GIS 15 MA/017: Personal Care/Consumer Directed Services Authorization Process for Medicaid Recipients Assessed for Participation in the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) Waivers
To: Local District Commissioners, Medicaid Directors, Supervisors of Long Term Care Services, Managed Care Coordinators
From: Mark Kissinger, Director Division of Long Term Care
Subject:Personal Care/Consumer Directed Services Authorization Process for Medicaid Recipients Assessed for Participation in the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) Waivers
Effective Date: Immediately
Contact Person: Bureau of Managed Long Term Care Staff
(518) 474-5888 or services@health.ny.gov
The purpose of this General Information System message is to inform the Local Departments of Social Services (LDSS) of the need to assess and provide needed Personal Care Services Program (PCSP) or Consumer Directed Personal Assistance Program (CDPAP) services to Medicaid recipients currently residing in nursing homes and seeking to transition to the community with the support of the Nursing Home Transition and Diversion (NHTD) or Traumatic Brain Injury (TBI) waiver programs.
As you are aware, individuals eligible for NHTD or TBI waiver services continue to combine waiver and state plan services. Often the provision of PCSP/CDPAP combined with NHTD or TBI waiver service is necessary for the individual's safe discharge from the nursing facility and must be in place upon discharge. Effective immediately, the waiver Regional Resource Development Center (RRDC) staff will notify the district where the individual is seeking to reside upon discharge, that the person is seeking waiver services and the proposed discharge/waiver eligibility date.
Following this notification, and upon receipt of a physician order as required in 18 NYCRR 505.14, district staff should conduct both a nursing and social assessment following existing regulatory procedures. Additionally, district staff should work with the RRDC staff and the Medicaid recipients waiver Service Coordinator to integrate the assessed PCSP/CDPAP within the overall service plan pending approval by the RRDC.
Districts are also advised that the same protocol will apply to any Managed Long Term Care (MLTC) enrollee residing in a nursing facility who wishes disenroll from their MLTC plan and upon discharge receive NHTD or TBI waiver services currently not available in MLTC.
Questions regarding this information can be sent to the following address: services@health.ny.gov
