CO Medicaid Community Transition Services (CTS)-- 8.553
(Transition Services from the Nursing Home to the Community)
(Transition Services from the Nursing Home to the Community)
8.553 COMMUNITY TRANSITION SERVICES
8.553.1 DEFINITIONS
Authorization Request means a request submitted by the Transition Coordination Agency to the Single Entry Point agency to authorize payment for delivery of Community Transition Services.
Community Transition Services (CTS) means activities essential to move a client from a skilled nursing facility and establish a community-based residence. Independent Living Core Services means information and referral services; independent living skills training; peer counseling, including cross-disability peer counseling; and individual and systems advocacy.
Transition Coordinator means a person employed by a Transition Coordination Agency to provide Transitional Case Management.
Transition Coordination Agency (TCA) means an agency that is certified by the Department to provide CTS and provides at least two Independent Living Core Services.
Transitional Case Management means case management exclusively supporting a client’s transition from a skilled nursing facility to a community-based residence. CODE OF COLORADO REGULATIONS 10 CCR 2505-10 8.500 Medical Services Board 285 8.553.2
BENEFITS 8.553.2.A.
CTS shall only be available to clients currently residing in a skilled nursing facility who are eligible for the Home and Community Based Services for the Elderly, Blind and Disabled (HCBSEBD) waiver.
8.553.2.B. CTS shall only be for the benefit of the client and may include the following:
1. Transitional Case Management.
2. Payment made for the following:
a. Security deposits that are required to obtain a lease on a residence.
b. Set-up fees or deposits for utility or service access, including telephone, electricity, heating and water.
c. Essential household items and furnishings such as a bed, linens, seating, lighting, dishes, utensils and food preparation items.
d. Moving expenses required to occupy a community-based residence.
e. Health and safety assurances including a one-time pest eradication and a onetime cleaning prior to occupancy.
f. A one-time purchase of food not to exceed $100.
8.553.2.C. The cost of CTS shall not exceed $2,000 per client unless otherwise authorized by the Department. 8.553.2.D. Items purchased through CTS shall be the property of the client. The client may take the property with him or her in the event of a move to another residence.
8.553.3 NON-BENEFITS
8.553.3.A. CTS shall not include the following:
1. Monthly rental expenses or other ongoing periodic residential expenses.
2. Recreation, entertainment or convenience items.
3. Items as described in 8.553.2.B.2 when already provided through other means.
4. Items as described in 8.553.2.B.2 when provided for the benefit of persons other than the client.
8.553.4 TCA QUALIFICATIONS 8.553.4.A. A TCA shall conform to all certification standards and procedures described in 10 C.C.R. 2505-10, Section 8.487, HCBS-EBD Provider Agencies.
8.553.4.B. A TCA shall meet all requirements as set forth in 8.553.5. CODE OF COLORADO REGULATIONS 10 CCR 2505-10 8.500 Medical Services Board 286 8.553.5 TCA RESPONSIBILITIES
8.553.5.A. TCAs shall administer the CTS benefit.
8.553.5.B. The TCA shall perform administrative functions, including ensuring timely reporting, onsite visits to clients, community coordination and outreach and client monitoring.
8.553.5.C. Staffing Requirements
1. The TCA shall document that each Transition Coordinator has received 20 hours of training or passed a Department-approved skills validation test in transition coordination knowledge and skills. The Transition Coordinator training or skills validation test shall include, but not be limited to:
a. Knowledge of populations served by the TCA and the target population served by the HCBS-EBD waiver.
b. Client interviewing and assessment skills.
c. Intervention and interpersonal communication skills.
d. Knowledge of available community resources and public assistance programs.
e. Transition plan development.
2. The TCA supervisor(s), at a minimum, shall meet all qualifications for a Transition Coordinator. Supervision shall include, but not be limited to, the following activities:
a. Arrangement and documentation of training or skills validation testing.
b. Assessment of client’s satisfaction with services.
c. Investigation of complaints.
d. Counseling with staff on difficult cases.
e. Oversight of record keeping by staff.
3. Training and skills validation shall be completed prior to the delivery of CTS.
8.553.5.D. The Transition Coordinator shall administer a Department-approved assessment to determine the client’s needs for housing, services and items necessary to establish a community-based residence.
