Nursing Facility Diversion Clause Samples
The Nursing Facility Diversion clause establishes procedures and criteria for redirecting individuals from admission to nursing facilities toward alternative care options, such as home- or community-based services. In practice, this clause may require an assessment of the individual's needs and eligibility for less restrictive care settings before approving nursing facility placement, and it may outline responsibilities for care coordinators or case managers in facilitating this process. Its core function is to ensure that individuals receive care in the least restrictive and most appropriate environment, thereby promoting independence and potentially reducing long-term care costs.
Nursing Facility Diversion. 1.2.1 LIDDA must designate a staff member as the Diversion Coordinator who: is at least credentialed as a qualified intellectual disability professional (“QIDP”); and has two years' experience in coordinating or providing services to individuals with intellectual and developmental disability (“IDD”), including those with complex medical needs, in the community.
1.2.2 LIDDA must ensure that the Diversion Coordinator performs the following duties:
A. On a quarterly basis, as indicated in the PASRR Reporting Manual, report to HHSC the number of individuals admitted to nursing facilities, diverted from nursing facilities, and residing in a nursing facility for more than 90 days;
B. On a quarterly basis, as indicated in the PASRR Reporting Manual, provide HHSC with information about barriers individuals have experienced in moving from a nursing facility to the community; and
C. Perform all duties described in the IDD PASRR Handbook.
Nursing Facility Diversion. 1.2.1 LIDDA must designate a staff member as the Diversion Coordinator who: is at least credentialed as a qualified intellectual disabilities professional (“QIDP”); and has two years' experience in coordinating or providing services to individuals with IDD, including those with complex medical needs, in the community.
1.2.2 LIDDA must ensure that the Diversion Coordinator performs the following duties:
A. On a quarterly basis, as indicated in the PASRR Reporting Manual, report to HHSC the number of individuals admitted to nursing facilities, diverted from nursing facilities, and residing in a nursing facility for more than 90 days; and
B. On a quarterly basis, as indicated in the PASRR Reporting Manual, provide HHSC with information about barriers individuals have experienced in moving from a nursing facility to the community.
Nursing Facility Diversion. 2.9.6.7.1 The CONTRACTOR shall develop and implement a nursing facility diversion process that complies with the requirements in this Section 2.9.6.7 and is prior approved in writing by TENNCARE. The diversion process shall not prohibit or delay a member’s access to nursing facility services when these services are medically necessary and requested by the member.
2.9.6.7.2 At a minimum the CONTRACTOR’s diversion process shall target the following groups for diversion activities:
2.9.6.7.2.1 Members in CHOICES Group 1 who are waiting for placement in a nursing facility;
2.9.6.7.2.2 CHOICES members residing in their own homes who have a negative change in circumstances and/or deterioration in health or functional status and who request nursing facility services;
2.9.6.7.2.3 CHOICES members residing in adult care homes or other community-based residential alternative settings who have a negative change in circumstances and/or deterioration in health or functional status and who request nursing facility services;
2.9.6.7.2.4 CHOICES and non-CHOICES members admitted to an inpatient hospital or inpatient rehabilitation who are not residents of a nursing facility; and
2.9.6.7.2.5 CHOICES and non-CHOICES members who are placed short-term in a nursing facility regardless of payer source.
2.9.6.7.3 The CONTRACTOR’s nursing facility diversion process shall be tailored to meet the needs of each group identified in Section 2.9.6.7.2 above.
2.9.6.7.4 The CONTRACTOR’s nursing facility diversion process shall include a detailed description of how the CONTRACTOR will work with providers (including hospitals regarding notice of admission and discharge planning; see Sections 2.9.6.3.4 and 2.9.6.3.11) to ensure appropriate communication among providers and between providers and the CONTRACTOR, training for key CONTRACTOR and provider staff, early identification of members who may be candidates for diversion (both CHOICES and non-CHOICES members), and follow-up activities to help sustain community living.
2.9.6.7.5 The CONTRACTOR’s nursing facility diversion process shall include specific timelines for each identified activity.
Nursing Facility Diversion. 2.9.6.7.1 The CONTRACTOR shall develop and implement a nursing facility diversion process that complies with the requirements in this Section A.2.9.6.7 and is prior approved in writing by TENNCARE. The diversion process shall not prohibit or delay a member’s access to nursing facility services when these services are medically necessary and requested by the member, provided that for persons who have an intellectual or developmental disability, the CONTRACTOR shall make every effort to provide services in the community and may admit a person to a nursing facility only in accordance with federal PASRR requirements.
2.9.6.7.2 At a minimum the CONTRACTOR’s diversion process shall target the following groups for diversion activities:
2.9.6.7.2.1 Members who are waiting for placement in a nursing facility;
2.9.6.7.2.2 CHOICES or ECF CHOICES members residing in their own homes who have a negative change in circumstances and/or deterioration in health or functional status and who request nursing facility services;
2.9.6.7.2.3 CHOICES or ECF CHOICES members residing in adult care homes or other community- based residential alternative settings who have a negative change in circumstances and/or deterioration in health or functional status and who request nursing facility services;