MA Eligible Individuals That Are Not Waiver Eligible

MA Eligible Individuals That Are Not Waiver Eligible

SNHT Funding Requests / Waiver CTS Funding Requests
NHT Program services and requests for services covered under Special NHT funding
Community Transition services mirrors the CTS services under the Waiver programs for individuals that are:
  • Not MA eligible in the community
  • MA eligible individuals that are not Waiver eligible
  • MA eligible individuals that are Waiver eligible but requested necessary services exceed the Waiver limit
/ Waiver services that can assist with NHT transitions
If individual is Waiver eligible, necessary services:
  • Must first be accessed through the Waiver, See codes below.
  • If service amounts exceed the Waiver limit, request may be submitted for SNHTF.
  • Waiver CTS funds limit of $4,000.00

Reviewed by NHT staff for approval. Final decision forwarded to Agency. Also shared with Waiver staff if applicable.
SNHT funding under the NHT program includes:
  • Home adaptations
  • Specialized Medical Equipment (SME)
  • On-going services
  • Stranded Costs
  • Other – Must Specify - This section is for services not specified above such as food or other items not covered by Waiver.
    Maximum food allowance is $200/mo
/ Reviewed by NHT staff for approval. Final decision forwarded to Agency and notice sent to the Waiver staff.
Waiver CTS funds limit of $4,000.00 includes:
  • W7332 - Essential Furnishing
  • W7333 - Moving Expenses
  • W7334 - Security Deposit*
  • W7335 - Specific one time set-up fees
  • W7336 - Personal & Environmental Health &Safety assurances
Note: Necessary Waiver CTS service(s) that exceeds the $4000 Waiverlimit should be requested under the SNHTF column.
*Important: Security Deposit funding request that is required to obtain a lease on an apartment or house. Rent is not covered by the Waiver nor can SNHTF be used for rent.
Home adaptations for non-MA eligible individuals should be submitted to SNHTF.
Requested services for home adaptations for Waiver eligible participants that exceeds the Waiver cap can be submitted to SNHTF – but only for the amount that exceeds the Waiver limit.
Note: Home adaptations for individuals enrolled in the Waiver should be first accessed through the Waiver program. / Some of the Waiver programs do not have environmental adaptations. In this case, AAA or NHTCA can request SNHT funding if the adaptation is deemed necessary for transition.
Some waivers have a cap on adaptations. If service amount exceeds the cap, AAA or NHT partner can request SNHT funding to cover amount necessary over cap.
Requests for specialized medical equipment (SME) should be submitted for SNHTF when it is not covered by third party, Medicare, Medicaid (State Plan/Fee Schedule) or Waiver program. / Waiver covered specialized medical equipment: State plan and third party payers should be accessed for coverage of SME before billing Waiver. SNHTF funding may be requested if SME is not covered by the Waiver.
Essential household set-up includes food and/or other items not covered by the Waiver.
Note: Maximum food allowance is $200.00/mo. / The $4,000.00 of Waiver CTS funds is a total for one participant over a lifetime and can be used to assist in more than one transition – but only up to the lifetime total amount of $4,000.00.
On-going services are for a maximum allowance of six months. Note: Agency guarantees to cover services at the conclusion of the six month term. / SNHTF can be requested if services for the Waiver eligible participant exceed the $4,000.00 limit.
Stranded costs: Transition expenses paid, but the consumer did not transition. Note: Agency will need to explain why the consumer did not transition. / Important: Refer to the specific Waiver for a list of covered services (billing codes).
SNHTF / Waiver CTS
Essential Furnishings
  • Not MA eligible in the community
  • MA eligible but not Waiver eligible
  • Waiver eligible but cost exceeds Waiver limit*
/
  • Enrolled into OLTL HCBS Waiver
  • W7332
  • Costs not to exceed Waiver limit - $4,000
  • Provide detailed list

Moving Expenses
  • Not MA eligible in the community
  • MA eligible but not Waiver eligible
  • Waiver eligible but cost exceeds Waiver limit*
/
  • Enrolled into OLTL HCBS Waiver
  • W7333
  • Costs not to exceed Waiver limit - $4,000

Other – Must Specify
  • Not MA eligible in the community
  • MA eligible but not Waiver eligible
  • Waiver eligible but not covered by Waiver
  • Waiver eligible but cost exceeds Waiver limit*
    Example – Food ($200 maximum per mo)
/
  • Not covered by the Waiver program

Personal and Environmental Health & Safety Assurances
  • Not MA eligible in the community
  • MA eligible but not Waiver eligible
  • Waiver eligible but cost exceeds Waiver limit*
/
  • Enrolled into OLTL HCBS Waiver
  • W7336
  • Costs not to exceed Waiver limit - $4,000

Security Deposits
  • Not MA eligible in the community
  • MA eligible but not Waiver eligible
  • Waiver eligible but cost exceeds Waiver limit*
  • SD that is required to obtain a lease on an apartment or house -SNHTF may not be used for rent
/
  • Enrolled into OLTL HCBS Waiver
  • W7334
  • Costs not to exceed Waiver limit - $4,000
  • Security deposit that is required to obtain a lease on an apartment of house - Rent is not covered by the Waiver

Specific One Time Set-Up Fees or Deposits
  • Not MA eligible in the community
  • MA eligible but not Waiver eligible
  • Waiver eligible but cost exceeds Waiver limit*
/
  • Enrolled into OLTL HCBS Waiver
  • W7335
  • Costs not to exceed Waiver limit - $4,000

Stranded Cost
  • Transition expenses approved and paid, but consumer did not transition
  • Must explain reason for not transitioning
/
  • Not covered by the Waiver program

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