The Connecticut Specialized Service State Plan Amendment (SPA) was approved by the Centers for Medicare and Medicaid Services (CMS) in June of 2019.
The SPA adds coverage and an add-on payment for specified habilitative specialized services (day services, habilitative behavior support and consultation, and service coordination) for DDS individuals residing in a skilled nursing facility who are 2l year of age or older and have been found through the Preadmission Screening and Resident Review (PASRR) process to need such services and meet the criteria for long term care.
Habilitative services are medically necessary services intended to assist the resident in partially or fully attaining, learning, maintaining, or improving developmental age-appropriate skills that were not fully acquired as a result of a congenital, genetic, or early-acquired health condition, and are required to maximize, to the extent practical, the resident's ability to function in his or her environment.
Important Components of Specialized Services:
- Specialized Services must be provided by community-based, DDS qualified providers that have been authorized to provide such service and must be consistent with achieving the outcomes identified in an individual’s plan of care.
- As specialized services is a SPA and not a waiver service, DDS providers approved to provide the support must work with DSS to direct bill to Medicaid for the service. Please review the information below regarding billing for specialized services.
- The day services can ONLY be delivered in a setting other than the resident's nursing facility.
- Transportation between the facility and the service site is included in the service rate.
If you are a provider looking for more information on how to provide specialized services please contact Resource Management in your region. For all other questions regarding specialized services please contact Krista Ostaszewski, Health Management Administrator at Krista.Ostaszewski@ct.gov