TOPIC: SPECIALIZED SERVICES

This webinar focused on how states can use a Medicaid State Plan Amendment (SPA) to include Home and Community-Based Waiver Services (HCBS) in the nursing facility benefit to support individuals with PASRR conditions through specialized services.

This webinar will help attendees understand PASRR’s role in providing mental health care services and the role of participants’ engagement in their care. Attendees will learn about 1) the PASRR Technical Assistance Center’s prior work and materials regarding mental health issues, 2) the federal requirements, 3) PASRR’s role for individuals with mental health conditions, including the development of person-centered plans, 4) PASRR’s connection to current state initiatives, and 4) specialized services add-ons for mental health.

This webinar will initially highlight the important role of Specialized Services in the PASRR process, with references to Subpart B and C regulatory requirements for Long Term Care Facilities and PASRR, and review of related guidance in FAQs on the subject. The webinar will then shift to facilitated panel discussion with up to five states that are providing Specialized Services. The states will be selected from those who have actively participated in the Specialized Services Workgroup calls.

The Code of Federal Regulations (CFR) is clear at §483.102 that PASRR is required for all individuals who apply to or reside in a Medicaid-licensed nursing facility (NF), regardless of insurance type (Medicaid, Medicare, or private pay). Thus, private pay applicants who test positive at Level I could be found at Level II to need specialized services. By definition, however, all services supplied to individuals who have private insurance are not covered by the state. This includes specialized services, whatever those are determined to be.

In order to be eligible for federal financial participation (FFP), Specialized Services must be included in the State Plan. They are considered “specialized add-on services” that can be provided under the nursing facility benefit authorized the Section 1905(a) of the Social Security Act.

This webinar will discuss the number of ways to finance specialized services in nursing facilities. Access and quality of care is impacted by the ability to finance a resident’s service needs. This presentation will examine a variety of payment alternatives available to pay for services provided to individuals with ID/DD and mental illness while residents of nursing facilities; including Medicaid, Medicare, managed care and delivery system reform initiatives. An overview of the types of payment methods and examples will be provided.