HD39 - Preadmission Screening (PAS) Reimbursement Study


Executive Summary:
This study on the reimbursement rate paid to screeners from local Departments of Social Service (DSS) and the Virginia Department of Health (VDH) was mandated by Item 307.H of the 2007 Appropriation Act. These Preadmission Screens (PAS) are used to determine eligibility for Medicaid long-term care services, including nursing facilities, certain home and community-based care waivers and PACE. DSS and VDH performed 6,809 screens of individuals residing in the community. This study does not examine reimbursement to hospitals for similar screens of individuals residing in the hospital.

For each PAS in the community, the current rate established in 1982 is $69 for VDH and $31 for DSS. DMAS only pays the federal share, 75% for VDH ($51.75) and 50% for DSS ($15.50) based on federal Medicaid rules, because the state share is in the other agencies’ budgets.

DMAS used time study information from 2003 to determine the number of hours per PAS. DMAS used salary and benefit costs and hours to develop a 2007 cost per hour for nurses, social workers and clerical staff. Combining this information with mileage information, DMAS determined a 2007 cost per screen of $134.84 for VDH and $116.65 for DSS.

Even though DMAS only reimburses DSS the federal share on $31, DMAS currently fully reimburses DSS for all of its Medicaid related activities, including PAS, through its cost allocation plan. It is not anticipated that increasing the direct rate paid from $31 to $116.65 will affect the total federal funds transferred from DMAS to DSS. Increasing the rate paid to VDH will increase the total federal funds transferred to VDH by $336,000 annually, based on the number of screens performed in 2006.

The Centers for Medicare and Medicaid Services (CMS), the federal agency responsible for enforcing federal Medicaid regulations, is closely scrutinizing reimbursement to other government entities. In particular, CMS has audited reimbursement to VDH and DSS for PAS twice in the last four years. DMAS sees no issues with complying with CMS regulations, however, as long as VDH begins to reconcile its costs annually. DSS already does this.