8.553.5.E. The Transition Coordinator shall work with the client to create and implement a transition plan agreed upon by the Transition Coordinator and the client. The Transition Coordinator and the client shall sign the transition plan to signify agreement.
1. The Transition Coordinator shall submit the signed transition plan to the client’s Single Entry Point (SEP) case manager for approval prior to plan implementation.
2. The plan shall include the items needed for the client to transition to a community-based residence. If after the plan has been approved the Transition Coordinator determines additional purchases are required, the Transition Coordinator shall submit a plan revision for approval prior to the purchases. CODE OF COLORADO REGULATIONS 10 CCR 2505-10 8.500 Medical Services Board 287
8.553.5.F. The Transition Coordinator shall work with the client to obtain a residence and any items necessary to establish a community-based residence.
8.553.5.G. The Transition Coordinator shall conduct a minimum of four on-site visits of the residence to ensure all essential furnishings, utilities, community resources and services are in place. If the Transition Coordinator finds any of the supports to be insufficient for the client to successfully live in the community, the Transition Coordinator shall correct the deficiencies. The on-site visits shall occur at the following intervals:
1. Prior to the client’s discharge from the skilled nursing facility. a. If possible, the client shall accompany the Transition Coordinator during the onsite visit prior to discharge. If the client is unable to participate in the on-site visit, the Transition Coordinator shall document the reason in the client’s file.
2. The day of the move.
3. One week after the transition to ensure the client has the proper supports to continue successfully living in the community.
4. One month after the transition to ensure the client has the proper supports to continue successfully living in the community.
8.553.6 SINGLE ENTRY POINT AGENCY RESPONSIBILITIES
8.553.6.A. The SEP case manager shall perform a review to assure all items in the transition plan meet the criteria of the benefit described in 8.553.2. 1. The SEP case manager shall complete a review of the transition plan and shall notify the TCA of approval or denial of the plan within ten business days of receipt.
8.553.7 AUTHORIZATION REQUESTS
8.553.7.A. The TCA shall submit the Department prescribed Authorization Request (AR) form to the SEP case manager to authorize payment for CTS.
1. The TCA shall only submit the AR to authorize payment for any purchases or deposits after the client transitions to the community. The AR shall include a Department-approved cost report including copies of cancelled checks and copies of receipts detailing the items purchased and the cost.
a. Any expenses submitted on the cost report for items that are not included in the approved transition plan shall be considered non-allowable expenses and shall not be reimbursed.
b. The SEP case manager shall complete a review of the AR and the cost report and shall notify the TCA of approval or denial of the AR and if applicable, any non-allowable expenses on the cost report within ten business days of receipt.
2. The TCA shall only submit the AR for Transitional Case Management once the Transition Coordinator has conducted the on-site visit one month after the client’s transition.
a. The SEP case manager shall approve the AR only after verifying that the client is established in a community-based residence. CODE OF COLORADO REGULATIONS 10 CCR 2505-10 8.500 Medical Services Board 288
b. The SEP case manager shall complete a review of the AR and shall notify the TCA of approval or denial within ten business days of receipt.
8.553.7.B. The SEP case manager shall complete a review of the AR and the cost report within ten business days of receipt. The SEP case manager shall notify the TCA of approval of the AR and if applicable, any non-allowable expenses on the cost report.
1. Approval of the AR by the SEP case manager shall authorize the TCA to submit claims to the Department’s fiscal agent for authorized CTS provided during the authorized period. Payment of claims is conditional upon the client’s financial eligibility on the dates of service and the TCA’s use of correct billing procedures.
8.553.7.C. Incomplete ARs shall be returned to the TCA for correction within ten business days of receipt by the SEP agency.
8.553.8 REIMBURSEMENT
8.553.8.A. The TCA shall conform to all reimbursement procedures described in 10 C.C.R. 2505-10, Section 8.487.200 Provider Reimbursement.
8.553.8.B. Payment for CTS shall be the lower of the billed charges or the maximum rate of reimbursement.
8.553.8.C. The cost of Transitional Case Management shall be reimbursed by one unit of service completed when the client is established in a community-based residence as verified by the SEP case manager.
