00 a.m.]
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