Discover how to apply for NHTD waiver program with our simplified guide to make the process easier!
October 23, 2024
The NHTD (Nursing Home Transition and Diversion) Waiver Program is a home and community-based initiative in New York. It assists Medicaid-eligible seniors and individuals with physical disabilities in receiving comprehensive services while living in a community-based setting instead of a nursing home or other institutional facilities [1]. The program is designed to help individuals maintain their independence and enhance their quality of life.
The NHTD Waiver Program allows the State of New York to cover specific services for older or disabled individuals who opt to live in their own homes or with family members, thereby delaying or preventing nursing home stays. The program also provides support for individuals transitioning from institutional settings back to their homes.
| Key Features | Description |
|---|---|
| Target Population | Seniors and individuals with physical disabilities |
| Primary Goal | To provide comprehensive services to prevent institutionalization |
| Coverage | Home-based services for Medicaid beneficiaries |
| Services Provided | Personal care, respite care, and other supportive services |
The NHTD program is rooted in the philosophy that individuals with physical disabilities and seniors have the same rights as the general population. This includes the right to control their lives, manage risks, and learn from their experiences while ensuring their health and welfare in the community [1].
The program emphasizes personal plans and aims to empower participants, enhancing their quality of life and enabling them to actively participate in their communities. It ensures that individuals receive the necessary support to remain healthy and safe while avoiding the need for nursing home placement.
| Philosophy Components | Focus Areas |
|---|---|
| Individual Empowerment | Control over personal care decisions |
| Community Inclusion | Engagement in community activities |
| Health and Safety | Access to necessary health services and supports |
Determining eligibility for the NHTD Waiver Program is crucial to ensure that individuals receive the care and services needed to thrive in their communities. The criteria and overview of the application process help clarify what is required to apply successfully.
To qualify for the NHTD Waiver Program, individuals must meet specific criteria:
All Services except Nursing Facility Service
Community Coverage with Community-Based Long-Term Care
Outpatient Coverage with Community-Based Long-Term Care
Verification of Medicaid coverage from the New York State system is essential [3].
Freedom of Choice Form: Applicants must sign a Freedom of Choice form, indicating their decision to participate in the waiver program rather than residing in a nursing facility [3].
Living Arrangements: Individuals must identify actual living arrangements that comply with the Home and Community Based (HCB) Settings Rule.
Cost Neutrality: The services outlined in the Initial Service Plan (ISP) must meet regional and statewide cost neutrality requirements, ensuring total expenses do not exceed what would have been spent if the individual had been in a nursing home [3].
The application process for the NHTD Waiver Program involves various steps that must be followed carefully:
| Step | Description |
|---|---|
| 1. Confirm Medicaid Eligibility | Verify that the applicant has the appropriate Medicaid coverage for community-based long-term care. |
| 2. Complete the NHLOC Assessment | Undergo an assessment to establish the need for Nursing Home Level of Care within 90 days of applying. |
| 3. Sign Your Freedom of Choice Form | Indicate participation in the waiver program instead of a nursing facility. |
| 4. Identify Living Arrangements | Provide information on living arrangements compliant with HCB Settings Rule. |
| 5. Develop Initial Service Plan | Create an Initial Service Plan that adheres to cost neutrality requirements. |
Following these guidelines ensures that applicants prepare adequately for their pursuit of the NHTD Waiver Program, enhancing their chances of successful approval.
To apply for the NHTD program in New York, individuals currently residing in a nursing home should first discuss their intentions with a discharge planner. This professional can make a referral to Open Doors and/or the Regional Resource Development Center (RRDC) for assistance. Those living in the community can directly contact the RRDC in their area to start the application process. The initial step involves meeting with the RRDC to facilitate the application and understand the available services.
The application process includes several essential steps:
| Step | Description |
|---|---|
| 1 | Contact an agency or Medicaid service coordinator. |
| 2 | Undergo an assessment to determine eligibility based on care needs, age, and other relevant factors. |
| 3 | Collaborate with a service coordinator to develop a personalized care plan. |
This process is crucial for ensuring that applicants receive the support they need to transition to the community or maintain their independence within it [4].
Completing the application involves several key documents and procedures. Once eligibility is established, the individual works closely with a Service Coordinator to develop an Initial Service Plan (ISP). This plan outlines the necessary services and supports for maintaining health and welfare in the community.
The following documents are typically required for the application:
| Document | Purpose |
|---|---|
| Initial Service Plan (ISP) | Details demographic information, assessment of strengths, needs, and goals, and strategies to minimize isolation and risks. |
| Plan of Protective Oversight (PPO) | Ensures the individual's safety and well-being while receiving services. |
| Uniform Assessment System New York (UAS-NY) documentation | Provides detailed information on the individual's needs and circumstances. |
The completion and submission of these documents must occur within 60 days of the approval date. The Service Coordinator is responsible for submitting these forms and ensuring that all necessary information is accurately documented [5].
Successfully navigating this process will enable individuals to access services designed to delay or prevent nursing home stays, supporting a smoother transition back to community living.
