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NEW YORK STATE DEPARTMENT
OF HEALTH
Nursing Home Transition and Diversion Waiver
Home and Community-Based
Services
Medicaid Waiver for
Nursing Home Transition and Diversion
The Home and
Community-Based Services (HCBS) Medicaid Waiver for
Nursing Home Transition and Diversion (NHTD) is one of
the options available to New Yorkers with disabilities
and seniors so they may receive services in the most
appropriate, least restrictive setting. This summary
provides a general overview of the NHTD waiver.
I. Philosophy
The NHTD Medicaid waiver
was developed based on the philosophy that individuals
with disabilities and/or seniors have the same
rights as others to:
-
Be in control of
their lives.
-
Encounter and manage
risks and learn from their experiences.
II. What is an HCBS
Medicaid Waiver?
A waiver:
-
Is an opportunity for comprehensive
services to be available in the community rather
than in an institution.
-
Allows states to
assemble a package of carefully tailored services to
meet the needs of a targeted group in a
community-based setting.
-
Maintains the waiver
participant’s health and welfare through an
individualized service plan.
-
Assures the overall
cost of serving waiver participants in the community
is less than the cost of serving a similar group in
an institution.
III. Why did New York
State Develop the NHTD Medicaid Waiver?
-
State legislation
authorized a new HCBS Medicaid waiver to provide a
cost-effective community-based alternative to
nursing facility care, reflecting the State’s
commitment to serve all persons in the least
restrictive setting, appropriate to their needs.
-
Individuals with
disabilities and seniors, their
families and other interested persons advocated for
additional options for community-based services and
supports.
-
Otherwise existing
Medicaid services and other supports may not be
sufficient or most efficient to meet the needs of
some individuals with disabilities and
seniors to transition into or remain in the
community.
IV. What are the
Expected Outcomes?
·
Participants will have an additional
community-based choice.
-
Participants will
have opportunities to live meaningful and productive
lives in their communities.
-
Families and other
informal caregivers will have access to additional
supports to assist them in their caregiver roles.
V. To be Eligible for
the NHTD Medicaid Waiver an Individual Must:
·
Be capable of living in the community
with needed assistance from available informal
supports, non-Medicaid supports and/or Medicaid State
Plan services and be in need of one or more
waiver service;
·
Be eligible for nursing home level of
care;
·
Be authorized to receive Medicaid
Community Based Long Term Care;
·
Be at least 18 years of age or older;
·
Be considered part of an aggregate group
that can be cared for at less cost in the
community than a similar group in a nursing home;
·
Choose to live in the community as a
participant in this waiver rather than in a nursing
home; and
·
Not participate in another HCBS waiver.
VI. Regional Resource
Development Centers (RRDC)
The NHTD waiver is
administered through a network of Regional Resource
Development Centers (RRDC), each covering specific
counties throughout the State. The contact person at
the RRDC is the Regional Resource Development Specialist
(RRDS). Additionally, the RRDC employs a Nurse
Evaluator (NE).
Responsibilities of the
RRDS include:
-
Interviewing
potential waiver participants;
-
Assisting
participants to access approved providers for
Service Coordination;
-
Reviewing Service
Plans for approval;
-
Determining whether
an applicant participant meets all non-financial
eligibility requirements for the waiver;
-
Maintaining regional
budgets for waiver services; and
-
Issuing Notice of
Decision forms to applicants to approve or deny
waiver participation and to participants as
necessary for ongoing participation.
Responsibilities of the
NE include:
-
Utilizing clinical
expertise to review medically complex Service Plans;
-
Providing technical
assistance to the RRDS and waiver service providers;
and
-
Resolving issues
associated with level of care determinations.
VII. Quality
Management Specialists (QMS)
The NHTD waiver relies on
a network of Quality Management Specialists (QMS)
throughout NYS, each covering specific regions.
The primary
responsibility of the Specialists is to assure quality
under the waiver through a range of functions,
including:
-
Assisting in the
retrospective review of Service Plans;
-
Reviewing Service
Plans over $300 per day;
-
Overseeing the
incident reporting process;
-
Conducting
participant satisfaction surveys; and
-
Performing trend
analysis in their regions with recommendations for
improvements.
