With approximately one week before the deadline for passage of the state budget, Pennsylvania House and Senate leadership and PA Governor Tom Corbett have reached agreement on the level of spending for FY 2012-13 budget. PA House Appropriations Chairman Rep. Bill Adolph (R-Delaware) and leaders from the House and Senate joined Governor Corbett at a June 20 press conference to announce an agreement on a spending figure for the Fiscal Year 2012-13 state budget. The legislative leaders and the Governor agreed on a spending figure of $27.656 billion. The final budget number includes approximately $500 million of restored funding that the Senate proposed after Governor. Corbett released his budget proposal at $27.1 billion. Details on just how the state will apply the $27.656 billion are being negotiated. Legislators are still negotiating for restoration of human services funding that Governor Corbett proposed to be cut by 20 percent. The House and Senate leadership have negotiated partial restoration of the funds, but as of June 22 legislators were still seeking further restoration. http://www.pahousegop.com/NewsItem.aspx?NewsID=14679. See http://www.pahousegop.com/NewsItem.aspx?NewsID=14660
On June 20 PA DPW Office of Developmental Programs (ODP) issued an ODP Informational Memo 048-12 providing updates to the fiscal year (FY) 2012-2013 renewal process, new funding stream, clarification on mileage rate change, fee schedule geographical areas, and other helpful information. Addressing administrative entities (AEs), supports coordination organizations (SCOs), direct service providers (waiver and base providers), and other interested parties, ODP said that the informational memo is intended to communicate: FY 2012-2013 rate load information, service definition changes: AE and SCO action, P/FDS Cap Exceptions, billing waiver ineligible residential services, Human Service Development Fund (HSDF) and base funded services, adding transportation mile to the vendor screens versus billed amount, reminders for Transportation Trip/Zone, clarification on fee schedule geographical areas, provider qualification impact on service contract conversion from provisional on-hold (POH) to real in HCSIS, participant directed services (PDS) reminders. Concerning the HSDF fund, ODP said that if not approved in the final budget by the General Assembly, a future ODP communication will detail instructions and provide direction on HSDF. FMI: See www.odpconsulting.net.
The PA DPW Office of Long Term Living (OLTL) has notified its service coordination entities and service providers that a rate notice was issued on June 9, 2012, which contained rates for OLTL Home and Community-Based Services, effective June 1, 2012. A thirty-day comment period is included in the notice. The OLTL rate notice is located at http://www.pabulletin.com/secure/data/vol42/42-23/1058.html.
In the June 23 edition of the Pennsylvania Bulletin, the PA Department of Public Welfare (DPW) announced changes to the Medical Assistance (MA) program fee schedule. The changes are effective for services provided on and after June 25, 2012. DPW said that it will be both adding and end-dating procedure codes and that some of the newly added procedure codes will require prior authorization. DPW plans to publish the fees for the new procedure codes in an MA Bulletin to be issued to all providers. The procedure codes are being added to the MA Program Fee Schedule as a result of the 2012 HCPCS updates and significant program exception requests. DPW is also adding back to the MA fee schedule a procedure code and procedure code/modifier combinations for EEG monitoring and re-establishing payment for the procedure. Certain codes related to durable medical equipment (DME) are being added to the MA Program Fee Schedule but will require prior authorization. Many procedures are also being end-dated. Written comments regarding this notice should be sent to the Department of Public Welfare, Office of Medical Assistance Programs, c/o Deputy Secretary’s Office, Attention: Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. FMI: See www.pabulletin.com.
In the June 23 edition of the Pennsylvania Bulletin, the PA Department of Public Welfare (DPW) issued a formal notice that the Hospital Quality Incentive Pilot Program and the Hospital Quality Care Investment Grant Program were being discontinued. The HQI pilot program was established to provide and reward a hospital’s performance on various quality related measures. DPW provided for incremental adjustments to the scheduled increases to be applied to inpatient disproportionate share hospital and direct medical education payments based on the hospital’s performance on these quality measures. Through an application process, the grant program provided an incentive for acute care general hospitals to initiate quality improvement projects by offsetting some of the costs related to the implementation of the project. DPW published notice of its intent to discontinue the pilot and grant programs in the June 25, 2011 edition of the Pennsylvania Bulletin. DPW said that it received no public comments during the 30-day comment period and implemented the changes as described in its notice of intent. DPW received State Plan Amendment approval from the Centers for Medicare and Medicaid Services (CMS) to discontinue the Pilot and Grant Programs in February of 2012. The elimination of the programs will save the Commonwealth $2.254 million ($1 million in State general funds and $1.254 million in Federal funds) in FY 2010-2011 and $2.226 million ($1 million in State general funds and $1.226 million in Federal funds) in FY 2011-2012. FMI: See www.pabulletin.com.
On June 21 the PA DPW Office of Developmental Programs (ODP) issued an informational memo, clarifying appeals rights for FY 2012-2013 Consolidated and P/FDS waiver rates and providing ODP methodology information. Attachments included: FY 12-13 provider revenue estimates for all services, FY 12-13 total fee schedule estimates by provider, and FY 12-13 geographical area development. Providers received notice of FY 2012-2013 fee schedule rates on May 25, 2012, via Informational Memo 041-12. Providers with cost based rates received a letter outlining their rates on May 25, 2012. Both the information memo and the provider rate letter referred to the FY 2012-2013 rates as “estimated” rates. As outlined in the rate letters and informational memo, these rates are estimated because they are contingent on final amounts appropriated by the General Assembly. ODP said that when the FY 2012-2013 budget is finalized, the Department will issue public notices and/or individual rate letters notifying providers that their rates are final. ODP said that it expects the final rates to be effective July 1, 2012. ODP said that providers should wait until the final notices for fee schedule rates and/or individual rate letters are issued before filing an appeal. Providers should also consult their legal counsel regarding appeal rights. The memo also includes ODP’s estimates of projected provider revenue for total estimated revenues and total estimated fee schedule revenues. Additional details regarding ODP’s methodology used to determine the three areas and area factors for FY 2012-2013 are also provided. If more information is needed, please contact PARF at firstname.lastname@example.org. FMI: See www.odpconsulting.net.