8.553.8.D. Reimbursement shall be made only for items listed on the transition plan with an accompanying receipt.
8.553.1 DEFINITIONS
Authorization Request means a request submitted by the Transition Coordination Agency to the Single Entry Point agency to authorize payment for delivery of Community Transition Services.
Community Transition Services (CTS) means activities essential to move a client from a skilled nursing facility and establish a community-based residence. Independent Living Core Services means information and referral services; independent living skills training; peer counseling, including cross-disability peer counseling; and individual and systems advocacy.
Transition Coordinator means a person employed by a Transition Coordination Agency to provide Transitional Case Management.
Transition Coordination Agency (TCA) means an agency that is certified by the Department to provide CTS and provides at least two Independent Living Core Services.
Transitional Case Management means case management exclusively supporting a client’s transition from a skilled nursing facility to a community-based residence. CODE OF COLORADO REGULATIONS 10 CCR 2505-10 8.500 Medical Services Board 285 8.553.2
BENEFITS 8.553.2.A.
CTS shall only be available to clients currently residing in a skilled nursing facility who are eligible for the Home and Community Based Services for the Elderly, Blind and Disabled (HCBSEBD) waiver.
8.553.2.B. CTS shall only be for the benefit of the client and may include the following:
1. Transitional Case Management.
2. Payment made for the following:
a. Security deposits that are required to obtain a lease on a residence.
b. Set-up fees or deposits for utility or service access, including telephone, electricity, heating and water.
c. Essential household items and furnishings such as a bed, linens, seating, lighting, dishes, utensils and food preparation items.
d. Moving expenses required to occupy a community-based residence.
e. Health and safety assurances including a one-time pest eradication and a onetime cleaning prior to occupancy.
f. A one-time purchase of food not to exceed $100.
8.553.2.C. The cost of CTS shall not exceed $2,000 per client unless otherwise authorized by the Department. 8.553.2.D. Items purchased through CTS shall be the property of the client. The client may take the property with him or her in the event of a move to another residence.
8.553.3 NON-BENEFITS
8.553.3.A. CTS shall not include the following:
1. Monthly rental expenses or other ongoing periodic residential expenses.
2. Recreation, entertainment or convenience items.
3. Items as described in 8.553.2.B.2 when already provided through other means.
4. Items as described in 8.553.2.B.2 when provided for the benefit of persons other than the client.
8.553.4 TCA QUALIFICATIONS 8.553.4.A. A TCA shall conform to all certification standards and procedures described in 10 C.C.R. 2505-10, Section 8.487, HCBS-EBD Provider Agencies.
8.553.4.B. A TCA shall meet all requirements as set forth in 8.553.5. CODE OF COLORADO REGULATIONS 10 CCR 2505-10 8.500 Medical Services Board 286 8.553.5 TCA RESPONSIBILITIES
8.553.5.A. TCAs shall administer the CTS benefit.
8.553.5.B. The TCA shall perform administrative functions, including ensuring timely reporting, onsite visits to clients, community coordination and outreach and client monitoring.
8.553.5.C. Staffing Requirements
1. The TCA shall document that each Transition Coordinator has received 20 hours of training or passed a Department-approved skills validation test in transition coordination knowledge and skills. The Transition Coordinator training or skills validation test shall include, but not be limited to:
a. Knowledge of populations served by the TCA and the target population served by the HCBS-EBD waiver.
b. Client interviewing and assessment skills.
c. Intervention and interpersonal communication skills.
d. Knowledge of available community resources and public assistance programs.
e. Transition plan development.
2. The TCA supervisor(s), at a minimum, shall meet all qualifications for a Transition Coordinator. Supervision shall include, but not be limited to, the following activities:
a. Arrangement and documentation of training or skills validation testing.
b. Assessment of client’s satisfaction with services.
c. Investigation of complaints.
d. Counseling with staff on difficult cases.
e. Oversight of record keeping by staff.
3. Training and skills validation shall be completed prior to the delivery of CTS.
8.553.5.D. The Transition Coordinator shall administer a Department-approved assessment to determine the client’s needs for housing, services and items necessary to establish a community-based residence.
