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NHTD/TBI Waiver
Service Coordination Services

Service coordinator working with an elderly women

The Abba Human Services Foundation offers Service coordination through the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) Medicaid waiver programs. We provide comprehensive Service Coordination to help individuals receive the necessary supports and resources to remain integrated in their home and community.

Our experienced Service Coordinators work in partnership with each individual to ensure they receive the most appropriate services based on their unique needs.

 

Our Service Coordination includes the following:

  • Focuses on keeping you in your home and community
  • Assists in obtaining and maintaining benefits and entitlements (Medicaid, Medicare, Food Stamps)
  • Coordinates services with provides such as doctors, day services, transportation, etc.

We are committed to helping individuals achieve their goals and maintain their independence in a way that best suits their needs.

Introduction

Woman smiling and drinking tea with a nurse
The NHTD/TBI Waiver Services are designed to address you or your loved one’s unique needs. All other services including informal supports, non-Medicaid services, federally funded services and Medicaid State Plan services are explored before utilizing waiver services. Waiver services must be cost effective and necessary to avoid institutionalization.

So What Is Service Coordination?

Service Coordination is an individually designed intervention which provides assistance to you or your loved one whom is a waiver applicant/participant in gaining access to needed waiver and Medicaid State Plan services, as well as may other services. local, state and federally funded educational, vocational, social, medical and any other services. These interventions are 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.

Service coordinator working with an elderly women

How Do We Operate?

We work with you to establish a service plan. Changes can be made whenever you need to assure safety and dignity living in a community setting. We review the service plan at monthly service coordination visits and bi-annual team meetings.



Doctor going over a plan with a patient

 

 

Abba Human Services Foundation is approved by the New York State Department of Health to provide Service Coordination to participants of two unique programs in the State – Traumatic Brain Injury (TBI) Waiver Services & Nursing Home Transition & Diversion (NHTD) Waiver Services in the Lower Hudson Valley Region of New York State.   Abba’s expert and experienced team of Service Coordinators presently handle the case management needs of a number of individuals in this region.

 

Abba’s case management services is expanding geographically to the NYC region and functionally to the field of Mental Health services.

Access To Services

If you or someone whom you are representing is interested in becoming a waiver participant, please contact the Regional Resource Development Center (RRDC). The contact information is listed below.

 

Lower Hudson Valley Region includes counties of Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster & Westchester

New York City Region includes the five boroughs of New York City

 

For support in either Region, contact:

Westchester Independent Living Center (WILC)

10 County Center Rd. White Plains, NY 10607

 

Phone: (914) 682-3926 / Fax: (914) 682-8518

 

Click below for websites of both Waiver programs:

Traumatic Brain Injury Regional Resource Development Center

Nursing Home Transition and Diversion Regional Resource Development Center

Nursing Home Transition and Diversion (NHTD) Waiver Eligibility Criteria

To participate in the NHTD waiver you must meet al of the following criteria:

  1. Be a recipient of Medicaid coverage that supports community-based long-term care services.
  2. Be between the ages of 18 and 64 with a physical disability, or age 65 and older upon application to the waiver.
  3. Be assessed to need a nursing home level of care. Nursing home eligibility is determined by the Hospital and Community Patient Review Instrument and SCREEN (PRI/SCREEN).
  4. Sign the Freedom of Choice form indicating whether you choose to participate in the NHTD waiver.
  5. Be able to identify the actual location and living arrangements in which the waiver participant will be living when participating in the waiver;
  6. Complete and submit an Application Packet which includes the Initial Service Plan in cooperation with the Service Coordinator.
  7. Have a completed Plan for Protective Oversight (PPO).
  8. Be able to live in the community where health and welfare can be maintained as determined by the Regional Resource Development Specialist (RRDS).

Traumatic Brain Injury (TBI) Waiver Eligibility Criteria

To participate in the TBI waiver you must meet all of the following criteria:

  1. Be a recipient of Medicaid coverage that supports community-based long-term care services;
  2. Have a diagnosis of traumatic brain injury (TBI);
  3. Be between the ages of 18 and 64 upon application to the waiver;
  4. Be assessed to need a nursing home level of care as a direct result of the traumatic brain injury. Nursing home eligibilty is determined by the Hospital and Community Patient Review Instrument and SCREEN (PRI/SCREEN).
  5. Choose to participate in the waiver rather than reside in a nursing facility by signing the Freedoe of Choice form, Application for Participation form, and Service Coordination Selection form.
  6. Identify the residence in which the waiver participant will be living when receiving waiver services;
  7. Complete an Initial Service Plan and Application Packet in cooperation with a Service Coordinator and be approved by the Regional Resource Development Specialist (RRDS).
  8. Have a completed Plan for Protective Oversight (PPO).

Contact

The Abba Human Services Foundation is dedicated to assisting you or someone close to you in obtaining the essential support and services required to foster continued living within the community. To learn more please get in touch:

Service Coordinator Supervisor Mercedes Rios

Abba Human Services Foundation

2622 South Avenue, Suite B

Wappingers Falls, NY 12590

Cell: 845-502-3701

[email protected]

References

https://www.health.ny.gov/facilities/long_term_care/waiver/nhtd_manual/section_06/index.htm

https://www.health.ny.gov/health_care/medicaid/program/longterm/tbi.htm

https://www.health.ny.gov/health_care/medicaid/redesign/nhtd_overview.htm

https://www.health.ny.gov/health_care/medicaid/redesign/tbi_overview.htm

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