AmeriHealth Caritas/Keystone First Clarifies EVV Paper Timesheet Requirements
PAS
UPMC CHC Issues Updated EVV Guidance
UPMC Community HealthChoices (CHC) has released updated guidance for Personal Assistance Services (PAS) regarding record keeping and electronic visit verification (EVV) requirements. The guidance includes information about documentation and EVV requirements, as well as an extensive list of frequently asked questions (FAQs). View the full guidance and FAQ here.
PAS/SCE Strategic Member Meeting — March 1, 2023
Philadelphia Health Law Project Resource: Writing a Letter of Medical Necessity
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:
- Introduce Yourself and Why You’re Writing
- Describe Your Patient
- Explain WHY the Requested PAS Hours Are Medically Necessary
- Expand on Your Opinion With Helpful Details
- Restate Your Conclusion
- Proofread
- Sign, Date, & Deliver
HCSIS Service Plan Updates for the OBRA Waiver and Act 150 Program
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.
DHS Announces MA Fee Schedule Revisions in OBRA Waiver
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.