Community Transitional Services (CTS)
Definition
Community Transitional Services (CTS) are defined as individually designed services intended to assist a waiver participant to transition from a nursing home to living in the community. CTS is a one time service per waiver enrollment. If the waiver participant has been discontinued from the program and now is a resident of the nursing home, they can access this service again, if needed. This service is only provided when transitioning from a nursing home. These funds are not available to move from the participant's home in the community to another location in the community. The funding limits for this service are separate and apart from the limits applied to Moving Assistance, and the two services will not be used at the same time in any approved Service Plan.
CTS provide funding for the reasonable costs of one-time set-up expenses for individuals transitioning from a nursing home to their own home or apartment in the community. Reasonable costs are defined as necessary expenses for an individual to establish his/her living space.
These services must be included in the ISP and may not exceed $5,000 per waiver enrollment, including the 10% administrative fee payable to the CTS provider. Approved costs will be covered by CTS up to thirty (30) days prior to the individual's discharge into the community.
This service includes:
- The cost of moving essential furniture and other belongings;
- Security Deposits, including broker's fees to obtain a lease on an apartment or home;
- Purchasing essential furnishings;
- Set up fees or deposits for utility or service access (e.g. telephone, electricity, heating);
- Health and safety assurances, such as pest removal, allergen control or one-time cleaning prior to occupancy.
This service will not be used to purchase diversional or recreational items, such as television/ VCRs/ DVDs/ or music systems.
Provider Qualifications
All CTS providers must be approved providers of Service Coordination in the NHTD waiver. When the participant chooses the provider of CTS it does not have to be the same agency providing Service Coordination to the participant. Someone other than the participant's SC must be the individual responsible for arranging CTS. The provider of this service must designate an individual who has sufficient knowledge and skills to work with subcontractors and to assist the participant in utilizing this service.
Approval Process for CTS
| Step 1 | The applicant, SC, and anyone selected by the applicant, determines if any CTS is required prior to discharge from the nursing home into the community. |
|---|---|
| Step 2 | If appropriate, a comprehensive list of the items needed or anticipated expenses is developed by the applicant and SC. |
| Step 3 | The applicant and SC explore all possible resources including informal supports and community resources for these items. |
| Step 4 | After all other resources are explored and utilized, the SC compiles a detailed list of items and anticipated expenses using the Community Transitional Services Description and Cost Projection form (refer to Appendix C - form C.9); |
| Step | The SC and applicant select an approved CTS provider and include the contact information on the Community Transitional Services Description and Cost Projection form. |
| Step 6 | After completing the Community Transitional Services Description and Cost Projection Form, the applicant and SC sign the form. |
| Step 7 | The SC sends the Community Transitional Services Description and Cost Projection Form to the CTS provider for their signature and Medicaid provider number. NOTE: For moving costs and for services for health and safety assurances (e.g. cleaning) - if the cost of either one of these services is greater than $1,000, three (3) bids must be obtained and submitted by the CTS provider, along with the CTS Description and Cost Projection form. |
| Step 8 | The CTS provider returns the completed Community Transitional Services Description and Cost Projection form to the applicant's SC. |
| Step 9 | The SC submits the complete Community Transitional Services Description and Cost Projection form with the ISP to the RRDS. |
| Step 10 | The RRDS reviews and approves the costs detailed for CTS. |
| Step 11 | The RRDS notifies the SC of approval for CTS. |
| Step 12 | The SC notifies the CTS provider that the applicant has been approved for CTS. |
| Step 13 | The CTS provider makes the approved payment directly to the broker, utility company and/or the landlord for a security deposit. The CTS provider purchases the approved essential furnishings with prior approval by the RRDS. All receipts and any remaining balance must be maintained by the CTS provider. |
| Step 14 | The CTS provider completes the Waiver Services Final Cost form, which certifies that the CTS was provided in accordance with the ISP. The CTS provider must maintain original receipts. A copy of the original receipts is attached to an itemized list of items purchased to the Waiver Services Final Cost form and submitted to the SC. |
| Step 15 | The SC signs the complete Waiver Services Final Cost form and submits it to the RRDS for approval. |
| Step 16 | The RRDS completes the RRDS Approval of Final Cost form and provides a copy to the CTS provider and SC. |
| Step 17 | The CTS provider seeks reimbursement after receiving a copy of the NOD - Authorization from the SC. |
Reimbursement
CTS must be provided by a DOH approved provider and included in the Initial SP to be reimbursed. Prior to making the purchases, if the cost is greater than 10% more than the estimate then another Community Transitional Services Description and Cost Projection form has to be submitted to justify the request. Reimbursement will not be provided if the actual cost of the CTS exceeds ten (10) percent of the projected cost and the CTS provider did not obtain prior approval.
This Service is reimbursed on a cost basis. Total one-time reimbursement for CTS must not exceed $5,000 per waiver enrollment, which may include a 10% administrative fee payable to the CTS provider.
