55 Pa. Code § 6100.571 - Fee schedule rates
(a) The
Department will establish fee schedule rates, based on the factors in
subsection (b), using a market-based approach so that payments are consistent
with efficiency, economy and quality of care and sufficient to enlist enough
providers so that services are available to at least the extent that such
services are available to the general population in the geographic
area.
(b) In establishing the fee
schedule rates in subsection (a), the Department will examine and use data
relating to the following factors:
(1) The
service needs of the individuals.
(2) Staff wages, including education,
experience, licensure requirements and certification requirements.
(3) Staff-related expenses, including
benefits, training, recruitment and supervision.
(4)
Productivity.
Productivity is the amount of service delivered relative to the level of
staffing provided.
(5)
Occupancy. Occupancy is the cost related to occupying a space,
including rent, taxes, insurance, depreciation and amortization
expenses.
(6) Direct and indirect
program and administration-related expenses.
(7) Geographic costs based on the location
where the HCBS is provided.
(8)
Federally-approved HCBS definitions in the waiver and determinations made about
cost components that reflect reasonable and necessary costs related to the
delivery of each HCBS.
(9) The cost
of implementing applicable Federal and State statutes and regulations and local
ordinances.
(10) Other factors that
impact costs.
(c) The
Department will update the data used in subsection (b) at least every 3
years.
(d) The Department will
publish a description of its rate setting methodology used in subsection (a) as
a notice in the Pennsylvania Bulletin for public review and
comment. The description will include a discussion of the use of the factors in
subsection (b) to establish the fee schedule rates; a discussion of the data
and data sources used; and the fee schedule rates.
(e) The Department will make available to the
public a summary of the public comments received in response to the notice in
subsection (d) and the Department's response to the public
comments.
Notes
This section cited in 55 Pa. Code § 6100.803 (relating to organized health care delivery system).
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