In order to
ascertain the human and financial impact of the Medical Assistance (MA) fee-for-Service
(FFS) limitations on partial hospitalization services identified in the proposed
Department of Public Welfare fiscal year 2005/06 budget request, PCPA asks
that adult partial hospitalization service providers in FFS areas complete
the following survey using fiscal year 2004 information and return responses
to Betty Simmonds at PCPA by April
1. Please type responses and email them to Simmonds. If you would like a Microsoft
Word copy of the document to respond directly below the question, please email
Simmonds at betty@paproviders.org.
Responses will not be individually identified in the analysis. The information
will be used to bolster advocacy efforts.
Name of Agency:
Address:
Contact person:
Telephone: Email:
1. Number of persons served in partial hospital programs during calendar year 2004?
2. Licensed capacity? Average Daily Census?
3. Specialized partial hospitalization programs, e.g., geriatric, dual diagnosis… and licensed capacity for each?
4. Number of persons served per specialized program during 2004?
5. Number of persons receiving more than 540 hours of partial hospital service during 2004? More than 720 hours?
6. Number of persons in specialized partial hospital programs that received more than 540 hours of service?
7. Projected financial loss from reduction in partial hospital service from 720 to 540 hours?
8. Please list the diagnoses of persons receiving more than 540 hours of partial hospital services.
9. What percentage of clients require Medical Assistance Transportation Program services to attend partial hospitalization programs?
Please complete one form for each provider, regardless of the number of service locations.
