4600, Transition Assistance Services

4610 Transition Assistance Services Introduction

Revision 19-13; Effective November 5, 2019

Transition Assistance Services (TAS) is a STAR+PLUS Home and Community Based Services (HCBS) program service designed to assist Medicaid members who are transitioning from a nursing facility (NF) to the community. An NF resident discharged from the NF into a waiver program is eligible to receive up to $2,500 in TAS for assistance with setting up a household. TAS is available on a one-time only basis and is not available to residents moving from an NF who are approved for any of the following waiver services:

• adult foster care (AFC) services; or
• assisted living facility (ALF) services.

4611 Transition Assistance Services Service Description

Revision 19-13; Effective November 5, 2019

Transition Assistance Services (TAS) pays for non-recurring, set-up expenses for members transitioning from nursing facilities (NFs) to a home in the community. TAS is a benefit to cover basic and essential household items. Allowable expenses are those necessary to enable the member to establish a basic household and may include:

• payment of security deposits required to lease an apartment or home;
• set-up fees or deposits to establish utility services for the home, including telephone, electricity, gas and water;
• purchase of essential furnishings for the apartment or home, including table, chairs, window blinds, eating utensils, food preparation items, bath linens, cleaning supplies and toiletries;
• payment of moving expenses required to move into or occupy the home or apartment; and
• payment for services to ensure the health and safety of the member in the apartment or home, such as pest eradication, allergen control or a one-time cleaning before occupancy.

TAS does not include relocation services and is not available to assist the applicant in locating a residence.

4620 Transition Assistance Services Procedures at the Initial Interview

Revision 19-13; Effective November 5, 2019

All STAR+PLUS Home and Community Based Services (HCBS) program applicants who are in a nursing facility (NF) must be advised of the availability of Transition Assistance Services (TAS) and screened for the potential need for services.

Within 14 business days of learning of a request to move to the community, the managed care organization (MCO) service coordinator discusses the applicant’s or member’s available living arrangements in the community and asks the applicant or member where he or she intends to live upon discharge from the NF.

TAS may be considered when the applicant or member:

• plans to rent an unfurnished apartment;
• plans to rent an unfurnished house;
• has a home, but all the utilities have been off while in the NF;
• has a home, but it may need cleaning, pest eradication or allergen control before it can be occupied again; or
• needs his or her belongings moved to the new residence.

If these or any other situations exist in which the applicant could benefit from TAS services, continue with the screening for TAS.

4630 Identification of Needed Items and Services

Revision 19-13; Effective November 5, 2019

The managed care organization (MCO) conducts the interview with the applicant and/or authorized representative (AR) to identify the applicant's needs and determines if other resources are available to meet the needs. The MCO service coordinator completes Form 8604, Transition Assistance Services (TAS) Assessment and Authorization, by marking each identified need and writing a description of the exact need.

Example: If the applicant needs a deposit made for electricity, the MCO enters the name and address of the utility company and the amount required.

The applicant selects a TAS agency from the list of contracted agencies.

4640 Items and Services Included Under TAS

Revision 19-13; Effective November 5, 2019

Form 8604, Transition Assistance Services (TAS) Assessment and Authorization, is divided into three main categories: deposits, household needs and site preparation needs.

4640.1 Deposits

Revision 19-13; Effective November 5, 2019

Deposits include security deposits for rental and utilities, including basic telephone service. Security deposits or utility deposits must be in the applicant’s or member’s name. 
Security deposits may be paid as long as the payment is specifically called a security deposit and not rent, the payment is for a one-time expense, and the amount of the payment is no more than the equivalent of two months’ rent. Transition Assistance Services (TAS) cannot pay for rent.

TAS can be used to pay for arrears on previous utilities if the account is in the member's name and the member will not be able to get the utilities unless the previous balance is paid. TAS cannot pay the first month's payment on utilities.

TAS can be used to pay for a telephone since it is a basic need, but minutes or services on the telephone are not allowable expenses.

TAS cannot pay for any charges for upgraded services beyond the basic service.

TAS funds can be used to pay for initial setup or reconnection fees for propane or butane service, including the minimal supply of fuel if the utility company has a policy that requires a minimal supply of fuel to be delivered during the initial or reconnection service call. TAS funds cannot be used to top off a tank with fuel when the member’s home is connected and has a supply of butane or propane.

4640.2 Household Needs

Revision 19-13; Effective November 5, 2019

Household needs include basic furniture or appliances. This includes bedroom furniture, living room furniture, kitchen furniture, refrigerator, stove, washer, dryer, cleaning supplies and toiletries, etc.

An applicant or member may request a specific brand or type of appliance, furniture or other Transition Assistance Services (TAS) item if the applicant’s or member’s needs are met within the cost limit.

