The PASRR Technical Assistance Center helps states fulfill the goals of Preadmission Screening and Resident Review

Enhanced 75% Match for PASRR: An Overview

CMS policy on use of the enhanced match for PASRR is remarkably simple: The enhanced match rate of 75% is intended to help states pay for all activities that support the administration of the federally required program.  

State staff do not need to ask whether a specific activity or supply is on a defined list of PASRR-reimbursable items. There is no such list. Instead, state staff should consider the following questions:

  1. Can the activity or supply legitimately be considered a cost of administering PASRR?

  2. Is the activity or supply properly documented and auditable?

Legitimate activities include -- but are not limited to -- training staff; conducting quality monitoring; and writing requests for proposals (RFPs) to hire vendor to perform some of the necessary functions.

Legitimate supplies include -- but are not limited to -- computers used to collect data from PASRR Level I screens and Level II evaluations; the cost of printing training materials; and the costs of purchasing vendored PASRR services.

To claim the enhanced match successfully, the relevant PASRR authorities must take several practical steps:

  1. The State Intellectual Disability Authority (SIDA) and the State Mental Health Authority (SMHA) must execute agreements with the State Medicaid Agency (SMA) that will allow those agencies to obtain reimbursement for their activities from the SMA. These are state-level agreements, and they vary widely in detail. CMS cannot advise states on the particulars of these agreements. However, PTAC can offer free technical assistance to states looking for guidance in this area.

  2. The SMA must enter the actual claim dollar amounts on two designated lines of CMS Form 64, the form it transmits to the Centers for Medicare and Medicaid services to claim reimbursement for monies spent on the Medicaid program. The enhanced match is automatically computed; the SMA does not need to take any special steps to obtain it. The SMA does not need to ask permission from CMS before entering dollar amounts on these lines.

  3. Before it can claim the enhanced match, the SMA may wish to secure an approved "cost allocation plan" (CAP) from the Division of Cost Allocation of the Program Support Center (PSC/DCA). The CAP does not enumerate a specific activities and supplies. Rather, it identifies a method for determining which costs can be claimed on CMS Form 64. These methods can, for example, include time and motion studies and other ways of establishing the effort spent on PASRR-related activities. For more information on this topic, see the PTAC webinar on CAPs from July of 2013.

  4. Ultimately, the state PASRR authorities must secure the 25% state match for PASRR activities (i.e., 25 cents of every dollar). The state is required to supply its match to meet the minimum federal requirements of participation in the Medicaid program. To enhance their PASRR program -- for example, by implementing a robust quality monitoring process -- state staff will have to confront challenges that are ultimately more political than they are administrative. 

PASRR staff should keep several additional points in mind:

  1. Only the SMA has a legal and fiduciary relationship with CMS. The SIDA and SMHA do not have this relationship, and therefore cannot seek reimbursement from CMS.

  2. CMS cannot advise states on matters that are state-specific. That said, CMS will remind state agencies of their obligations. PTAC and its expert team of consultants can provide free technical assistance on state-specific matters.

  3. Although CMS does not approved CAPs, the Financial Management (FM) Group in the CMS Regional Office will review the CAP before PSC/DCA approves it. Staff in the CMS FM Group are typically not experts in the administration of specific programs. SMAs wishing to get a CAP approved should first contact the PASRR lead in their RO, so that they are aware of the plan can offer feedback early in the process. A list of PASRR RO leads can be found in this file

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