DHS Releases MA Fee Schedule Revisions in OBRA Waiver & Act 150 Program
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.
