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Tags Posts tagged with "fee schedule rates"

fee schedule rates

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Today the Department of Human Services (Department) published final notice of Fee Schedule Rates for services funded through the Consolidated, Community Living, Person/Family Directed Support (P/FDS), and Adult Autism Waivers and the Department-established fees for base-funded services as a correction to the rates previously published August 1, 2024.

Due to a calculation error, the Department has made corrections to the Fee Schedule Rates for the following services funded through the Consolidated, Community Living, and P/FDS Waivers and base-funding:

  • Community Participation Support, effective July 1, 2024; and
  • Life Sharing Without Day 1-person needs group 3 and 4, effective October 1, 2024.

Additionally, due to a mistake in aligning the procedure code with the correct Statewide fee, the Department is republishing the Fee Schedule Rates for the following services funded through the Adult Autism Waiver effective July 1, 2024:

  • Residential Habilitation
  • Specialized Skill Development
  • Supported Employment
  • Career Planning
  • Therapies
  • Day Unit Respite
  • 15-Minute Unit Respite
  • Supports Coordination
  • Transportation — Trip

This publication presents an opportunity for providers to appeal these specific rates. The deadline for filing an appeal for these rates is December 2, 2024.

For further information, view ODPANN 24-107 or contact Carol Ferenz, IDD Division Director.

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RCPA has developed and submitted comments to ODP regarding the rate setting methodology and fee schedule rates proposed to take effect on July 1, 2024. These comments are based upon several member meetings, listening sessions, and member feedback.

The proposed rates are contingent upon the passage of the governor’s budget. We are grateful to the governor for the investment in ID/A services he has recommended. However, we are concerned about the inconsistent application of increases proposed by ODP across various services and the faulty rate assumptions utilized to develop those rates.

For more information, read the comments submitted here. Please contact Carol Ferenz with any questions.

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ODP Announcement 22-051 informs stakeholders that the following Fee Schedule Rates have been published as final in the Pennsylvania Bulletin:

  • Family Medical Support Assistance services funded through the Consolidated, Community Living, and Person/Family Directed Support (P/FDS) Waivers;
  • Remote Community Participation Support/Day Habilitation services funded through the Consolidated, Community Living, P/FDS, and Adult Autism Waivers; and
  • Medically Complex Life Sharing services and Transition to Independent Living payments funded through the Consolidated Waiver.

Read the announcement for further details.

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ODP Announcement 22-021 provides guidance on the upcoming rate increases for the Adult Autism Waiver. Compensation is beginning March 1, 2022; the new rates will be implemented in the Home and Community Services Information System (HCSIS) on March 1, 2022. All Individual Support Plans (ISPs), including ISPs in draft, pending review, or pending approval status, will be updated with the new rates for each of the applicable services. An additional fiscal segment will automatically be added on each ISP for each service that is impacted by the rate change.

Providers are strongly encouraged to review Service Authorization Notices or the Provider Service Detail report in HCSIS to confirm the new rates were loaded, authorized, and that they are billing the increased Fee Schedule Rate before attempting to bill for any services rendered March 1, 2022, and after.

Compensation for the Period July 1, 2021, through February 28, 2022

Providers should bill normally for any services rendered from July 1, 2021, through February 28, 2022. 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 July 1, 2021, through February 28, 2022. This is intended to eliminate the provider’s effort of voiding and re-billing claims.

ODP anticipates processing gross adjustments during the April to May 2022 timeframe to ensure all billing for dates of service July 1, 2021, through February 28, 2022, has been completed. Because the rates will be loaded into HCSIS effective July 1, 2021, and the gross adjustment compensation will be issued by ODP, providers should not adjust any claims after April 1, 2022, submitted for services rendered on July 1, 2021, through February 28, 2022.

Adjustment of a claim(s) for services delivered during these dates will result in a duplication of payment that will need to be repaid. Providers are strongly encouraged to bill in a timely manner to minimize the need for corrections.

For questions on how to resolve billing errors for services that were rendered on July 1, 2021, through February 28, 2022, contact Amber Bennett.

Correction to Rates for Small Group Employment and Residential Habilitation Ineligible Fees

Because of an internal editing error, the rates for Small Group Employment and Residential Habilitation: Community Home Ineligible published in the Pennsylvania Bulletin (52 Pa.B. 1326, February 26, 2022) were incorrect. The correct rates, with the corresponding procedure codes, are higher than what was published. The corrected rates are also available on the Department of Human Services’ website.

