Introduction

Attention all Home Health Care Providers enrolled in Pennsylvania’s Medical Assistance (MA) Program: significant updates have been made to the MA Program Fee Schedule, affecting the provision of shift care services provided by home health aides to MA beneficiaries under 21 years of age. These changes, detailed in bulletins #05–23–06,07–23–01, are pivotal in shaping the landscape of Medicaid-funded home health care services in Pennsylvania. Here’s what you need to know.

Reference Bulletins

For an in-depth understanding and to verify the specifics outlined in this article, providers are encouraged to consult the official bulletins:

• Bulletin #05–23–06, #07–23–01

These bulletins serve as the authoritative documents for these updates and changes. Make sure to review them carefully for full compliance.

Revalidation of MA Enrollment

First and foremost, it’s crucial for all providers to revalidate their MA enrollment for each service location every five years. Providers are urged to log into PROMISe to check revalidation dates and ensure compliance. Submissions for revalidation must be made at least 60 days prior to the given revalidation dates.

Purpose and Scope of the Bulletin

The core purpose of the recent bulletins is to inform providers about changes to the fee schedule for shift care services, specifically for beneficiaries under 21. These updates will take effect from October 1, 2023. If your agency offers home health services to this demographic, these changes will apply to you.

Regulatory Background

Historically, federal regulations prohibited Medicaid payments for personal care services (PCS) provided by a beneficiary’s legally responsible family member. During the COVID-19 pandemic, a Section 1135 waiver was temporarily put in place to override this rule. However, as of May 11, 2023, the Public Health Emergency has ended, terminating the waiver as well.

New Guidelines for PCS

From October 1, 2023, the MA program will cover services provided by home health aides to MA beneficiaries under 21 years of age. Under new CMS guidelines, personal care services provided by a qualified parent or other legally responsible relative (LRR) will now be allowable, provided they meet certain requirements.

Updated Procedure Codes

Prepare for new coding procedures, effective October 1, 2023:

• G0156 with modifier U7: This is for pediatric home health aide services by a non-LRR.

• G0156 with modifiers U7 and SC: This is for pediatric home health aide services by an LRR.

Existing PCS procedure codes S9122 and T1019 will be ended as of September 30, 2023.

Billing and Reporting Adjustments

For services provided on or after October 1, 2023, the new procedure codes and modifiers must be used. Any existing authorizations for old codes will be manually adjusted by the Department. It’s imperative to report any shift changes between LRR and non-LRR aides to ensure that claims are processed without denial.

Upcoming Information

A separate bulletin will be issued soon, addressing updates to electronic visit verification requirements for pediatric home health aide services.

Conclusion

Staying updated on these changes is crucial for maintaining compliance and ensuring uninterrupted provision of services. Make sure to consult the Office of Medical Assistance Programs website for additional details and clarification.

For questions or comments, contact the Fee-for-Service Provider Service Center at 1–800–537–8862.

Be proactive, stay informed, and adapt to these pivotal changes to continue providing quality care to your beneficiaries.

Original Document

Click the link below or copy and paste the URL to your web browser for access:

https://www.dhs.pa.gov/docs/Publications/Documents/FORMS%20AND%20PUBS%20OMAP/MAB2023091101.pdf

Helpful Links for Providers

· Contact Information for Providers (pa.gov)

· Enrollment Provider File FAQ (pa.gov)

· Listservs (pa.gov)

· Quick Tips (pa.gov)

· What’s New at OMAP (pa.gov)