Fiscal Year 2025-2026 Fee Schedule Rates

Purpose

To announce the Early Intervention Infant Toddler Fiscal Year 2025-2026 fee schedule rates. Announcement EI 23-02 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 a directive from the Centers for Medicare & Medicaid Services 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 for most services. 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 for all services but Special Instruction Vision and Hearing.

The 2025-26 Budget signed by Governor Josh Shapiro included an additional $13.2 million in state funding for Early Intervention services, with $10 million of this funding specifically targeting provider rates.

Discussion

The attached Fee Schedule includes the unit rate for all Early Intervention services, except for Vision and Hearing. The fee schedule rates represent a 7% rate increase with some exceptions. For Fiscal Year 2025-2026, rates for Vision and Hearing will continue to be negotiated between Infant Toddler Early Intervention Programs and providers. Additionally, rates for Social Work services will remain unchanged, as they fall under the “hold harmless” consideration ensuring that no rate will be reduced when considering the recommended rates from the Pennsylvania Early Intervention System Rate Study.

Providers of Early Intervention services must comply with all applicable State and Federal statutes and regulations and policies which pertain to participation in the Pennsylvania Medicaid Assistance Program. Guidelines for the use of tele-intervention may be found in MA Bulletin 99-22-02.

Infant Toddler Early Intervention Programs are responsible for monitoring all contracted providers to ensure that all 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

1. Infant Toddler Early Intervention Programs should share this announcement with all of their contracted Early Intervention providers.
2. Infant Toddler Early Intervention Programs and providers should use the updated Fiscal Year 2025-2026 fee schedule rates to bill for services delivered on or after July 1, 2025.
3. OCDEL will coordinate with County programs to communicate Mass Adjustment coordination with all Early Intervention providers.
4. Infant Toddler Early Intervention Programs shall revise all applicable policies and procedures.

Attachment

Downloadable Content