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ODP Announcement 22-026 is to announce that the proposed Fee Schedule Rates and Department-Established Fees for Consolidated, Community Living and P/FDS Waiver services, as well as the Community Intellectual Disability Base-funded program were published at 52 Pa.B. 102 (January 1, 2022).

The Department received comments from 134 stakeholders regarding the proposed changes to the Fee Schedule Rates and Department-Established Fees. After reviewing the comments on the proposed rates, the Department determined that an increase to the Fee Schedule Rates for the Agency With Choice Financial Management Services monthly administrative fee from $285.28 to $311.68 was necessary to cover staff wages and the costs of implementing participant directed services in accordance with requirements in the approved Waivers.

No other changes were made to the rates as a result of public comment.

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The Department of Human Services (DHS) is providing final notice of the Fee Schedule Rates and Department-Established Fees for services funded through the Consolidated, Community Living, and Person/Family Directed Support (P/FDS) Waivers as well as the Community Intellectual Disability Base-Funded Program.

The Fee Schedule Rates are effective January 1, 2022, with the exception of the rates for Agency With Choice Financial Management Services (AWC FMS) and direct Community Participation Support services. The Fee Schedule Rates for AWC-FMS will be effective on March 1, 2022. The Fee Schedule Rates for direct Community Participation Support services will be effective six months after the expiration of the federal novel coronavirus (COVID-19) public health emergency, and the temporary increases to the Fee Schedule Rates that are currently in place will end. The Department-Established Fees are effective July 1, 2022.

The full announcement with the specific rates can be found here.

These rates will be in effect for the next three years. Providers have the right to appeal these rates to the Bureau of Hearings and Appeals. Any provider who wishes to appeal must do so within 30 days of the notice, and those who do not appeal within that period will lose the right to challenge rates before the Bureau.

RCPA is hosting a “How to File a Rate Appeal” webinar on March 7, 2022, from 1:00 pm–2:00 pm. Otherwise, you should consult an attorney with experience filing such appeals.

Contact Carol Ferenz with any questions.

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ODP Announcement 22-007 informs providers that the new Fee Schedule Rates and Department-established fees are anticipated to be visible on Individual Support Plans (ISPs) in HCSIS on February 14, 2022.

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 February 15, 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 14, 2022.

Of note, on January 6, 2022, the P/FDS cap was increased to $41,000, and the Community Living Waiver cap was increased to $85,000.

This communication provides guidance and addresses Individual Support Plan (ISP) related impacts.

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Image by Werner Moser from Pixabay

ODP Announcement 21-095 discusses the availability of a 30-day public comment period for the proposed fee schedule rates for services funded through the Consolidated, Community Living, Person/Family Directed Support (P/FDS), and Adult Autism Waivers as well as Base-funded programs. Please review the announcement for further details on both the rates and the public comment period.

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Image by Werner Moser from Pixabay

Open for Public Comment: Proposed Amendments and Fee Schedule Rates for Services Impacted by Waiver Amendments

ODP Announcement 21-072 was distributed by the Office of Developmental Programs (ODP) today. The purpose of this communication is to announce that the proposed amendments to the Consolidated, Community Living, Person/Family Directed Support (P/FDS), and Adult Autism (AAW) Waivers are available for public review and comment. ODP is also making available for public review and comment the rate setting methodology and proposed Fee Schedule Rates for services in the Waivers that are impacted by the proposed amendments.

Information regarding the proposed waiver amendment changes, including how to provide comments, can be found in the Pennsylvania Bulletin, Volume 51, Number 42, published on Saturday, October 16, 2021. The waiver amendments, the side-by-side documents, and the assumption logs used to develop the Fee Schedule Rates are available.

There is a 30-day public comment period that starts on October 16, 2021, and ends on November 15, 2021. Comments should be addressed to:

Julie Mochon
Department of Human Services, Office of Developmental Programs
625 Forster Street, Room 510
Harrisburg, PA 17120

Comments may also be submitted to ODP using subject header ”Waiver Amendment Comments.”

This ODP Announcement also includes links to register for three webinars that ODP will hold to receive comments on the proposed Waiver amendments: two webinars for the Consolidated, P/FDS, and Community Living Waivers, and one for the Adult Autism Waiver.

RCPA will be scheduling a member meeting to prepare comments to submit. If you are interested in participating, please contact Carol Ferenz, RCPA Director, IDD Division.

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