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SERVICE COORDINATION

12/20/2005 12:00:00 AM

DOH NURSING HOME TRANSITION & DIVERSION MEDICAID WAIVER APPLICATION

M e m o r a n d u m

TO:              Service Coordination Committee Members

FROM:         Joanne Genovese, Vice President,

                             Regulatory Affairs & Policy Development

DATE:          December 20, 2005

RE:             DOH Nursing Home Transition & Diversion Medicaid Waiver Application

Pursuant to enacted legislation (S.7115), the Department of Health (DOH) has developed and submitted to the Centers for Medicare and Medicaid Services (CMS) an application for the new Nursing Home Transition and Diversion Medicaid Waiver (NHTD).  The waiver will provide new opportunities for enhanced nursing home transition and diversion for individuals who wish to return to or remain in the community.

The CMS application is structured on the following key areas:

Management

State contracted Regional Resource Development Center (RRDC) staff will manage applicant non-financial waiver eligibility determinations, needs assessments, participant service plan approval/maintenance, and public information dissemination.

Eligibility

Individuals choose to participate in the waiver.  Participants must be:  at least eighteen years of age; eligible and/or authorized for Medicaid services; assessed to require nursing home level of care yet capable of living in the community with the assistance of Medicaid State Plan and waiver services as part of an aggregate group that can be cared for at less cost in the community than they


would have otherwise been cared for in a nursing facility. The application requests the opportunity to serve at least 5,000 individuals statewide within three years, as outlined in the authorizing legislation.  Accordingly, the initial waiver application anticipates the phase-in of 1,000 participants in year one, adding 1,500 new participants in year two, and another 2,500 participants in year three.

Waiver Services

The initial waiver application focuses on services already approved and tested in the Traumatic Brain Injury (TBI) and Long Term Home Health Care Program (LTHHCP) waivers, including:  Service Coordination; Assistive Technology; Home and Community Support Services; Independent Living Skills Training; Environmental Modifications; Community Integration Counseling; Community Transition Services; Congregate and Home Delivered Meals; Moving Assistance; Nursing Assessment; Nutritional Counseling; Positive Behavioral Interventions and Supports; Respiratory Therapy; Structured Day Programs; and Respite Services.  New services are Home Visits by Medical Personnel and Peer mentoring.

Participant Directed Services

Participant direction of waiver services is not included in the initial waiver application.  The Department is exploring the scope and reimbursement methodology for this service to determine the feasibility of a technical amendment to add this service.  However, NHTD participants will have access to the State Plan Consumer Directed Personal Assistance Program under which consumer direction of State Plan personal care and nursing is possible.

CP of NYS will continue to monitor this waiver application and will notify the field when CMS approves the waiver application for operation.

cc:        Affiliate Executive Directors

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