Understanding Medicaid Home and Community Services: A Primer, 2010 Edition. Bundling Payments

10/29/2010

Bundled rates are permitted for services that are by design multi-component or, as a practical matter, very difficult to break down into separate billing components; for example, rates for a single worker who supervises several residents and engages in one-on-one interactions with them for varying lengths of time. States are expected to have effective means to verify that bundled services are in fact providing the claimed components. Monthly rates are not as useful for this purpose as are daily or, in some cases, hourly bundled rates, which can account for resident absences from a facility for varying amounts of time for other services, such as offsite vocational programs.

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