Nursing Home Transition and Diversion Medicaid Waiver Program
Purpose and Layout
This Program Manual was created to provide information about the policies and procedures of the Nursing Home Transition and Diversion (NHTD) Medicaid Waiver program. This manual is written for Service Coordinators and other waiver service providers, Regional Resource Development Centers (RRDC), Regional Resource Development Specialists (RRDS), Nurse Evaluators (NE), and Quality Management Specialists (QMS). It can also be shared with applicants and waiver participants upon request.
Sections one (I) through ten (X) of this Program Manual outline the policies and procedures of the NHTD waiver. Section eleven (XI) contains Appendices A through G, which are the forms used in the various areas/components of the waiver program. Section twelve (XII) is the Glossary of Terms relevant to the waiver program. Section thirteen (XIII) contains the maps outlining the regions for the Regional Resource Development Centers (RRDC) and the Quality Management Specialists (QMS).
Special Note:Whenever the term 'applicant' or 'participant' is used in this Program Manual, it also includes reference, if applicable to the presence of a court appointed Legal Guardian or Committee, or other legal entity designated to act on behalf of the applicant/participant, unless specifically stated otherwise.
2008 Program Manual
- Complete Nursing Home Transition and Diversion Medicaid Waiver Program Manual with Forms in Portable Document Format (PDF, 9.0MB, 385pg.)
- Nursing Home Transition and Diversion Medicaid Waiver Program Manual without Forms in Portable Document Format (PDF, 2.2MB, 196pg.)
Section Navigation
Section I:
Back to IndexSection II:
Back to IndexSection III:
- Becoming a Waiver Provider
- Qualifications for Provider Agencies
- Provider Responsibilities
- Application Process
- Subcontracting for Waiver Services
- Vendor Holds and Disenrollment Initiated by DOH Waiver Management Staff
- Waiver Provider Request to Terminate Provider Agreement
- Provider Termination of Waiver Services to an Individual Waiver Participant
- Housing
Section IV:
- Roles and Responsibilities
- Regional Resource Development Center (RRDC)
- Regional Resource Development Specialist (RRDS)
- Skills
- Roles and Responsibilities of the RRDS
- 1. Information, Resource and Referral
- 2. Development of Community Resources
- 3. Manage Provider Enrollment and Training
- 4. Interview and Preliminary Assessment of Potential Waiver Participants
- 5. Review of All Service Plans
- 6. Administer Notice of Decisions (NOD)
- 7. Maintain Regional Budgets
- 8. Incident Reporting
- 9. Technical Assistance to Participants, Family Members and Others
- 10. Technical Assistance to Providers
- 11. Technical Assistance to QMS, Other RRDS, Community Agencies and the State
- 12. Develop and Submit Reports to DOH
- 13. Other Roles and Responsibilities as Defined by DOH and Supported by the RRDC Contract with DOH
- Nurse Evaluator (NE)
- Skills
- Roles and Responsibilities of the NE
- 1. Technical Assistance and Support to the RRDC/RRDS
- 2. Resource to Providers
- 3. Technical Assistance to QMS and Nurse Evaluator
- 4. Technical Assistance to Participants, Family Members and Others
- 5. Incident Reporting
- 6. Develop and Submit Reports to DOH
- 7. Other Roles and Responsibilities as Defined by DOH and Supported by the RRDC Contract with DOH
- Quality Management Specialist (QMS)
- Skills
- Roles and Responsibilities of the QMS
- 1. Incident Reporting
- 2. Quality Monitoring
- 3. Review of Service Plans
- 4. Development of Community Resources
- 5. Information and Resource
- 6. Develop and Submit Reports to DOH
- 7. Technical Assistance to other QMSs, RRDC, RRDS, Providers, and the DOH
- 8. Other Roles and Responsibilities as Defined by DOH
Section V:
- The Service Plan
- Types of Service Plans
- Insurance, Resources and Funding Information Sheet
- Plan for Protective Oversight (PPO)
- Development of the ISP
- Coordination of Non-Waiver Services
- Scheduling of Waiver Services
- Submission of the Application Packet and ISP
- Review and Determination Process for the ISP