TAS items may be placed in a home other than the applicant’s or member’s only when furnishings are not available and are necessary for the applicant or member to transition to the community. TAS cannot pay for items that would only be used by the other person.

If existing items are not usable and the lack of a usable basic or essential item creates a barrier keeping the member from returning to the community, the item is considered a need.

4640.3 Housewares

Revision 19-13; Effective November 5, 2019

Housewares can include pots, pans, dishes, silverware, cooking utensils, linens, towels, clock and other small items required for the household.

4640.4 Small Appliances

Revision 19-13; Effective November 5, 2019

Small appliances include a microwave oven, electric can opener, coffee pot, toaster, etc.

4640.5 Cleaning Supplies

Revision 19-13; Effective November 5, 2019

Cleaning supplies include a mop, broom, vacuum, brushes, soaps and cleaning agents.

4640.6 Other Items Not Listed

Revision 19-13; Effective November 5, 2019

Any special requests from the applicant or member not covered in the general list that meet the criteria as basic essential items to move to the community may be considered.

4641 Services and Items Not Included in TAS

Revision 19-13; Effective November 5, 2019

Transition Assistance Services (TAS) does not include any items or services that are included under STAR+PLUS Home and Community Based Services (HCBS) program services such as adaptive aids, minor home modifications (MHMs), medical supplies or medications.

TAS does not include any recreational items or appliances, including televisions, VCR or DVD players, games, computers, cable TV, satellite TV, exercise equipment, vehicles or other modes of transportation.

TAS does not cover the cost of repairs or expansion on the member’s dwelling. TAS is not used for remodeling or renovation, upgrading of existing items or purchasing non-essential items.

TAS funds cannot be used for food. The managed care organization (MCO) may refer the member to emergency Supplemental Nutrition Assistance Program (SNAP) or local food pantry resources.

The room and board (R&B) charge is not an allowable TAS expense.

TAS does not pay for monthly rental or mortgage agreements or ongoing utility charges.

4642 Site Preparation

Revision 19-13; Effective November 5, 2019

Site preparation can include the following services:

• moving expenses, which include the cost of moving the applicant’s or member’s items from another location, or delivery charges on large purchased items;
• pest eradication, if the applicant’s or member’s place of residence has been unattended and some type of extermination is needed;
• allergen control, if the applicant’s or member’s place of residence has been unattended or the applicant or member is moving into a place that poses a respiratory health problem; or
• one-time cleaning, if the applicant’s or member’s place of residence has been unattended or the applicant or member is moving into a private home or apartment where pre-move-in cleaning should not be expected (for example, a family friend has an empty house available, but cannot provide the cleaning).

Transition Assistance Services (TAS) cannot pay for septic systems.

4650 Estimated Cost of Items and Services

Revision 19-13; Effective November 5, 2019

The managed care organization (MCO) service coordinator provides a description and estimated cost of each item identified as needed under each service category on Form 8604, Transition Assistance Services (TAS) Assessment and Authorization. The actual cost of an item may be used, if known. The amounts, either actual or estimated, must be less than or equal to $2,500.

The MCO service coordinator must be as specific as possible when describing what items are needed and the estimated cost. The description must include size, color, specific types or any other identifying information, as specified by the member, which will assist the TAS agency in meeting the member’s needs.

4651 Totaling the Estimated Cost and Authorization of TAS

Revision 19-13; Effective November 5, 2019

The managed care organization (MCO) service coordinator totals each section of Form 8604, Transition Assistance Services (TAS) Assessment and Authorization, and enters the amounts in the totals section to arrive at the final amount to be authorized under the TAS program. The $2,500 total amount is not entered as a flat rate.

The applicant or member must sign the form stating that the items listed are the basic, essential needs required to move into the community, and he or she agrees that the TAS agency selected is authorized to make the purchases for him or her.

The applicant or member selects a TAS agency from the list of contracted agencies.

The MCO service coordinator must explain to the applicant that the service will not be authorized until the applicant is determined eligible for STAR+PLUS Home and Community Based Services (HCBS) program services and notified in writing that he or she is eligible. The MCO service coordinator must contact the applicant or authorized representative (AR) before certification to verify the applicant has made arrangements for relocating to the community and has finalized a projected discharge date.

The MCO service coordinator includes TAS on Form H1700-1, Individual Service Plan (Pg. 1). The MCO service coordinator sends the applicant the notification of eligibility and sends the TAS agency Form 8604 and the authorization. The completion date on the authorization is two business days before the projected nursing facility (NF) discharge date. Allow at least five business days between the authorization date and the completion date. The TAS agency is expected to have all services and items completed by that date. For situations in which a shorter completion date is needed, the MCO service coordinator must contact the TAS agency and negotiate an earlier date. The MCO service coordinator will code those items as delivered prior to the arrival date.

