6210 Nursing Home Transition Eligibility Criteria | ACCESS-TO-SERVICES-5200-MANUAL
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Georgia Division of Aging Services |
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Chapter: |
6000 Community Transitions |
Effective Date: |
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Section Title: |
Nursing Home Transition Eligibility Criteria |
Reviewed or Updated in: |
MT 2019-01 |
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Section Number: |
6210 |
Previous Update: |
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Summary Statement
DAS sets eligibility criteria for the Nursing Home Transition (NHT) program. Clients are deemed eligible in an objective manner based on assessment scoring.
Basic Considerations
NHT agencies will support transition of eligible clients based on the following criteria:
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Triage Risk Assessment
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Income criteria
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Minimum 20 day stay in facility (consecutive stays in a facility, including hospital, may be used to accumulate 20-day total)
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Documented transition barriers or risks for readmission
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Citizenship or Legal Status
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DON-R
NHT agencies must be able to document why the individual must rely on NHT Transition Services to transition. Individuals transitioning home prior to a Care Plan being entered into the DAS Data System will not be considered eligible for NHT services. Transition barriers must be identified and documented prior to transition.
Should NHT agencies transition non-eligible clients, and expend NHT funds to support the transition, those funds may be recouped at audit.
Definitions
- Planning List
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Group of individuals who have requested assistance in Nursing Home Transition and are eligible but have not yet transitioned back into the community.
- Facility
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A Nursing Home, sometimes called Skilled Nursing Facility. This term can also be used to refer to the following inpatient facility types from which NHT referrals may be accepted: Intermediate Care Facilities (ICFs or ICF/MRs), Long-Term Acute Care facilities, Complex Rehabilitation facilities, and Veterans Affairs hospitals.
DAS Procedures
DAS NHT Staff may review eligibility criteria for any NHT Client as part of quality assurance activities.
DAS NHT Staff will verify citizenship and residency eligibility after receiving required documentation.
NHT Provider Procedures
Establish Eligibility
NHT agency staff are responsible for establishing or ensuring eligibility for NHT Clients. Use the following criteria for NHT eligibility:
| Step 1 |
Age: Individuals who are 55 or older[1] |
| Step 2 |
Income: Client’s gross monthly income must be less than the average cost of care for a nursing home in Georgia[2] to be eligible to utilize NHT Transition Service Funds. |
| Step 3 |
Assets: Assets are not currently considered in NHT eligibility decisions. |
| Step 4 |
Length of Stay: Client must have a length of stay of a minimum of twenty (20) consecutive days in a facility. Multiple, unbroken facility stays may be added to achieve the 20 day stay. Example: 10 days in the hospital and 10 days in the nursing facility. |
| Step 5 |
Citizenship & Residency: Individual must be a citizen or have proof of legal status. Complete Appendix C form |
Triage Risk Assessment Tool
Each NHT Client must have an appropriate Triage Risk Assessment score to be considered eligible.
Level 1: Lowest priority. Not NHT Eligible. Appropriate for MDS-Q Options Counseling.
Level 2: Medium priority. Eligible for NHT with a clearly identified transition barrier and minimum DON-R Level of Impairment score of 15.
Level 3: High priority. Eligible for NHT with a clearly identified transition barrier. Should be evaluated for MFP and/or waiver services.
DONR must be completed.
If NHT Agency staff are unsure of a potential client’s eligibility, contact DAS staff for approval.