Nursing Home Transition and Diversion Fee Changes
LeadingAge NY previously reported confirmation with the Department of Health (DOH) that the Nursing Home Transition and Diversion (NHTD) rates for some of the waiver services were increased by three percent. This is similair to what we reported in December 2014 for the Traumatic Brain Injury (TBI) waiver. According to DOH the NHTD rates were loaded into eMedNY around July 13. The increases are for those waiver services where the rate amounts are fixed.
NHTD waiver service providers were notified via eMedNY on Aug. 3 of the fee changes. Please note that Home and Community Support Services (HCSS) will no longer be based on a county basis but is now an upstate/downstate rate.
|
NHTD Program/Service |
New Fee (Upstate) |
New Fee (Downstate) |
|
Home and Community Support Services (HCSS) *Note that there will no longer be a county differential. |
$23.53* (per hour) |
$22.45* (per hour) |
|
HCSS Nursing Visit |
$61.80 (per visit) |
$61.80 (per visit) |
|
Positive Behavior Intervention and Supports (PBIS) |
$54.04 (per hour) |
$70.04 (per hour) |
|
Structured Day Program (SDP) |
$17.56 (per hour) |
$22.66 (per hour) |
|
Independent Living Skills Training (ILST) |
$36.02 (per hour) |
$47.74 (per hour) |
|
Community Integration Counseling (CIC) |
$72.03 (per hour) |
$93.73 (per hour) |
|
Ongoing Service Coordination |
$393.92 (monthly) |
$511.91 (monthly) |
|
Initial Service Coordination Diversion (upon eligibility) |
$537.99 |
$699.37 |
|
Initial Service Coordination/Transition Level I (upon eligibility) |
$931.91 |
$1211.28 |
|
Initial Service Coordination/Transition Level II (upon eligibility) |
$1325.84 |
$1723.19 |
As we reported, the rate increase would not include some services such as moving or environmental modifications (E-mods) where providers are reimbursed for the final cost of the project.
It does state in the eMedNY announcement that the Centers for Medicare and Medicaid Services (CMS) approval is still pending. LeadingAge NY will continue its advocacy with other stakeholders to obtain CMS approval in supporting the NHTD rate increases.
As a reminder this follows DOH extending from Jan. 2016 to Jan. 2017 the date for transitioning this waiver to mandatory Medicaid managed care (mainstream and managed long term care).
We will keep you posted as we receive any additional information.
Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871