September 1, 2017

What Must States do to Claim the Enhanced 75% Match Rate?

"States may claim the enhanced 75% match rate for PASRR-related activities by completing the Form CMS-64. Specifically, a state should use line 10 to claim its “Preadmission Screenings Costs,” i.e. PASRR activities that happen before admission into a nursing facility. A state should use Line 11 for “Resident Review Activities Costs,” i.e. resident evaluations triggered by a significant change in condition that affects an individual's disability-specific needs.

Although the match rate for lines 10 and 11 is 75%, accurate allocation of costs across these two categories is important. States should contact the Financial Management Group in the State Medicaid Agency (SMA) for more information on how to allocate PASRR costs that are shared across Preadmission Screening (line 10) and Resident Review (line 11) activities.
States input the amount of money spent for each line 10 and line 11 in Column A (Total Computable) of Form CMS-64. The system will automatically calculate the 75% match rate for these expenditures.

Claiming the enhanced 75% match rate for PASRR-related activities entails more than just completing Form CMS-64. States must also consider the following:

The establishment of interagency agreements among the SMA, the state mental health authority (SMHA), and the state intellectual disability authority (SIDA). These relationships should be arranged in a way such that costs can be clearly tracked, especially those that are related to PASRR.

A mechanism for the transfer of funds, which can take a variety of forms. In some states, this involves the actual transfer of money from one account to another. Other states use a rolling credit/debit sheet that is maintained among the participating agencies.

Time studies to provide evidence for claiming time that is spent on PASRR-related activities. There are many issues to consider when designing time studies, including variations in sample size, time of year, number of days, etc. The best design will depend to some degree on the specific activity being measured. Contracts between the SMA and its vendors (e.g. Level II evaluators) should clearly spell out the kinds of reports the vendor will provide to support the state's PASRR claims.

An approved cost allocation plan to provide evidence to support claims made on lines 10 and 11 of Form CMS-64."