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May 26, 2005

 
MEDICAID INFORMATION RELEASE MA05-23
 
TO:                 All Personal Care Service (PCS) Providers and School Districts Providing Medicaid Services
 
FROM:           Leslie M. Clement, Deputy Administrator
 
SUBJECT:     NEW PCS PAYMENT RATES EFFECTIVE JULY 1, 2005
 
Effective July 1, 2005, Medicaid will make some changes to its reimbursement rates for Personal Assistance Services (personal care and attendant services).  As required by Idaho Code and IDAPA 16.03.09.148, the Department conducted a salary survey to calculate the new rates.  The maximum allowable amounts are based on wages and salaries paid for comparable positions within nursing facilities and intermediate care facilities for the mentally retarded (ICF/MRs).
 

Services provided on or before June 30, 2005 must be billed separately from services provided on or after July 1, 2005.  There may be an error in your payment if you do not use separate claim forms.
 
 The new rates are listed below by procedure code:

SUPERVISORY RN CODES:
G9002 Coordinated Care Fee – Maintenance Rate (Agency)                    $ 69.93/visit
G9001 Coordinated Care Fee – Initial (School)                                        $ 69.93/plan    
T1001  Nursing Assessment/Evaluation (Agency)                                      $ 34.08/visit
T1001  Nursing Assessment/Evaluation (School)                                       $ 34.08/visit
 
SUPERVISORY QMRP CODES:
G9001 Coordinated Care Fee – Initial (Agency)                                       $ 89.53/visit
H2020 Therapeutic Behavioral Services (Agency)                                     $ 29.84/day
 
PERSONAL ASSISTANCE SERVICE PROVIDER CODES:
            Agency Providers
T1019              Personal Care                                                                  $ 3.49/15 min. unit
T1004              Services of a Qualified Nursing Aide                                 $ 3.49/15 min. unit
S5145              Foster Care, Therapeutic – Child                                      $ 72.67/day
S5145 HQ[1]      Foster Care, Therapeutic – Group                                 $ 62.43/day per client
 
Independent Provider’s Home (no withholding)
S5145              Foster Care, Therapeutic – Child                                     $ 69.46/day
          (Children under Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program only)
S5145 HQ1      Foster Care, Therapeutic – Group                                  $ 51.02/day per client
          (Children under EPSDT Program only)     
                                           
HOME AND COMMUNITY BASED SERVICES:
S5125 U21       Attendant Care Services                                                $ 3.49/15 min. unit
T1001 U21       Nursing Assessment/Evaluation (Agency)                       $ 34.08
 
OTHER:
 S5140-U2        Adult Residential Care                                      **
            **  For Certified Family Homes and Residential and Assisted Living Facilities that bill this          code, you will receive a letter notifying you of the new rate for each participant.  If you do not receive a letter for a participant living in your facility, please notify your local Regional Medicaid  Services unit. Approval of service by the Regional Medicaid Services unit is still required prior to delivery of service.

Reminder
Per IDAPA 16.03.09.146.02.b. “All PCS must be provided under the order of a licensed physician or authorized provider.”
 

If you have questions about this process, please contact your Regional Medicaid Services office.   Thank you for your participation in the Idaho Medicaid Program.
 
IDAHO MEDICAID PROVIDER HANDBOOK:
This information release does not replace information in your Idaho Medicaid Provider Handbook.
 
LC/sp
 


[1] Procedure code modifier