Nursing Home Transition and Diversion Waiver Program

Service Coordination is an individually designed intervention which provides primary assistance to the waiver applicant/participant in gaining access to needed waiver and Medicaid State Plan services, as well as other local, state and federally funded educational, vocational, social, medical, and any other services. These interventionsare expected to result in assuring the waiver participant’s health and welfare and increasing independence, integration and productivity. The Service Coordinator (SC) will assist the applicants/participants in obtaining and coordinating the services that are necessary to return to or remain in the community.

Independent Living Skills Training (ILST) services are individually designed to improve/maintain the ability to live as independently as possible in the community. ILST assists with recovering skills that have been decreased by onset of disability. ILST is targeted to those with progressive illnesses to maintain essential skills. Such skills include: self-care, medication management, task completion, communication skills, interpersonal skills, socialization, sensory/ motor skills, transportation skills, reduction of maladaptive behaviors, money management, problem-solving skills, vocational skills, and household maintenance.

Community Integration Counseling (CIC) is an individually designed service intended to assist waiver participants who are experiencing significant problems managing the emotional responses inherent in adjusting to a significant physical or cognitive disability while living in the community. CIC is a counseling service provided to the waiver participant who is coping with altered abilities and skills, a revision of long term expectations, or changes in roles in relation to significant others. This service is primarily provided in the provider’s office or the waiver participant’s home.

Positive Behavioral Interventions and Supports (PBIS) services are individually designed and are provided to waiver participants who have significant behavioral difficulties that may jeopardize their ability to remain in the community of choice due to inappropriate responses to events in their environment. The PBIS should be provided in the situation where the significant maladaptive behavior occurs.

Structured Day Program (SDP) services are individually designed services, provided in an outpatient congregate setting or in the community, to improve or maintain the waiver participant’s skills and ability to live as independently as possible in the community. Services may include assessment, training and supervision to an individual with self-care, task completion, communication skills, interpersonal skills, problem- solving skills, socialization, sensory/motor skills, mobility, community transportation skills, reduction/elimination of maladaptive behaviors, money management skills, and skills to maintain a household.

Nutritional Counseling and Educational Services are individually designed services which provide an assessment of the waiver participant’s nutritional needs and food patterns, and the planning for the provision of food and drink appropriate for the waiver participant’s conditions, or the provision of nutrition education, and counseling to meet normal and therapeutic needs.