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Tags Posts tagged with "PAS"

PAS

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The Information Sharing and Advisory Committee (ISAC) met today and discussed several items of interest. Deputy Secretary Ahrens provided an update on the budget and Performance-Based Contracting, including changes made to the program based on public comment. The Deputy Secretary reported that more than 95% of current residential providers have signed a new contract, and a small number have submitted their data to be evaluated for a tier assignment in the first submission period. The majority of providers appear to be waiting until February 2025 to submit data for tier assignments.

UPDATE: The PowerPoint presentation is now available and can be viewed here.

ODP is still in the procurement process of finding a Performance Analysis Service (PAS) provider.  Madeline Wagner has joined the ODP staff as the PBC Measure Coordinator and began in July. The Supports Coordinator Strategic Thinking Group is planning to reconvene on September 11, 2024.

ODP staff provided updates on the strategies that are being utilized to work toward ISAC recommendations. Recommendation #2, Promote Self-Direction, Choice & Control, and Recommendation #14, Racial Equity were reviewed.

Recommendation #1, Assure Effective Communication, and also Recommendation #8, Simplify the System, were also discussed.

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The Pennsylvania Health Law Project (PHLP) has a new resource for health care providers that explains how to write a strong letter of medical necessity when requesting Personal Assistance Services (PAS).

The brochure includes some sample language that may be useful in describing your medial opinion. The guide outlines seven key steps:

  1. Introduce Yourself and Why You’re Writing
  2. Describe Your Patient
  3. Explain WHY the Requested PAS Hours Are Medically Necessary
  4. Expand on Your Opinion With Helpful Details
  5. Restate Your Conclusion
  6. Proofread
  7. Sign, Date, & Deliver

Read PHLP’s Guide for Physicians

Read PHLP’s Sample Letter of Medical Necessity

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Effective January 1, 2022, there will be a rate increase in the OBRA Waiver and Act 150 Program for Personal Assistance Services (PAS) procedure codes W1793, W1793 TT, W1792, and W1792 TU. The new rates for the OBRA Waiver and Act 150 Program were announced in the Pennsylvania Bulletin on November 6, 2021, Volume 51, Number 45 issue and can be found on the Pennsylvania Bulletin website.

New rates are based on the participant’s county of residence. Home and Community Services Information System (HCSIS) service plans will be updated by December 31, 2021. SCs do not need to make any service plan updates for this rate change, as an HCSIS system-wide update is being deployed to make the necessary service data rate updates onto the impacted service plans.

A chart listing the OBRA Waiver and the Act 150 Program counties, categorized by fiscal region, is located here. If you have any questions related to this email, please contact the OLTL Provider Inquiry Line at 1-800-932-0939, OPTION 2, Monday–Friday from 9:00 am–12:00 pm and 1:00 pm–4:00 pm.

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Included in the August 24, 2019 Pennsylvania Bulletin was a notice from the Department of Human Services (DHS) about a change in the fee schedule rates for Personal Assistance Services (PAS) procedure codes (W1793, W1793TT, W1792, and W1792TU), and for Residential Habilitation procedure codes W0100 and W0102 in the Medical Assistance OBRA Waiver. The changes in the fee schedule rates for these services will be effective on January 1, 2020.

The existing fee schedule rates for PAS (Agency) and PAS (CSLA), procedure codes W1793 and W1793 TT, are increased by 2%. The intent of the increase is to provide for a wage increase for direct care workers providing agency-directed personal assistance services. DHS is also increasing the PAS (Consumer) and PAS (Consumer Overtime) rates, procedure codes W1792, and W1792 TU, to maintain equity in all the PAS rates in the OBRA waiver.

In addition, the existing fee schedule rates for Residential Habilitation procedure codes W0100 and W0102 are increased to include a 3 percent vacancy factor. A vacancy factor had not previously been included in the rate methodology; however, the Department recognizes that providers may not always deliver services to participants at full capacity. Therefore, a 3 percent vacancy factor will be applied to adjust the rates to account for the days the residential provider did not provide services to the participant. The provider cannot bill for days the participant did not receive services, but rather is paid a higher rate for days the participant received services. A vacancy factor of 3 percent was applied to reflect payment to providers for an average number of vacant days.

The fee schedule rates are available in the notice. Written comments regarding these fee schedule rates will be accepted through close of business on Monday, September 23, 2019 and should be sent to the Department of Human Services, Office of Long-Term Living, Bureau of Policy Development and Communications Management, Attention: Marilyn Yocum, PO Box 8025, Harrisburg, PA 17105-8025. Comments may also be submitted to the Department via email. Comments received within 30 days will be considered in subsequent revisions to the fee schedule.

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