§ 205.528

205.528 Hospital -to-Home Transition Program. (1) The Department for Medicaid Services shall submit a waiver or waiver amendment for approval to the Centers for Medicare and Medicaid Services in order to establish the Hospital -to-Home Transition Program to provide coverage for services provided by an appr oved Medicaid waiver provider to elderly and physically disabled persons over the age of eighteen (18) years. The program shall provide coverage for up to sixty (60) days for services not otherwise provided as part of the Medicaid essential benefits covera ge in order to assist waiver applicants while transitioning from an institutional setting to their home or to a community setting. (2) The Hospital -to-Home Transition Program shall provide nonmedical support services to applicants, including but not limite d to: (a) Adult day -care services; (b) Attendant services; (c) Home -delivered meal services; and (d) Transportation services. (3) The daily cost of services covered by the Hospital -to-Home Transition Program shall be less than the average daily Medicaid pa yment for a stay at a nursing facility.

d) Transportation services. (3) The daily cost of services covered by the Hospital -to-Home Transition Program shall be less than the average daily Medicaid pa yment for a stay at a nursing facility. (4) An applicant shall be eligible for the Hospital -to-Home Transition Program if the applicant: (a) Is determined to be functionally eligible for services in his or her home or community setting; and (b) Has a pendi ng application for Medicaid waiver services, provided that he or she complies with all other medical assistance application requirements. (5) The cabinet shall develop a screening tool to determine whether an applicant meets the eligibility criteria under subsection (4) of this section for the Hospital -to-Home Transition Program. The screening tool shall include but not be limited to the following: (a) Procedures for determining whether an applicant is functionally able to live at home or in a community set ting; (b) Procedures for determining financial eligibility; (c) Procedures to address patient treatment preferences; and (d) Procedures to address patient goals of care and family caregiver concerns.

ting; (b) Procedures for determining financial eligibility; (c) Procedures to address patient treatment preferences; and (d) Procedures to address patient goals of care and family caregiver concerns. (6) An applicant for the program shall: (a) Sign a written agreement attesting to the accuracy of the financial and other information that the applicant provides; and (b) Complete a Medicaid application on the date the applicant is screened for functional eligibility or not later than ten (10) days from the screening. (7) The cabinet shall make the Medicaid level of care final determination of eligibility for Medicaid and Medicaid waiver services by sixty (60) days following an eligible applicant's discharge from an institutional setting to a home or community setting. (8) The cabinet shall request funding to support the waiver program. Not later than July 1, 2016, subject to appropriations provided by the General Assembly and approval of the waiver or waiver amendment from the Centers for Medicare an d Medicaid Services, the cabinet shall initiate the Hospital -to-Home Transition Program as described in this section.

and approval of the waiver or waiver amendment from the Centers for Medicare an d Medicaid Services, the cabinet shall initiate the Hospital -to-Home Transition Program as described in this section. (9) The Department for Medicaid Services shall promulgate administrative regulations to implement this section. Effective: June 24, 2015 History: Created 2015 Ky. Acts ch. 98, sec. 1, effective June 24, 2015.