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Tags Posts tagged with "MA Fee Schedule"

MA Fee Schedule

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On February 28, 2026, the Department of Human Services (DHS) Office of Long-Term Living (OLTL) published a notice in the Pennsylvania Bulletin announcing a change in the fee schedule rates in the OBRA Waiver and the Act 150 Program for Participant-Directed Personal Assistance Services (PAS) procedure codes W1792 and W1792 TU. This fee schedule rate change is effective January 1, 2026. A revised fee schedule is available here.

Written comments regarding these fee schedule rates can be sent to the Department of Human Services, Office of Long-Term Living, Bureau of Policy Development and Communications Management, P.O. Box 8025, Harrisburg, PA 17105-8025. Comments can also be submitted via email. Comments received within the 30-day comment period will be considered in subsequent revisions to the fee schedule.

OLTL previously issued a listserv on December 19, 2025, confirming the Fiscal Year 2025/26 budget, signed into law on November 12, 2025, which included a $21 million investment to strengthen the workforce through increased wages for direct care workers (DCW) providing services in the Participant-Directed model for OLTL Fee-for-Service programs.

To support the January 1, 2026, effective date, OLTL updated the PROMISe™ system and the Home and Community Services Information System (HCSIS) with the revised rates. Service Coordinators (SC) did not need to make any service plan updates for the rate change, as a HCSIS system-wide update was implemented to make the necessary service data rate updates to the affected service plans.

SCs are encouraged to reach out to OBRA Waiver and Act 150 Program participants that utilize Participant-Directed PAS to ensure they are aware of the rate change and that their DCWs may receive increases in their pay rates.

SCs may also receive specific questions from OBRA Waiver and Act 150 Program participants that utilize Participant-Directed PAS supported by Financial Management Services (FMS) through the FMS vendor Public Partnerships, LLC (PPL). SCs should refer participants to the PPL Customer Service hotline at 877-908-1750 for specific questions about how the rate increase in the OBRA Waiver and Act 150 Program will impact the pay of their DCWs.

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The Office of Mental Health and Substance Abuse Services (OMHSAS) has announced that Psychiatric Rehabilitation Services (PRS) has been added to the Medical Assistance Program Fee Schedule, effective January 1, 2026.

On January 30, 2026, the Centers for Medicare & Medicaid Services approved the addition of PRS as a rehabilitative service to the Medicaid State Plan, leading to the issuance of OMHSAS-26-01, “Payment for Psychiatric Rehabilitation Services.” Prior to the inclusion in the Medicaid State Plan, PRS was available only to MA beneficiaries enrolled in Behavioral Health HealthChoices as an in lieu of service. PRS is now available as a state plan service to MA beneficiaries in the Fee-for-Service and Behavioral Health HealthChoices delivery systems.

The published bulletin OMHSAS-26-01 can be found here. Please contact RCPA COO and Mental Health Director Jim Sharp with any questions.

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The Pennsylvania Department of Human Services released Medical Assistance Bulletin 99-24-03 on May 28, 2024, detailing updates to the Medical Assistance (MA) Program Fee Schedule based on the 2024 Healthcare Common Procedure Coding System (HCPCS) changes. These updates include new codes such as 90867, 90868, and 90869 for transcranial magnetic stimulation (TMS) treatment billing, along with additional modifications to other procedure codes, setting of limitations, fee adjustments, and new prior authorization requirements effective from the same date. This bulletin applies to all providers serving MA beneficiaries under the Fee-for-Service system and those in the MA Managed Care system should contact their respective organizations for specific billing guidance.

For more detailed information, read the full bulletin here.

If you have any other questions, please contact RCPA COO and Policy Director Jim Sharp.

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The Department of Human Services (DHS) published a notice in the Pennsylvania Bulletin for November 12, 2022, that announces revisions to the Medical Assistance (MA) fee schedule for the OBRA Waiver and the Act 150 Program: Personal Assistance Services (PAS) (Agency with Choice) and Respite (Agency with Choice).

DHS proposes the following substantive and technical changes to the OBRA Waiver:

  • Add Agency with Choice as a Financial Management Services model for the participant-directed services of PAS and Respite;
  • Revise the Benefits Counseling service definition;
  • Amend the responsibilities of the Fiscal/Employer Agent;
  • Update the Quality Improvement Strategy to the current process;
  • Add a new performance measure for Agency with Choice; and
  • Remove a performance measure that is duplicative.

The proposed OBRA Waiver amendment and a summary of all revisions are available for review on the OLTL Waiver Amendments, Renewals, and Accompanying HCBS Transition Plans web page under Additional Resources.

The following table provides the procedure code and rates for PAS (Agency with Choice):

Region OBRA Waiver
and Act 150		 Procedure Code Modifier Rate Unit
1 X W0164 N/A $4.02 15 minutes
2 X W0164 N/A $3.89 15 minutes
3 X W0164 N/A $4.12 15 minutes
4 X W0164 N/A $4.58 15 minutes

The following table provides the procedure code and rates for Respite (Agency with Choice):

Region OBRA Waiver
and Act 150		 Procedure Code Modifier Rate Unit
1 X W0165 N/A $4 15 minutes
2 X W0165 N/A $3.90 15 minutes
3 X W0165 N/A $4.12 15 minutes
4 X W0165 N/A $4.59 15 minutes

Interested persons are invited to submit written comments regarding these fee schedule rates and the proposed amendment to the Department of Human Services, Office of Long-Term Living, Bureau of Policy Development and Communications Management, Attention: Robyn Kokus, P.O. Box 8025, Harrisburg, PA 17105-8025. Comments can also be sent via email. Use ”OBRA 2023” as the subject line. Comments received within 30 days will be considered in subsequent revisions to the fee schedule or for revisions to the proposed amendment.

The revisions to the fee schedule and the amendment are proposed to take effect April 1, 2023.

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