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February 11, 2014

Paying for Specialized Services: New Mechanisms for States

The February 2014 PASRR webinar "Paying for Specialized Services: New Mechanisms for States" occurred on Tuesday, February 11th, at 1 PM EST (10 AM PST).

You can download a PDF version of the presentation slides at the bottom of this webpage.

The webinar was led by Dan Timmel, PASRR policy director at the Centers for Medicare and Medicaid Services and Dr. Ed Kako, Director of the PASRR Technical Assistance Center (PTAC).

Synopsis of the Topic:

Federal regulations relating to the Preadmission Screening and Resident Review (PASRR) program require states to provide for or arrange "specialized services" for nursing home residents with serious mental illness or intellectual/developmental disabilities who need disability-specific services beyond what nursing homes must provide under their daily rate. Owing to an ambiguity in federal regulations, states vary considerably in how specialized services are defined, provided, and paid for.

CMS has developed new guidance clarifying state responsibility.

Specialized services:
Must be provided to residents of nursing facilities or individuals residing in the community – that is, not to individuals in institutions that provide acute care, such as inpatient psychiatric hospitals or ICF/IIDs; and
Cannot be a finite set, but must include whatever disability-specific an individual needs.

CMS has identified two mechanisms for states to pay for specialized services under a state's nursing home benefit:

1) under the NF benefit, as supplemental payments to the NF; as or

2) as certain State Plan services (e.g., rehabilitation). Providers of home and community-based services could also provide services in NFs (though they would need to use different billing since waivers cannot pay for institutional care).
By allowing states to provide "waiver-like" services to nursing facility residents, these new payment options will help individuals maintain and improve their functioning, and ultimately transition to community settings.


Ed Kako
Dr. Ed Kako is the Director of the PASRR Technical Assistance Center (PTAC) and has several years of experience providing technical assistance around PASRR policy.

Dan Timmel
Dan Timmel is the PASRR policy director at the Centers for Medicare and Medicaid Services (CMS). Dan has twenty years of experience in public health and clinical social work including a period of teaching at the University of Maryland School of Medicine.

Acknowledgment of Commercial Support

There was no commercial support received for this CME activity.

Objectives - After attending this program, participants should be able to:

• Explain the sources of confusion around the definition of specialized services.
• Reiterate and clarify the new CMS guidance on providing specialized services to NF residents.
• Describe the new mechanisms available to states to pay for specialized services.

Bibliographic Sources: Please see presentation slides

Copyright: All faculties in this activity have given their permission for publication.

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