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Update on NHTD/TBI Waiver Transition

The Nursing Home Transition & Diversion (NHTD)/Traumatic Brain Injury (TBI) Waiver Transition Workgroup held a webinar on Dec. 7, 2017 to review its Draft Transition Plan. Please click here to access the presentation slides and here for the Q&A portion of the webinar.

The webinar highlighted the following topics. Some noteworthy details are also provided.

Revised Timeline:

  • April 2018: Release of Revised Transition Plan for public comment
  • June 2018: Submission of Transition Plan to the Centers for Medicare and Medicaid Services (CMS)
  • July 2018: Submission of the 1115 Waiver Amendment
  • Sept. 1, 2018: CMS approval of Transition Plan
  • Sept. 1, 2018: Begin training with Plans
  • Oct. 1, 2018: Cease enrollment of new waiver providers and expansion of existing providers
  • Nov. 1, 2018: Service Plan approval deadline for waiver participants and cease new referrals and intakes
  • On or around Dec. 1, 2018: Announcement letters
  • Jan. 1, 2019: 60-day notice and voluntary enrollment
  • March 2019: 30-day notice and implementation of mandatory enrollment
  • April 1, 2019: Services begin

Services and Service Coordination – This will be a main service in Managed Long Term Care (MLTC) for waiver recipients. The primary concern is to offer a service that is conflict free and not duplicative of care management services provided in the managed care model but offers additional discrete services beyond the scope of care management. 

Managed Care Person-Centered Service Plans

Regional Resource Development Centers (RRDCs) – RRDCs will continue to have a role in the managed care model and will serve as a resource so that the managed care plans and providers receive appropriate training and education related to services and special needs populations.

Outline of Contract Amendment Process

Transition of NHTD/TBI waiver participants – The RRDCs will assist participants in transitioning to managed care. Each 1915(c) waiver participant will have a transition plan developed in conjunction with their current service coordinator and their MCO Care Manager to ensure that all services remain in place.

Continuity of Care – Any waiver participant transitioning to MLTC will be deemed eligible for Community Based Long Term Care for two years as long as the member actively participates in services identified in the person-centered service plan.

Continuity for services for providers of care – The Department of Health (DOH) is proposing to establish a two-year continuity of care period for participants and service providers, provided certain requirements are upheld. DOH has proposed a two-year rate guarantee based on the approved rates at the time of transition. Services provided during the six-month transition period will be accessed through Fee for Service.

Orientation and Training Plans 

Consumer Education and Information

There will be upcoming webinars on payment rates and Conflict of Interest (COI) provisions related to the waiver transition. LeadingAge NY will alert members of the upcoming dates as they are announced.

Contact: Meg Carr Everett, meverett@leadingageny.org, 518-867-8871