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  Agenda Item # 8.       
ALA Planning Network Advisory Committee
Meeting Date: 12/12/2017  
Title:    PASRR Specialized Services Rates Update
Presented by: Jacob Ulczynski

AGENDA ITEM DESCRIPTION:
Presentation and discussion on PASRR Specialized Services Rates.
BACKGROUND/HISTORY:
Effective December 1, 2017, HHSC plans to implement an array of PASRR Specialized Services for Medicaid clients who reside in nursing facilities. Federal law requires a state to provide specialized services to a nursing facility resident with mental illness or an intellectual disability who require a nursing facility level of care. See 42 U.S.C. §1396r(e)(7); 42 C.F.R. §§ 483.116(b)(2), 483.120(b). “Specialized services” mean, in short, therapies and activities provided while an individual resides in a nursing facility that go beyond the services normally provided in a nursing facility and that are directed toward improving the individual’s level of independent functioning. See 42 C.F.R. §§ 483.120(a), (c), 483.440(a)(1).

HHSC conducted a public hearing to receive comment on proposed Medicaid payment rates for Preadmission Screening and Resident Review (PASRR) Specialized Services for Medicaid clients residing in Nursing Facilities on Friday, November 10, 2017. Since the implementation of the PASRR program, HHSC has payed for the Specialized Services through General Revenue dollars. 
DISCUSSION:
The proposed rates for the following services are based on the fully-funded rates for Home and Community-Based Services (HCS) for the 2018-2019 biennium: Supported Employment, Employment Assistance, Behavioral Support, and Day Habilitation. The proposed rate for Independent Living Skills Training is based on the rate for HCS Supported Home Living which became effective August 1, 2017.

The proposed rate for Habilitation Coordination is modeled on Targeted Case Management data for adults from 2015 Cost Reports submitted by Local IDD Authorities (LIDDAs) and Case Management Agency (CMA) data from 2015 Cost Reports submitted by Community Living Assistance and Support Services (CLASS) providers, inflated to the 2018-2019 biennium.

HHSC proposes the following payment rates for PASRR Specialized Services to be effective December 1, 2017: 
Service Current rate (GR) Proposed Medicaid Rate $ Change % Change
Supported Employment (per hour) $33.10 $29.15 -$3.95 -12%
Employment Assistance (per hour) $33.10 $29.66 -$3.44 -10%
Independent Living Skills Training (per hour) $22.41 $17.73 -$4.68 -21%
Behavioral Support (per hour) $79.53 $86.87 +$7.34 +9%
Habilitation Coordination* (monthly) $182.80 $208.23 +$25.43 +14%
Day Habilitation (per day) $44.76 $41.83 -$2.93 -7%
*Case management provided outside the 180-day window of transition.
FINANCIAL IMPACT:
This will result in financial impact to the IDD Services program as reduced rates will result in reduced revenues. Staff were able to minimize the impact of this rate change through conservative budgeting practices.
STAFF RECOMMENDATION:
Information item; no action required.  Please contact Jacob Ulczynski for any questions 210-832-5035. JUlczynski@aacog.com

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