8.553.5.E. The Transition Coordinator shall work with the client to create and implement a transition plan agreed upon by the Transition Coordinator and the client. The Transition Coordinator and the client shall sign the transition plan to signify agreement.
1. The Transition Coordinator shall submit the signed transition plan to the client’s Single Entry Point (SEP) case manager for approval prior to plan implementation.
2. The plan shall include the items needed for the client to transition to a community-based residence. If after the plan has been approved the Transition Coordinator determines additional purchases are required, the Transition Coordinator shall submit a plan revision for approval prior to the purchases. CODE OF COLORADO REGULATIONS 10 CCR 2505-10 8.500 Medical Services Board 287
8.553.5.F. The Transition Coordinator shall work with the client to obtain a residence and any items necessary to establish a community-based residence.
8.553.5.G. The Transition Coordinator shall conduct a minimum of four on-site visits of the residence to ensure all essential furnishings, utilities, community resources and services are in place. If the Transition Coordinator finds any of the supports to be insufficient for the client to successfully live in the community, the Transition Coordinator shall correct the deficiencies. The on-site visits shall occur at the following intervals:
1. Prior to the client’s discharge from the skilled nursing facility. a. If possible, the client shall accompany the Transition Coordinator during the onsite visit prior to discharge. If the client is unable to participate in the on-site visit, the Transition Coordinator shall document the reason in the client’s file.
2. The day of the move.
3. One week after the transition to ensure the client has the proper supports to continue successfully living in the community.
4. One month after the transition to ensure the client has the proper supports to continue successfully living in the community.
8.553.6 SINGLE ENTRY POINT AGENCY RESPONSIBILITIES
8.553.6.A. The SEP case manager shall perform a review to assure all items in the transition plan meet the criteria of the benefit described in 8.553.2. 1. The SEP case manager shall complete a review of the transition plan and shall notify the TCA of approval or denial of the plan within ten business days of receipt.
8.553.7 AUTHORIZATION REQUESTS
8.553.7.A. The TCA shall submit the Department prescribed Authorization Request (AR) form to the SEP case manager to authorize payment for CTS.
1. The TCA shall only submit the AR to authorize payment for any purchases or deposits after the client transitions to the community. The AR shall include a Department-approved cost report including copies of cancelled checks and copies of receipts detailing the items purchased and the cost.
a. Any expenses submitted on the cost report for items that are not included in the approved transition plan shall be considered non-allowable expenses and shall not be reimbursed.
b. The SEP case manager shall complete a review of the AR and the cost report and shall notify the TCA of approval or denial of the AR and if applicable, any non-allowable expenses on the cost report within ten business days of receipt.
2. The TCA shall only submit the AR for Transitional Case Management once the Transition Coordinator has conducted the on-site visit one month after the client’s transition.
a. The SEP case manager shall approve the AR only after verifying that the client is established in a community-based residence. CODE OF COLORADO REGULATIONS 10 CCR 2505-10 8.500 Medical Services Board 288
b. The SEP case manager shall complete a review of the AR and shall notify the TCA of approval or denial within ten business days of receipt.
8.553.7.B. The SEP case manager shall complete a review of the AR and the cost report within ten business days of receipt. The SEP case manager shall notify the TCA of approval of the AR and if applicable, any non-allowable expenses on the cost report.
1. Approval of the AR by the SEP case manager shall authorize the TCA to submit claims to the Department’s fiscal agent for authorized CTS provided during the authorized period. Payment of claims is conditional upon the client’s financial eligibility on the dates of service and the TCA’s use of correct billing procedures.
8.553.7.C. Incomplete ARs shall be returned to the TCA for correction within ten business days of receipt by the SEP agency.
8.553.8 REIMBURSEMENT
8.553.8.A. The TCA shall conform to all reimbursement procedures described in 10 C.C.R. 2505-10, Section 8.487.200 Provider Reimbursement.
8.553.8.B. Payment for CTS shall be the lower of the billed charges or the maximum rate of reimbursement.
8.553.8.C. The cost of Transitional Case Management shall be reimbursed by one unit of service completed when the client is established in a community-based residence as verified by the SEP case manager.
8.553.8.D. Reimbursement shall be made only for items listed on the transition plan with an accompanying receipt.