4000, Authorization and Referral Process

Revision 06-0; Effective May 22, 2006

The provider agency must accept all individuals of any waiver program who are referred to the provider agency for services.


The case manager will:

  • meet with the nursing facility resident and/or the resident's representative to discuss the waiver service array and living arrangement options, and obtain the resident's choice of provider agencies;
  • work with the resident and/or the resident's representative to identify the essential Transition Assistance Services (TAS) needed under the categories of Deposits, Household Needs and Site Preparation, as found on the assessment form;
  • determine if other resources are available to purchase the needed services; and
  • document the identified services/items on the TAS assessment form.

The case manager will:

  • finalize and authorize waiver services once the applicant meets all of the eligibility criteria;
  • contact the applicant to confirm the nursing facility discharge date and the individual's new address in the community; and
  • notify the individual that he/she is eligible for waiver services, including TAS, and send the individual a waiver eligibility notice.
3The case manager will send the TAS authorization form and assessment forms to the selected TAS provider agency. The authorization form will include the individual's identifying information (name, address, etc.), the total dollar amount authorized for TAS and the TAS completion date. The assessment form will include the authorized services/items and the corresponding maximum dollar amount authorized.
4The case manager will notify the TAS provider agency when an individual will not relocate into the community as planned. The case manager will also request that the provider agency not make any TAS purchases. The TAS provider agency can submit a claim for services that were already purchased and delivered.