- Waiver Contact List
- Implementation of the Approved Service Plan
- Ongoing Review of the Service Plan
- Development of the Addendum
- Submission of the Addendum
- Review and Approval Process for the Addendum
- Development of the RSP
- Delinquent Individual Service Reports (ISR) From Waiver Service Providers
- Submission of the RSP
- Delinquent Submission of the RSP by the SC
- Review and Approval Process for RSP
- Process for Changing a Provider
- Transferring Regions
Section VI:
- Waiver Services
- Service Coordination
- Assistive Technology (AT)
- Community Integration Counseling (CIC)
- Community Transitional Services (CTS)
- Congregate and Home Delivered Meals
- Environmental Modifications Services (E-mods)
- Definition
- Allowable E-mods
- Provider Qualifications
- Approval Process for E-mods for a Home
- Repairs
- Reimbursement
- E-mods for Vehicles - Currently under review for revisions
- Home and Community Support Services (HCSS)
- Home Visits by Medical Personnel
- Independent Living Skills Training (ILST)
- Moving Assistance
- Nutritional Counseling/Educational Services
- Peer Mentoring
- Positive Behavioral Interventions and Supports (PBIS)
- Respiratory Therapy
- Respite Services
- Structured Day Program Services
- Wellness Counseling Service
Section VII:
- Record Keeping - Introduction
Section VIII:
Back to IndexSection IX:
- Quality Management Program
- Framework for a Quality Management Program
- NHTD Quality Management Program
- CMS Waiver Assurances
- A. Level of Care (LOC) - Nursing Home Eligibility
- 1. Waiver applicants for whom there is reasonable indication that waiver services may be needed in the future are provided an individual LOC evaluation.
- 2. The LOC of enrolled participants are reevaluated at least annuallyor as specified in the approved waiver.
- 3. The processes and instruments described in the approved waiver are applied to determine LOC.
- 4. The state monitors LOC decisions and takes action to address inappropriate LOC determinations.
- B. Individual Service Plan (ISP)
- 1. Service Plans address all participants' assessed needs (including health and safety risk factors) and personal goals, either by the provision of waiver services or through other means.
- 2. The state monitors Service Plan development in accordance with its policies and procedures and takes appropriate action when it identifies inadequacies in Service Plan development.
- 3. Service Plans are updated/revised at least annually or when warranted by changes in the waiver participant's needs. In the (6) months.
- 4. Services are delivered in accordance with the Service Plan, including in the type, scope, amount, duration, and frequency specified in the Service Plan.
- 5. Participants are afforded choice between waiver services and institutional care.
- 6. Participants are afforded choice between/among waiver services and providers.
- C. Qualified Providers
- 1. The state verifies that providers meet required licensure and/or certification standards and adhere to other standards prior to their furnishing waiver services; and the state verifies on a periodic basis that providers continue to meet required licensure and/or certification standards and/or adhere to other state standards; and the state monitors non-licensed/non-certified providers to assure adherence to waiver requirements.
- 2. The state implements its policies and procedures for verifying that provider training has been conducted in accordance with state requirements and the approved waiver.
- D. Health and Welfare
- E. Administrative Authority
- F. Financial Accountability
- A. Level of Care (LOC) - Nursing Home Eligibility
- NHTD Quality Management Program Tools and Processes
Section X:
- Incident Reporting Policy and Complaint Procedure
- Introduction
- Incident Reporting Policy
- Background and Intent
- Serious Reportable Incidents (SRI)
- Serious Reportable Incident Reporting Procedure
- Investigation of Serious Reportable Incidents
- Provider's Serious Incident Review Committee
- Recordable Incidents
- Waiver Service Provider's Internal Complaint Procedure