Additional applicant information to the TAS agency may be included on Form 8604 or Form H2067-MC, Managed Care Programs Communication. Form 8604 is mailed after the applicant or member is determined eligible for STAR+PLUS HCBS program services.

The TAS agency may only obtain items or services for which the agency has received authorization on Form 8604. If the TAS agency identifies other items or services that the applicant or member may need, the TAS agency must obtain prior approval from the MCO. Refer to Section 4652, Changes to the Authorization, below.

4652 Changes to the Authorization

Revision 19-13; Effective November 5, 2019

If the Transition Assistance Services (TAS) agency or the member identifies additional items required by the member after the TAS authorization has been sent, the TAS agency must obtain approval from the managed care organization (MCO) on Form 8604, Transition Assistance Services (TAS) Assessment and Authorization, prior to obtaining the item or service.

The TAS agency must stay within the total dollar amount authorized on Form 8604. If the total amount of the items or services needed is more than the total amount authorized, the TAS agency must obtain prior approval and an updated Form 8604 from the MCO. The MCO service coordinator must update Form H1700-1, Individual Service Plan (Pg. 1), to reflect the change in the amount for funds authorized.

The MCO must send an amended Form 8604 updating the authorization to the TAS agency within two business days with the additional items and amounts authorized.

MCO approval is required to authorize delivery of TAS services.

4660 Transition Assistance Services Agency Responsibilities

Revision 19-13; Effective November 5, 2019

The Transition Assistance Services (TAS) agency accepts all members referred by the managed care organization (MCO). Upon receipt of the authorization, the TAS agency must review the forms carefully and contact the MCO if there are any questions regarding what has been authorized. This contact must occur by the next business day of receipt of the forms, and before any TAS purchase is made. The MCO contacts the member, if necessary, to discuss the item in question. The MCO provides a revised TAS authorization form within two business days if it clarifies an item is authorized or approves a change to the authorization.

The TAS agency purchases the authorized items or services and arranges and pays for the delivery of the purchased items, if applicable. The TAS agency only purchases services or items within the dollar amount authorized by the MCO. The TAS agency contacts the member or authorized representative (AR), if necessary, to coordinate service delivery.

The TAS agency delivers the authorized services by the completion date recorded on the TAS authorization form. The agency provides a copy of the purchase receipts and any original product warranty information to the member. The TAS agency maintains the original purchase receipts, including sales tax, delivery or installation charges.

The TAS agency orally notifies the MCO of a delivery delay before the completion due date and documents the delay. The agency also contacts the member or AR by the completion date to confirm that all authorized TAS services were delivered.

4670 Three-Day Monitor Required

Revision 19-13; Effective November 5, 2019

The managed care organization (MCO) monitors the member within three business days after the discharge date to assure that all services and items authorized through the Transition Assistance Services (TAS) agency have been received. If the member reports that any items have not been delivered or services not performed, the MCO contacts the TAS agency by telephone and follows up in writing. Written documentation must be maintained in the member’s case record.

4680 Failure to Leave the Nursing Facility

Revision 19-13; Effective November 5, 2019

While the managed care organization (MCO) makes every effort to confirm that the member has definite plans to leave the nursing facility (NF), there may be situations in which the member changes his or her mind or has a change in his or her health making it impossible for the member to relocate to the community as planned. In this situation, the MCO notifies the Transition Assistance Services (TAS) agency that the member is no longer moving and no further items are to be purchased.

The TAS agency must attempt to return any item(s) purchased on behalf of the member and collect a refund for the amount of the purchase. The TAS agency also must attempt to recoup security, utility and other deposits paid on behalf of the member.

• If the TAS agency is unsuccessful in returning the item(s) for the amount of monies paid, or the deposits paid on behalf of the member cannot be recouped, the TAS agency is entitled to the cost of the item(s) and/or reimbursement for deposits paid, not to exceed the authorized amount. The TAS agency sends the MCO written notice stating the item(s) could not be returned or the deposits could not be recouped. The MCO contacts a local charity to donate the items and makes arrangements for pick up. The charity must serve members whose needs are similar to those of the member for whom the items were purchased or must be dedicated to assisting the member to establish a home.
• If the TAS agency is able to return the item(s) or receives the deposits back, the TAS agency is not entitled to reimbursement. If the TAS agency recoups part of the monies paid, the TAS agency is entitled to the costs of the item(s) or deposits less any monies recouped. Any claims that had been filed and paid for the item(s) or deposits would need to be adjusted by the TAS agency to pay the monies back to the MCO.
• If a service has already been provided (for example, pest eradication), the TAS agency is entitled to the costs of the service, not to exceed the authorized amount.

If the member is only in the community for a few days and returns to the NF, the member keeps the item(s) purchased through TAS.