Nursing Facility Transition/Diversion services assist individuals to live in the community and/or avoid institutionalization when possible.
The goal is to both facilitate nursing facility transition back into a community setting, like an assisted living facility, and/or prevent nursing home placement for Members with an imminent need for nursing facility level of care. Members have a choice of residing in an assisted living setting as an alternative to long-term placement in a nursing home when they meet eligibility requirements.
The assisted living provider is responsible for meeting the needs of the Member, including assistance with Activities of Daily Living (ALDs), Instrumental ALDs (IALDs), meals, transportation, companion services, medication oversight, and therapeutic social and recreational programming provided in a home-like environment.
This includes 24-hour direct care staff on-site to meet scheduled unpredictable needs in a way that promotes maximum dignity and independence, and to provide supervision, safety, and security.
Eligibility and Exclusion Criteria
Nursing Facility Transition
To be eligible for Nursing Facility Transition Services, a Member:
- Has resided in a nursing facility for 60 days or longer;
- Is willing to live in an assisted living setting as an alternative to a nursing home; and
- Is able to reside safely in an assisted living facility with appropriate and cost-effective supports.
Nursing Facility Diversion
To be eligible for Nursing Facility Diversion Services, a Member must be:
- Interested in remaining in the community;
- Willing and able to reside safely in an assisted living facility with appropriate and cost-effective supports and services; and
- Currently receiving medically necessary nursing facility level of care or meet the minimum criteria to receive nursing home services and in lieu of going into a facility, is choosing to remain in the community and continue to receive medically necessary services at an assisted living facility.