Note: The approved rate for PASRR Evaluation completion and related activities is effective for local authority claim submissions. Any new claim submissions will be paid the rate of $12.73 per 15-minute increments, or $50.92 per hour, with a cap of six hours.
Any claims submitted since PASRR Release 1 deployment and before July 23, 2103, automatically will be recouped and rebilled at this new approved rate.
- When the local authority submits a PASRR Evaluation, the Texas Medicaid & Healthcare Partnership automatically will generate a request for the Texas Health and Human Services Commission to create a service authorization for PE completion. If the mental illness section is completed, a mental illness PE completion request will be generated. If the intellectual and developmental disability section is completed, an IDD PE completion request will be generated. If both sections are completed, a mental illness PE and IDD PE completion request will be generated.
- HHSC will generate a one-day service authorization for mental illness or IDD PE completion, using the assessment date as the begin and end dates.
- The history section of the PE authorization tab will indicate the status of each PE completion request to HHSC. If an error happened while processing the request at HHSC, a specific response code and description will appear in the history.
- Once the service authorization has been created at HHSC (and appears on the person’s Medicaid Eligibility Service Authorization Verification report) the local authority can submit one or more claims to TMHP for the total number of billable hours spent on the PE in quarter hour increments.
- The Line Item Control Number will be required for PE completion claims. This will enable the local authority to bill for multiple activities for one PE on a single claim, rather than rolling them up into a daily total number of units (hours) on the claim. The LICN is currently required for IDD Targeted Case Management follow-up encounters (Service Group 14, Service Code 12C).
- Claims for IDD or mental illness PE completion can be submitted using the same Electronic Data Interchange file format as the IDD Targeted Case Management claims currently submitted by the local authorities, or can be entered in TexMedConnect (provided the local authority has a TexMedConnect submitter identification).
- The mechanism to populate the electronic file will be different for PE completion, because targeted case management is based on the number of encounters, while PE completion is based on the number of hours spent, in quarter hour increments. For example, if it took two hours and 45 minutes to complete all the billable activities associated with the assessment, the local authority will enter 2.75 units (hours) on the claim.
- If separate people (or local authorities) are completing the mental illness and IDD portions of the PE of a dually diagnosed person, the local authorities will bill for the number of hours each assessment took.
- If the same person is completing the mental illness and IDD portions of the PE of a dually diagnosed person, the local authority will need to split the total number of hours spent between the mental illness and IDD claims.
- Each claim will need to use the date of assessment, which will be different if the mental illness and IDD assessments of a dually diagnosed person are conducted on different days.
- PE completion can be billed in multiple claims, submitted on different days, as long as the total billable hours does not exceed six hours, and all claims for a specific PE completion use the date of assessment of that PE.
- The time spent participating in the Interdisciplinary Team meeting will be included in the total hours for PE Completion.
- A future enhancement will split out the Interdisciplinary Team participation into a separate service authorization, which will be billed separately by the local authority.
- There is no difference in submitting claims for Medicaid-eligible and non-Medicaid people. In both cases, HHSC will locate, validate or request the creation of a unique ID for the person (referred to on the PE as the Medicaid No. and on the claim as the Client/Medicaid No., even if the person is not Medicaid eligible).
|Input of PL-1 screening data into LTC online portal||No*|
|Preliminary scheduling call with facility to arrange assessment||Yes|
|Meeting/coordination with nursing facility staff||Yes|
|Review of person's medical records||Yes|
|Face-to-face communication with person||Yes|
|Communication/coordination with guardian and collateral contacts||Yes|
|PASRR evaluation results letter to Individual||Yes|
|Documentation and entry of evaluation data into LTC online portal||Yes|
|Participation in nursing facility IDT for PASRR-positive person||Yes|
|Completion of LTC online portal input following NF IDT meeting||Yes|