Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 120 - WAIVERED SERVICES › Part XX - Money Follows the Person › Section 12VAC30-120-2010 - Transition services

Current through Register Vol. 40, No. 24, July 15, 2024
A. Service
				  description. "Transition services" means set-up expenses for individuals who
				  are transitioning from an institution or licensed or certified
				  provider-operated living arrangement to a living arrangement in a private
				  residence, which may include an adult foster home, where the person is directly
				  responsible for his own living expenses.
				  12VAC30-120-2000 provides the
				  service description, criteria, service units and limitations, and provider
				  requirements for this service.
The individual's transition from an institution to the
					 community shall have a transition coordinator in order to receive EDCD Waiver
					 services or a case manager or health care coordinator if he shall be receiving
					 services through either the IFDDS, ID, or Technology Assisted Waivers.
B. Criteria for receipt of
				  services. In order to be provided, transition services shall be prior
				  authorized by DMAS or its designated agent. These services include rent or
				  utility deposits, basic furniture and appliances, health and safety assurances,
				  and other reasonable expenses incurred as part of a transition. For the
				  purposes of transition services, an institution means an ICF/IID, a nursing
				  facility, or a specialized care facility/hospital as defined at
				  42 CFR
				  435.1009. Transition services do not apply to
				  an acute care admission to a hospital.
C. Service units and limitations.
1. Services are available for one transition
				  per individual and must be expended within nine months from the date of
				  authorization. The total cost of these services shall not exceed $5,000, per
				  person lifetime limit coverage of transition costs to residents of nursing
				  facilities, specialized care facility/hospitals, or ICF/IID, who are Medicaid
				  recipients and are able to return to the community. The $5,000 maximum
				  allowance must be expended within nine months from the date of authorization
				  for transition services. It shall not be available to the individual after that
				  period of time. The DMAS designated fiscal agent shall manage the accounting of
				  the transition service. The transition coordinator for the EDCD Waiver or the
				  case manager or health care coordinator, as appropriate to the waiver, shall
				  ensure that the funding spent is reasonable and does not exceed the $5,000
				  maximum limit.
2. Allowable costs
				  include:
a. Security deposits and the first
				  month's rent that are required to obtain a lease on an apartment or
				  home;
b. Essential household
				  furnishings required to occupy and use a community domicile, including
				  furniture, window coverings, food preparation items, and bed/bath
				  linens;
c. Set-up fees or deposits
				  for utility or services access, including telephone, electricity, heating and
				  water;
d. Services necessary for
				  the individual's health, safety, and welfare such as pest eradication and
				  one-time cleaning prior to occupancy;
e. Moving expenses;
f. Fees to obtain a copy of a birth
				  certificate or an identification card or driver's license; and
g. Activities to assess need, arrange for,
				  and procure needed resources.
3. The services are furnished only to the
				  extent that they are reasonable and necessary as determined through the service
				  plan development process, are clearly identified in the service plan and the
				  person is unable to meet such expense, or when the services cannot be obtained
				  from another source.
4. The
				  expenses shall not include ongoing monthly rental or mortgage expenses, food,
				  regular utility charges, or household items that are intended for purely
				  diversional/recreational purposes. This service shall not include services or
				  items that are covered under other waiver services such as chore, homemaker,
				  environmental modifications and adaptations, or specialized supplies and
				  equipment.