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Tags Posts tagged with "Fee Schedule"

Fee Schedule

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The Office of Developmental Programs (ODP) has released information related to the FY 2024/2025 ICF Cost Report. The release includes the updated current version of the ID-46 form, along with documentation outlining the changes to be used when reporting FY 2024/2025 costs.

As previously announced by ODP Deputy Secretary Kristin Ahrens, the use of the HCBS fee schedule as a market rate limit for related-party Day Habilitation services has been eliminated for FY 2024/2025. The remaining cost report changes reflect improvements based on prior years’ experience.

ICF providers may now begin completing cost reports for each ICF site. Questions should be directed to Pam Gilbert, Fiscal Manager, ICF/ID Unit.

ODP has indicated that a follow-up email will be sent with more detailed instructions and submission requirements. Providers are reminded that all cost report submissions must be received no later than September 30, 2025.

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Last year, RCPA met with its provider members regarding the provision of group psychotherapy services via telehealth in the client’s home. RCPA then met with the Office of Mental Health and Substance Abuse Services (OMHSAS) to discuss the possibility of allowing this flexibility in an effort to fully realize the use of telehealth technology to enhance access.

Today, the Department of Human Services’ Medical Assistance (MA) Bulletin #99-25-02 outlines revisions to the MA fee schedule. The following changes are specific to behavioral services and are effective May 1, 2025:

  • Procedure code 99452 (Interprofessional Services) is now open for provider type (PT)/Specialty combination 08/184 (Outpatient Drug and Alcohol).
  • Place of Service (POS) 10 — Telehealth Provided in Patient’s Home is now available to use with the procedure code 90853 (group psychotherapy) for PT/Specialty combination 08/110 (Psychiatric Outpatient).

Please see the section titled “Behavioral Health Services” on page 6 of the bulletin for additional information related to these revisions.

If you have questions about these changes, please reach out to OMHSAS electronically or RCPA COO and Policy Director Jim Sharp.

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The Office of Developmental Programs (ODP) has shared an updated version of ODPANN 23-083. This bulletin announces the availability and criteria for Needs Group 5 (NG5) residential fee schedule rates and reissues the criteria, process, and procedures for residential fee schedule rate exceptions in the Consolidated Waiver. Please view the announcement for updated information, which has been highlighted red.

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During the Department of Human Services budget review this morning, Acting Secretary Arkoosh shared that part of the budget plan is to continue the enhanced rates for CPS and Transportation Trip. RCPA has confirmed that the Office of Developmental Programs (ODP) plans to publish the CPS and transportation rates for continuation beginning November 11, 2023, as part of the regular fee schedule. We will share more information as it becomes available.

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The Office of Child Development and Early Learning (OCDEL) has announced a 3% increase to all Early Intervention service rates from the previously published 2022/23 fee schedule.

Through the 2022/23 budget, a permanent rate increase of 3 percent for Early Intervention Services was enacted. This rate is in addition to the 3% increase funded through ARPA-IDEA previously published rates for 2021/22 and 2022/23. The Fee Schedule includes the 3% rate increase.

The funding must be used to enhance, expand, or strengthen IDEA and HCBS services. In 2021/22, OCDEL used the combined federal funds (ARPA-IDEA Part C & HCBS FMAP increase) to support the rate increase announced for fiscal year 2021/22 across all rates for Infant/Toddler Early Intervention services.

The Fee Schedule also includes the new Place of Service code for Tele-Intervention for Early Intervention. When providing services to a child and family by Tele-Intervention, the provider must identify the Place of Service for Tele-Intervention on the billing claim in PROMISe. The Place of Service for Tele-Intervention for Early Intervention is 02. The Centers for Medicare & Medicaid Services (CMS), for the purposes of Medicaid, defines telemedicine as the use of two-way, real time interactive telecommunications technology that includes, at a minimum, audio and video equipment as a mode of delivering healthcare services.

NEXT STEPS:

  1. Infant/Toddler programs should share this announcement with all of their Early Intervention providers.
  2. Infant/Toddler programs and providers should review the MA Bulletin 99-22-02 for further information.
  3. Infant/Toddler Early Intervention programs and providers can use the updated 2022/23 fee schedule rates for services delivered on and after July 1, 2022.
  4. Early Intervention claims filed prior to this announcement with eligible dates of services may be resubmitted as a claims adjustment at the time and expense of the Early Intervention provider. Timely filing requirements must be abided by at all times with no exceptions or exemptions.
  5. Infant/Toddler Early Intervention Providers shall update any guidance and billing protocols around place of service Tele-Intervention 02. Providers will need to begin to bill using the 02 Tele-Intervention Place of Service code as of July 1, 2022.
  6. Infant/Toddler Early Intervention Programs will need to have a process in place to review the Place of Service 02 when analyzing provider billing.

If you have any questions, contact OCDEL or RCPA Children’s Policy Director Jim Sharp.

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ODP Announcement 22-007: UPDATE provides information to providers in order to prepare for upcoming rate increases that are scheduled to be published in the Pennsylvania Bulletin on February 26, 2022.

Per the final public notice for Fee Schedule Rates, Department-established fees, and the AWC FMS Department-established fees rendered through the Consolidated, Community Living (CLW), and Person/Family Directed Support (P/FDS) waivers:

  • The anticipated effective date for the increased Fee Schedule Rates is January 1, 2022; however, the effective date in the Home and Community Services Information System (HCSIS) will be March 1, 2022.
  • The anticipated effective date for the Department-established fees for residential ineligible services is July 1, 2022, and HCSIS will reflect the same effective date.
  • Both the Fee Schedule Rates and Department-established fees for residential ineligible services will be visible in HCSIS on February 28, 2022. Compensation will be for the period January 1, 2022–February 28, 2022. The updated fee schedule rates will not be loaded in ISPs for the period January 1, 2022–February 28, 2022. Instead, the current rate will remain for that period, and ODP will be compensating providers, via gross adjustments, for the difference between the rate billed and the updated fee schedule rate for dates of service rendered during the period January 1, 2022–February 28, 2022. This is intended to eliminate the provider’s effort of voiding and rebilling claims.

ODP anticipates processing gross adjustments during the April to May 2022 timeframe to ensure all billing for dates of service January 1, 2022–February 28, 2022 has been completed. Providers are strongly encouraged to bill in a timely manner to minimize the need for corrections.

Since the new rates will have a begin date of March 1, 2022, two service/rate segments in authorized status will be present on ISPs, assuming no errors set. One service/rate segment will reflect the period July 1, 2021, to February 28, 2022, or the begin date of the service when it was initially authorized on the plan during Fiscal Year (FY) 2021–2022. The second service/rate segment will reflect the period March 1, 2022, to June 30, 2022.

Authorized units on the first service/rate segment, July 1, 2021–February 28, 2022, will reflect 67% of total authorized units for the FY 2021–2022. The second service/rate segment will reflect 33% of total authorized units for the remainder of FY 2021–2022. If an individual requires more than 33% of the total annual authorized units for the remainder of FY 2021–2022, a revision to the plan will be necessary to move units from the first service segment to the second service segment on the ISP. For the period July 1, 2021, to February 28, 2022, providers should bill normally for any services rendered.

See the ODP Announcement for the full instructions.

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