The Specialized Services Work Group Brought to you by the PASRR Technical Assistance Center www.pasrrassist.org Call-in through one of two ways listed below: Telephone: Computer Audio: Toll: +1 (914) 339-0020 Access Code: 202-220-560 Audio Pin: Shown once training starts 1. Select Telephone as your audio option 2. Dial the conference call number provided 3. Enter the access code followed by # 4. Enter the Audio PIN followed by #* 1. Select Mic and Speakers as your audio option 2. Click Settings or Sound Check to test your microphone and headset *If you do not see your Audio Pin, or if you need additional webinar-related assistance, contact the Organizers through Chat (in your GoToTraining Panel).
February 2015 Agenda 1. Welcome and Introductions 3:00 PM 3:05 PM 2. Quick Poll 3:05 PM 3:10 PM 3. Specialized Services FAQs 3:10 PM 3:40 PM Led by PTAC 5. Round Robin and Open Discussion 3:40 PM 3:55 PM 6. Wrap Up and Next Steps 3:55 PM 4:00 PM The next work group will meet on April 15 th, 2014 at 3 PM EST Please submit discussion items to cchang@mission-ag.com
Quick Poll of Attendees Please see the POLL section of your GoToTraining Panel Free TA is available through PTAC. Please request assistance by emailing info@pasrrassist.org Visit the PTAC website at www.pasrrassist.org
Specialized Services FAQs 1. What are Specialized Services? 2. Are Specialized Services provided only to residents of nursing homes? 3. Can providers of Specialized Services also provide waiver services or other home and community-based services? 4. Who pays for Specialized Services? 5. What is the relationship between Specialized Services and NF payment methodologies?
1. What are Specialized Services? (pt. 1) Specialized Services is a PASRR term of art for services provided to individuals who have a mental illness (MI), intellectual disability (ID), or a related condition (RC). Specialized Services have two key characteristics: 1. They go beyond the services normally provided in a nursing facility. Specialized Services exceed the typical capabilities of a NF. 2. They address individualized needs related to a person s MI, ID, or RC, as identified in the Level II evaluation.
1. What are Specialized Services? (pt. 2) Specialized Services can be financed in a variety of ways though Medicaid, Medicare, private pay, or state-only dollars. What ultimately matters is not how they are paid for, but whether they meet an individual s PASRR-specific needs. In recent years, CMS has placed renewed emphasis on the obligations states have to provide Specialized Services to individuals who need them. A useful overview of Specialized Services can be found in a presentation that PTAC and CMS delivered jointly at the 2013 HCBS Conference: http://www.pasrrassist.org/resources/services-and-supports-required-nfresidents-mi-and-id-meaning-pasrr-specialized-services
2. Are Specialized Services provided only to residents of nursing homes? The answer to this question depends on the benefit package to which those services belong. Services that are defined in the basic Medicaid State Plan are generally available to all individuals who meet the necessary functional and financial criteria regardless of where they reside. Specialized Services financed by Medicare are available to all eligible individuals who need them. States can choose to define some Medicaid-financed services only in their NF benefit; services defined in this way are available only to NF residents. Note that Specialized Services however they are financed do not have to be provided on the physical grounds of the NF. For example, a person-centered plan of care may indicate that a person with MI should have periodic visits to a psychosocial program in the community.
3. Can providers of Specialized Services also provide waiver services or other home and community-based services (HCBS)? Yes. Providers of Specialized Services can also provide HCBS. Indeed, the services in question can be closely related. The key difference is that the provider must use one billing code for individuals who are enrolled in a waiver and living in the community, and a different billing code for individuals who are residents of NFs. Providers of Specialized Services should have expertise in supporting individuals with MI/ID/RC. In many cases, a provider can continue supporting an individual once he or she has left the institution and returned to the community though, as noted above, the billing code that the provider uses would have to change to reflect the setting in which the individual resides.
4. Who pays for Specialized Services? According to 42 CFR 483.118(b)(2), the State must provide or arrange for the provision of the Specialized Services needed by the individual while he or she resides in the NF. The key words in this clause are provide or arrange (emphasis added). States can meet their obligations by paying for services that address an individual s PASRRspecific needs either with Medicaid dollars or with state-only dollars. States can also meet their obligations by coordinating services that the state does not finance most notably, those financed by Medicare and by private pay. What matters, ultimately, is whether the state meets the individual, PASRR-specific needs of its NF residents, and not how it does so. CMS has recently indicated that states have flexibility in how they finance Specialized Services when those services are provided through the NF benefit. See next section.
5. What is the relationship between Specialized Services and NF payment methodologies? (pt. 1) This question does not apply to Specialized Services that are financed in the following ways: Through Medicaid, but in the basic State Plan, and therefore available to everyone, including NF residents Through state-only dollars Through Medicare/Medigap Through private-pay/long-term care insurance Grants
5. What is the relationship between Specialized Services and NF payment methodologies? (pt. 2) This question applies only to Specialized Services that are a) financed by Medicaid, and b) limited to NF residents. For Specialized Services defined in this way, there are two basic funding scenarios: 1. The state pays the NF additional money on a per-service basis much as the state would pay NFs to provide ventilator care (for example) to individuals who need such care and the NF pays providers. In this scenarios, the providers of Specialized Services work as subcontractors to the NF. 2. Providers of Specialized Services bill the Medicaid agency directly (i.e., there is no contractual relationship between the NF and those providers).
5. What is the relationship between Specialized Services and NF payment methodologies? (pt. 3) In both of these scenarios, the entities that provide Specialized Services may also provide home and community-based services to individuals who live in the community. Additional information about these payment methodologies can be found below: February 2014 PTAC Webinar: http://www.pasrrassist.org/resources/paying-specialized-services-newmechanisms-states FAQ on PTAC website: http://www.pasrrassist.org/faq/95
Round Robin and Open Discussion
Thank you for participating in the February Specialized Services Work Group! The next work group will meet on: Wednesday, April 15 th 3 PM EST Resources from all past work groups can be accessed at: http://www.pasrrassist.org/resources/specialized-services-earlyadopters-work-group-resources Additional comments or questions may be directed to Claris Chang (cchang@mission-ag.com).