Returning or Remaining Home

Contracts often require managed care organizations (MCOs) to take steps to limit admissions to nursing facilities, or to encourage transitions from nursing facilities to a consumer’s home. For nursing home residents who wish to return after a hospitalization, the nursing facility may be required to hold the bed for a specified period of time.

Some states also have provisions that address transition from one MCO to another.

Contents – To access the full text, please click each sub-topic.

  • MCO’s process to limit nursing facility admissions must include detailed description of how MCO works with providers to ensure appropriate communication, training for key staff, early identification of consumers who may be candidates for transition, and follow-up activities to help sustain community living: Tennessee a
  • MCO’s care coordinator must visit consumer’s potential new residence with special attention to needs and safety: Tennessee b
  • MCO’s care coordinator must make in-home visit to consumer within 24 hours of consumer’s move to home, if consumer will be living independently or higher risk is indicated: Tennessee c
  • MCO must provide monthly in-home visits with consumer for first 90 days after move to home: Tennessee d
  • MCO must coordinate hospital discharge plan with family and hospital provider team: Florida e
  • MCO must collaborate with hospital, nursing facility, or other institution to implement discharge plan in consumer’s home: Florida f

  • MCO must have program to identify consumers who may be able to transition from nursing facility to community; program carried out through referrals, care coordination, and data analysis: Tennessee g
  • MCO must identify consumers at risk of becoming long-term nursing facility residents, including but not limited to consumer requesting or waiting for nursing facility placement, consumer admitted to a hospital, and consumer receiving short-term nursing facility care: Tennessee h
  • If consumer wants to transition to community, MCO must conduct in-facility assessment of consumer’s ability within 14 days: Tennessee i
  • Transition plan must address all services necessary to safely transition consumer to community, including housing, transportation, availability of caregivers, and any barriers to a safe transition and strategies to overcome those barriers: Tennessee j
  • MCO must approve transition plan and authorize any covered or cost effective alternative services included in the plan within 10 business days of completion of plan: Tennessee k
  • Transition plan must be fully implemented within 90 days from approval, except under extenuating circumstances documented in writing: Tennessee l
  • Transition planning must include other persons, such as family members and caregivers, at consumer’s choice. Tennessee m
  • MCO must track consumers that transition from nursing facility to community, or from community to nursing facility, and report to state: Florida n
  • For consumer no longer needing institutional care, MCO must arrange for at-home care as soon as possible, and no later than 90 days after effective date of eligibility: Arizona o
  • MCO must designate point of contact to receive referrals for nursing facility residents who may be able to return to community with at-home services: Texas p
  • When consumer enters nursing facility, MCO within 30 days must develop plan of care to transition consumer back to community, if possible. If initial review does not support return to community, service coordinator will conduct subsequent assessment within 90 days to see if changed circumstances now allow for return to community: Texas q

  • MCO may make available one-time payment to assist with expenses like deposits, furniture, and household supplies: Florida ($1,500 maximum) r, Tennessee ($2,000 maximum) s

  • MCO must make available home modifications such as ramps, grab-bars, bathroom modifications, necessary changes to electrical or plumbing systems, and doorway widening: Florida t, Hawaii u, Wisconsin v
  • MCO must make available window air conditioners when “necessary for the health and safety” of the consumer: Hawaii w
  • MCO must make available lifts and electronic devices activated by motion, light or voice: Wisconsin x
  • MCO must make available modifications that increase a home’s square footage when such modification is most cost-effective option: Wisconsin y

  • To extent necessary to maintain safe, clean and sanitary environment, MCO must make available heavy-duty cleaning when services are initiated; minor repairs to essential appliances limited to stoves, refrigerators, and water heaters; and fumigation and extermination services: Hawaii `` 

  • Up to 14 bed hold days for any reason resulting in temporary absence from nursing facility, with 30 days required between episodes: Florida aa
  • Up to 12 bed hold days for hospitalization, and up to 9 bed hold days for non-medical or “therapeutic” leave: Arizona bb
  • Nursing facilities and hospices must have bed hold policies consistent with Medicaid bed hold rules: Florida cc

  • MCO must provide consumer with moving assistance from one home to another when move is necessary due to eviction, rent increase, unsafe conditions, or lack of access for consumer with mobility limitations: Hawaii dd
  • Moving expenses include packing and moving of belongings: Hawaii ee

  • When consumer switches to another MCO, initial MCO must forward necessary case and medical records within 30 days: Florida ff

  • MCO’s withdrawal from program requires 180-day notice to state, in order to develop transition plan: Florida gg
  • If MCO is withdrawing, must continue services for up to 90 days or until consumer enrolls in another MCO, whichever occurs first: Florida hh
  1. Tenn. Contract, p. 133.  (back)
  2. Tenn. Contract, p. 135.  (back)
  3. Tenn. Contract, p. 137.  (back)
  4. Tenn. Contract, p. 137  (back)
  5. Fla. Contract, Atch. II, Exh. 8, p. 78  (back)
  6. Fla. Contract, Atch. II, Exh. 8, p. 78.  (back)
  7. Tenn. Contract, p. 133-34.  (back)
  8. Tenn. Contract, p. 133.  (back)
  9. Tenn. Contract, p. 134.  (back)
  10. Tenn. Contract, p. 136.  (back)
  11. Tenn. Contract, p. 136.  (back)
  12. Tenn. Contract, p. 136.  (back)
  13. Tenn. Contract, p. 135.  (back)
  14. Fla. Contract, Atch. II, Exh. 5, p. 14.  (back)
  15. Ariz. Contract, p. 38.  (back)
  16. Tex. Contract, p. 8-134.  (back)
  17. Tex. Contract, pp. 8-134 to 8-135.  (back)
  18. Fla. Contract, Atch. II, Exh. 117, p. 114.  (back)
  19. Tenn. Contract, p. 23.  (back)
  20. Fla. Contract, Atch. II, Exh. 5, p. 16.  (back)
  21. Haw. RFP, p. 136.   (back)
  22. Wis. Contract, p. 280.  (back)
  23. Haw. RFP, p. 136.  (back)
  24. Wis. Contract, p. 280.  (back)
  25. Wis. Contract, p. 280.  (back)
  26. Haw. RFP, p. 137.  (back)
  27. Fla. Contract, Atch. II, Exh. 117, p. 115.  (back)
  28. Ariz. Contract, p. 34.  (back)
  29. Fla. Contract, Atch. II, p. 76.  (back)
  30. Haw. RFP, p. 137.  (back)
  31. Haw. RFP, p. 137.  (back)
  32. Fla. Contract, Atch. II, Exh. 8, p. 77.  (back)
  33. Fla. Contract, Atch. II, Exh. 8, p. 77.  (back)
  34. Fla. Contract, Atch. II, Exh. 8, p. 77.  (back)

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