The Office of Mental Health and Substance Abuse Services (OMHSAS) teleconference November 21 discussed the urgent need for providers to submit information related to treatment services in long term structured residences (LTSRs) and possible mechanisms to facilitate payment. OMHSAS must submit a rate setting package to the Centers for Medicare and Medicaid Services (CMS) December 1. To assist OMHSAS, providers, through the counties, must submit a survey form (available from Betty Simmonds at PCPA) to OMHSAS by November 29 that identifies costs for treatment services related to LTSR. Costs for services provided for individuals residing at the LTSR but provided by a separate entity (e.g. partial hospitalization services provided off-site) should be included. Many counties and LTSR providers have already submitted information, but some providers had not seen the survey form. OMHSAS strongly encouraged providers to review previously submitted information and make changes as needed to capture all costs that could potentially be covered by Medical Assistance (MA). Providers were encouraged to enter detailed information about services that they thought might be covered, but were uncertain, then OMHSAS could make a determination about inclusion in the rate setting package. OMHSAS was clear that they do not expect programs to be changed to focus exclusively on MA reimbursable services. Instead, they want programs to continue to provide services and supports that are needed and to have those that are eligible be paid through MA, while the remainder are supported by state funds.
At this time OMHSAS has not determined whether to move forward with requirements for LTSRs to apply for partial hospital licensure with waivers or to require some other licensure process and use an alternative payment arrangement with bundled services. Whatever mechanism is used, it will involve clear documentation of services in order to support MA payment. OMHSAS is developing a template for documentation that may be helpful for providers. This template will be distributed when it is finalized.
PCPA members are asked to complete the survey if they have not already done so or review and revise information previously submitted to the county and OMHSAS based on input from the teleconference. Please contact county representatives to ensure that the latest version of the survey information is used. LTSR providers should submit revised survey information to the county before November 29 in order for the document to be certified submitted to OMHSAS by the deadline. Please contact Betty Simmonds with questions.
LTSR providers unable to participate in the teleconference who would like to talk with OMHSAS may contact Betty Simmonds so this can be facilitated. Neither OMHSAS nor PCPA wants to miss contact with affected LTSRs in this process.