VIII. Available NHTD
Waiver Services
NHTD waiver services are
used to complement already available sources of support
and services.
The
following provides general definitions. More specific
information will be provided to applicants and
participants as part of the service planning process.
Others may access on the DOH web under Long Term Care
http://www.nyhealth.gov/facilities/long_term_care/
1.
Service Coordination
Assistance with the
development and implementation of a person-centered
individualized Service Plan that will lead to the waiver
participant’s independence, integration into the
community, health and welfare.
2.
Assistive Technology
Equipment that will
improve the participant’s independence, decrease
reliance on staff and be a cost effective aid for
community integration. This service supplements Durable
Medical Equipment provided through the general Medicaid
program.
3.
Community Integration Counseling
Counseling service
provided to waiver participants who are coping with
altered abilities and skills, revisions in long term
expectations and/or changes in their roles in relation
to significant others.
4.
Community Transitional Services
Assistance in
transitioning from a nursing home back to the community,
including the cost of moving, essential furnishings,
deposits for utilities, security deposits or one-time
cleaning services prior to occupancy.
5.
Congregate and Home Delivered Meals
Meals for waiver
participants who cannot prepare or obtain nutritionally
adequate meals for themselves, or when the provision of
such meals will decrease the need for more costly
supports to provide in-home meal preparation.
6.
Environmental Modifications Services
Internal and external
physical adaptations to the home necessary to assure the
waiver participant’s health and welfare in that
setting. Environmental modifications may be made to a
residence owned by the participant or to rental units
with permission received from the landlord.
7.
Home and Community Support Services
Oversight and/or
supervision as a discrete service or in combination with
assistance with activities of daily living (ADL) and
instrumental activities of daily living (IADL).
8.
Home Visits by Medical Personnel
Services provided by a
physician, nurse practitioner or physician’s assistant
to diagnose, treat and monitor wellness to preserve the
waiver participant’s functional capacity to remain at
home. An evaluation of the caretaker’s ability to
maintain his/her role is conducted, as well as an
assessment of the living environment to identify if it
can support the participant’s medical needs.
9.
Independent Living Skills Training
Services
Training to improve or
maintain the waiver participant’s ability to live as
independently as possible by focusing on essential
community living skills such as task completion, money
management, interpersonal skills, sensory/motor skills,
problem solving skills and the ability to maintain a
household.
10.
Moving Assistance
Transport of the
participant’s possessions and furnishings when moving
from an inadequate or unsafe housing situation or to a
location where more informal supports will be available.
11. Nutritional
Counseling/Educational Services
Assessment, planning,
education and counseling for the waiver participant’s
nutritional needs and eating patterns.
12.
Peer Mentoring
Improvement of the waiver
participant’s self-sufficiency, self-reliance, and
ability to access needed services, goods and
opportunities in the community accomplished through
education, teaching, instruction, information sharing,
and self-advocacy training, provided by a “peer” (with
similar disabilities).
13.
Positive Behavioral
Interventions and Supports (PBIS)
Services intended to
decrease the frequency or intensity of the waiver
participant’s significant behavioral difficulties that
may jeopardize his/her ability to remain in the
community of choice due to inappropriate responses to
events in his/her environment.
14.
Respiratory Therapy
Services providing
preventive, maintenance and rehabilitative
airway-related techniques and procedures to the waiver
participant in his/her home
15.
Respite Services
Relief for non-paid
primary caregivers of a waiver participant provided in a
24 hour block of time in the home.
16.
Structured Day Program
Services
Outpatient congregate
setting providing services designed to improve or
maintain waiver participants’ skills and abilities to
live as independently as possible within the community.
Services may include a wide array of interventions and
supports ranging from pre-vocational skill building to
socially-oriented activities.
17.
Wellness Counseling
Service
Intermittent evaluation
visits to waiver participants who are medically stable
to assist them in maintaining optimal health status.
IX. The Use of a
Regional Aggregate Budgeting System
Federal rules require
cost neutrality, which is the assurance that the overall
Medicaid costs for waiver participants is less than the
Medicaid costs for a similar group of Medicaid
recipients residing in a nursing home.
The NHTD waiver will use
a regional aggregate cap to maintain cost neutrality.
This will permit the waiver to serve individuals with a
wide range of needs. |
