DHS COVID-19 PROVIDER GUIDANCE // ODP
ODP Announcement 21-017: Temporary Fee Schedule Rates for Community Participation Supportand Transportation Trip Services
Issued: February 3, 2021
All interested parties.
To announce the implementation of temporary changes to the Fee Schedule Rates for Community Participation Support services rendered through the Consolidated, Community Living and Person/Family Directed Support (P/FDS) waivers, for Transportation Trip services rendered through the Consolidated, Community Living, P/FDS and Adult Autism Waivers, and for Community Participation Support and Transportation Trip base-funded services managed through county programs for individuals with an intellectual disability.
The Department of Human Services (Department) is implementing temporary increases to the Fee Schedule Rates for Community Participation Support and Transportation Trip services. These increases are being made due to impacts on service as a result of the COVID-19 pandemic. The temporary increases to existing Fee Schedule Rates are retroactive to January 1, 2021. The temporary increases to the Fee Schedule Rates will end on June 30, 2021.
These temporary increases to the rates will also apply to the Department-established fees under 55 Pa. Code § 4300.115(a) (relating to Department established fees) for base-funded services managed through county programs for individuals with an intellectual disability under the Mental Health and Intellectual Disability Act of 1966 (50 P.S. §§ 4101—4704); 55 Pa. Code Chapter 4300 (relating to county mental health and intellectual disability fiscal manual); and 55 Pa. Code Chapter 6100 (relating to Services for Individuals with an Intellectual Disability or Autism).
The temporary Fee Schedule Rates will be loaded to PROMISeTM and providers can begin billing the increased Fee Schedule Rates on February 3, 2021. The Home and Community Services Information System (HCSIS) will automatically be updated to include the new Community Participation Support and Transportation Trip Fee Schedule Rates and critical revisions to Individual Support Plans (ISPs) will not be necessary to implement the change to the Fee Schedule Rates. Providers should review service authorizations to confirm that they are billing the increased Fee Schedule Rate.
ODP will be publishing a notice of temporary Fee Schedule Rates in the Pennsylvania Bulletin that includes instructions for submitting public comments.
Fee Schedule Rates
The Department used a market-based approach to establish the temporary Fee Schedule Rates for Community Participation Support and Transportation Trip services. To determine the temporary Fee Schedule Rates, the Department decreased the productivity assumptions due to individuals being absent from services as a result of the COVID-19 pandemic. The Department established the temporary increases to the Fee Schedule Rates to fund services provided at a level sufficient to ensure access, encourage provider participation, and promote provider choice during the COVID-19 pandemic, while at the same time ensuring cost effectiveness and fiscal accountability. The temporary increases to the Fee Schedule Rates represent the maximum rates that the Department will pay for services.
Fee Schedule Rate for Community Participation Support Services effective January 1, 2021 through June 30, 2021
Note: All rates in the table are per 15-minute unit.
|Service||Procedure Code||Staff to Individual Ratio||Temporary Fee Schedule Rate||Temporary Fee Schedule Rate |
for Enhanced Communication
Support — Facility
|W7222||1:11 to 1:15||$2.96||$3.27|
|W7223||1:7 to 1:10||$3.18||$3.61|
|W7226||1:14 to 1:6||$5.23||$6.01|
|W7224||1:2 to 1:3||$6.84||$7.90|
Support — Community
|W9351||1:2 to 1:3||$6.98||$8.02|
Fee Schedule Rate for Transportation Trip Services effective January 1, 2021 through June 2021
|Service||Unit of Service||Procedure Code||Temporary Fee |
|Zone 1 (Greater than 0 |
and up to 10 miles)
|Zone 2 (Greater than 10 |
and up to 30 miles)
|Zone 4 (Over 30 miles)||W7276||$69.19|
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