Binghamton-Southern Tier Nursing Home Transition and Diversion Medicaid Waiver Regional Resource Development Center

Serving the New York counties of:

• Allegany
• Broome
• Cattaraugus
• Cayuga
• Chemung
• Chenango
• Cortland
• Delaware
• Otsego
• Schuyler
• Steuben
• Tioga
• Tompkins

Under contract to: New York State Department of Health

Contact Information

Phone & Fax Numbers

(607) 724-2111 (Voice/TTY)

(607) 238-2694 (VP)

(607) 772-3617 (Fax)

Staff

Laura O'Hara, Lead Regional Resource Development Specialist (RRDS)

Anita Ferris, RRDS/Nurse Evaluator (NE)

Belinda Turck, RRDS

Daena Archer, Assistant RRDS

Danette Matteo, RRDS

Marci Germond, Administrative Assistant

Regional Resource Development Center

Introduction

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. 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 and encounter and manage risks and learn from their experiences.

The NHTD waiver is an opportunity for comprehensive services to be available in the community rather than in an institution, allows the state 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, and assures the overall cost of serving waiver participants in the community is less than the cost of serving a similar group in an institution.

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.

The expected outcomes are that participants will have an additional community-based choice, participants will have opportunities to live meaningful and productive lives in their communities, and that families and other informal caregivers will have access to additional supports to assist them in their caregiver roles.

Eligibility
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.

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 at: 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.

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