Applying for the NHTD Waiver Program involves several crucial steps to ensure that applicants receive the services they need. This section outlines the Assessment and Intake Meeting, as well as the Service Coordination and Provider Selection processes.
The application journey begins with an assessment to determine if the applicant requires a Nursing Home Level of Care (NHLOC) or Nursing Facility Level of Care (NFLOC). This assessment must be completed by medical professionals, social workers, or designated evaluators within 90 days of the application. It takes into account various factors including medical, cognitive, mental health, and functional issues.
Following this initial assessment, an intake meeting is scheduled with the applicant and the Regional Resource Development Center (RRDC). During this meeting, the applicant's eligibility for the program is further assessed. If the applicant is found eligible, they have 30 calendar days to choose a Service Coordination provider. The Service Coordinator plays a vital role in assisting the applicant with the application process and providing comprehensive information regarding available services and providers.
| Step | Description |
|---|---|
| Initial Assessment | Determining NHLOC or NFLOC needs within 90 days |
| Intake Meeting | Eligibility assessment with RRDC |
| Service Provider Choice | 30 days to select a Service Coordination provider |
Once an applicant has chosen a Service Coordinator, they will assist in completing the necessary documentation required for the NHTD Waiver Program. This documentation includes the Initial Service Plan (ISP), the Plan of Protective Oversight (PPO), the Uniform Assessment System New York (UAS-NY) documentation, and other required forms. The Service Coordinator must submit these documents to the RRDC within 60 days of the approval date.
The ISP typically includes demographic information, an assessment of the applicant's strengths and needs, goals for care, and strategies for minimizing risks and isolation. Selecting the right service provider is essential for ensuring that the applicant's specific needs are met and for facilitating the delivery of appropriate services.
| Document | Purpose |
|---|---|
| Initial Service Plan (ISP) | Includes demographic info and care strategies |
| Plan of Protective Oversight (PPO) | Ensures the applicant's safety and well-being |
| UAS-NY Documentation | Standardized assessment documentation |
By following these steps, applicants can effectively navigate the application process for the NHTD Waiver Program, ensuring they receive the care and services suited to their needs.
The review and approval process is a critical step in applying for the NHTD Waiver Program. It involves thorough evaluation and documentation to determine eligibility.
The application review process is managed by the Regional Resource Development Center (RRDC). Upon receiving a complete application packet, the RRDC has 14 days to determine the applicant's eligibility. This includes reviewing documentation such as the Initial Service Plan (ISP), which outlines the applicant's demographic information, assessment of strengths, needs, goals, and strategies to minimize isolation and risks [5].
Once the determination is made, the RRDC issues one of the following notices:
| Notice Type | Description |
|---|---|
| Notice of Decision of Authorization | Issued if the applicant is found eligible for the NHTD program. |
| Notice of Decision - Denial | Provided if the applicant is deemed ineligible, including reasons for the denial. |
After receiving the Notice of Decision, applicants who are denied have the right to appeal. They have 60 days from the date of the Notice of Decision to request a Fair Hearing. This appeal process allows individuals to contest the RRDC's decision and present additional information or clarification regarding their application [5].
The RRDC plays a pivotal role in ensuring the NHTD Waiver programs are accessible to eligible individuals, guiding them through both acceptance and denial avenues.
Once an applicant has received approval for the NHTD Waiver Program, the next steps involve initiating services and implementing a service plan. This ensures that the individual receives the support necessary to meet their needs.
The service initiation process formally begins only after receiving approval from the Regional Resource Development Center (RRDC). The initial step involves a referral to the RRDC, which verifies the applicant's eligibility during a phone call. During this call, essential information is gathered to complete a referral form [5].
After the referral is made, the RRDC will schedule an intake meeting with the applicant. At this meeting, the applicant's eligibility is reassessed. If eligibility is confirmed, the applicant has 30 calendar days to select a Service Coordination provider. This coordinator plays a vital role in facilitating the application process and providing details on available services.
| Step | Description |
|---|---|
| Referral to RRDC | Initial phone call to confirm basic eligibility and gather information. |
| Intake Meeting | Assessment of eligibility and service needs. |
| Service Coordination | Selection of a Service Coordinator within 30 days post-intake. |
Once the Service Coordination provider is selected, the completion and submission of the application take place. This involves reviewing and signing several critical documents, including:
The Service Coordinator assists in filling out these documents and submits the complete application packet to the RRDC within 60 days from the approval date.
The ISP encompasses demographic details, a comprehensive assessment of the individual’s strengths, needs, and goals, as well as strategies to minimize isolation and risks.
| Document | Purpose |
|---|---|
| Initial Service Plan (ISP) | Outlines needs, goals, and service strategies. |
| Plan of Protective Oversight (PPO) | Ensures safety and oversight of services. |
| UAS-NY Documentation | Standardized assessment for service evaluations. |
Through these processes, a structured approach ensures that the services provided meet the specific needs of individuals enrolled in the NHTD Waiver Program.
