Purpose
To announce the Early Intervention Infant/Toddler 2023-2024 fee schedule and update place of service code for tele-intervention. Announcement EI-22 #03 becomes obsolete on the effective date of this announcement.
Background
Historically, Infant/Toddler Early Intervention Programs reimbursed providers based upon the county negotiated rates consistent with 55 Pa Code § 4300.116. In response to the Centers for Medicare & Medicaid Services (CMS), directive and to alleviate concerns of inequitable reimbursement to all Infant/Toddler Early Intervention providers throughout the Commonwealth, the Office of Child Development and Early Learning (OCDEL) established state set rates consistent with 55 Pa Code § 4300.115. With this transition, Infant/Toddler Early Intervention programs and providers were no longer required to negotiate or determine unit costs based on the allowable cost standards in 55 Pa Code § 4300.82—4300.108 except for Special Instruction Vision and Hearing.
Medical Assistance Bulletin 99-22-02 Updates to Guidelines for the Delivery of Physical Health Services via Telemedicine was issued on May 6, 2022. The purpose of this bulletin is to clarify the guidelines for the delivery of services provided via Tele-Intervention. In response to the MA Bulletin 99-22-02 Early Intervention programs will formally support the use of Tele-Intervention.
OCDEL supports Tele-Intervention for children and families at the choice of the family. Tele-Intervention is not at the convenience or preference of the provider but rather what is in the best interest of the family and the family’s choice.
CMS has now differentiated Place of Service (POS) 02 from Place of Service (POS) 10 for telehealth.
- POS 02: Telehealth Provided Other than in Patient’s Home Descriptor: The location where health services and health related services are provided or received, through telecommunication technology. Patient is not located in their home when receiving health services or health related services through telecommunication technology.
- POS 10: Telehealth Provided in Patient’s Home Descriptor: The location where health services and health related services are provided.
Discussion
The attached Fee Schedule includes the new Place of Service code for Tele-Intervention for Early Intervention. When providing services to a child and family by Tele-Intervention, the provider must identify the Place of Service for Tele-Intervention on the billing claim in Promise. Beginning with services provided on or after July 1, 2023; the Place of Service 10 for Tele-Intervention for Early Intervention must be used.
Until otherwise revised; MA Bulletin 99-22-02 should be used for extensive guidance regarding providing Tele- Intervention.
Infant/Toddler Early Intervention Programs are responsible for monitoring providers to ensure contracted providers are submitting claims for eligible services that are delivered by qualified professionals. This responsibility includes confirming procedures are in place to ensure the appropriate use of funds that meet federal, state, and local requirements.
Next Steps
- Infant/Toddler programs should share this announcement with all of their Early Intervention providers.
- Infant/Toddler Early Intervention programs and providers can use the updated 2023-24 fee schedule rates for services delivered on an after July 1, 2023.
- Infant/Toddler Early Intervention Providers shall update any guidance, billing protocols around place of service Tele-Intervention 10. Providers will need to begin to bill using the 10 Tele-Intervention Place of Service code as of July 1, 2023.
- Infant/Toddler Early Intervention Programs will need to have a process in place to review the Place of Service 10 when reviewing provider billing.