TRANSITION AND SUPPORT SERVICES PROVIDER IN OHIO

Fatumata Kaba
Sep 17
4 min read

FACILITATING SMOOTH MOVES FROM INSTITUTIONAL TO COMMUNITY LIVING WITH PERSON-CENTERED SUPPORT

Transition and Support Services in Ohio help individuals with disabilities, chronic conditions, or age-related needs move from institutional or restrictive settings—such as nursing homes, hospitals, or intermediate care facilities—into home or community-based settings. These services are designed to ensure safe, successful transitions and reduce the risk of re-institutionalization. Transition and Support Services are authorized under Ohio Medicaid Home and Community-Based Services (HCBS) Waiver programs.

1. GOVERNING AGENCIES

Agency: Ohio Department of Medicaid (ODM)

Role: Oversees transition-related waiver services and provider enrollment under Medicaid.

Agency: Ohio Department of Developmental Disabilities (DODD)

Role: Coordinates transitions for individuals with intellectual or developmental disabilities under specific waiver programs.

Agency: Ohio Department of Aging (ODA)

Role: Oversees transition services for older adults through waivers such as PASSPORT and MyCare Ohio.

Agency: Centers for Medicare & Medicaid Services (CMS)**

Role: Provides federal oversight to ensure HCBS transition services meet standards for safety, quality, and person-centered planning.

2. TRANSITION AND SUPPORT SERVICES OVERVIEW

These services assist individuals in preparing for, executing, and sustaining a successful transition from an institutional setting to a home-based or community setting.

Approved providers may deliver:

Transition Planning: Assessment of needs, goals, and community placement options.
Housing Navigation: Assisting with locating, securing, and furnishing accessible housing.
Community Orientation: Teaching individuals to use public transportation, shops, and services.
Life Skills Development: Training in personal care, money management, meal prep, and safety.
Peer Mentoring: Connecting transitioning individuals with others who have successfully transitioned.
Health and Safety Planning: Coordinating supports to manage chronic conditions outside of institutions.
Service Coordination: Setting up HCBS services (e.g., homemaker, personal care, case management).
Household Setup: Support with purchasing furniture, basic appliances, and household supplies.
Follow-Along Support: Providing check-ins, re-assessments, and help addressing post-transition issues.
Documentation: Keeping records of all transition activities, progress notes, and stabilization plans.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register the business with the Ohio Secretary of State.
Obtain an EIN from the IRS and NPI (Type 2).
Enroll through the Ohio Medicaid Provider Network (MPN) or the DODD Provider Certification Portal.
Obtain provider certification through DODD if serving individuals with developmental disabilities.
Maintain general and professional liability insurance.
Develop detailed policies for transition planning, community integration, and safety follow-up.
Ensure staff meet training requirements, background checks, and person-centered planning competencies.

4. OHIO PROVIDER ENROLLMENT PROCESS

Initial Application:

Submit application through the Ohio MITS or DODD portal as a Transition Services Provider.

Documentation Submission:

Provide proof of registration, insurance, policies, and staff qualifications.

Readiness & Compliance Review:

ODM, DODD, or ODA review documentation, policies, and provider readiness to deliver supports.

Approval & Medicaid Billing:

Upon approval, providers receive Medicaid billing authorization and can deliver transition services under applicable waiver programs.

5. REQUIRED DOCUMENTATION

Articles of Incorporation (Ohio Secretary of State)
IRS EIN Confirmation
NPI Registration
Liability Insurance Certificates
Transition & Support Services Policy & Procedure Manual including:
- Transition planning and community reintegration process
- Risk management and follow-up safety procedures
- Person-centered planning protocols and documentation templates
- Staff credentialing and training records
- HIPAA compliance, client rights, and grievance handling
- Housing procurement, budgeting assistance, and essential setup protocols
- Quality assurance monitoring tools

6. STAFFING REQUIREMENTS

Role: Transition Services Coordinator

Requirements: Bachelor’s degree in social work, human services, or healthcare coordination; experience in discharge planning or HCBS navigation.

Role: Community Integration Specialists

Requirements: Experience supporting individuals transitioning to independent living; knowledge of local housing and support systems.

Role: Direct Support Professionals (DSPs)

Requirements: Experience with waiver participants and HCBS; training in personal care, community living, and advocacy.

All staff must complete:

DODD or ODA training (based on waiver population)
HIPAA and participant rights modules
Person-centered planning and documentation training
Emergency response and safety training
Ongoing continuing education and annual performance reviews

7. MEDICAID WAIVER PROGRAMS

Transition and Support Services are available under the following Ohio Medicaid Waivers:

Individual Options (IO) Waiver
Level One Waiver
SELF Waiver
PASSPORT Waiver
Ohio Home Care Waiver
MyCare Ohio (Managed Long-Term Services and Supports)

8. TIMELINE TO LAUNCH

Phase: Business Formation & Credentialing

Timeline: 1–2 months

Phase: Staff Hiring & Training + Policy Development

Timeline: 2–3 months

Phase: Medicaid Enrollment & Certification Approval

Timeline: 60–90 days

Phase: Service Activation & Medicaid Billing Setup

Timeline: 30–45 days

9. CONTACT INFORMATION

Ohio Department of Medicaid (ODM)

Website: https://medicaid.ohio.gov

Ohio Department of Developmental Disabilities (DODD)

Website: https://dodd.ohio.gov

Ohio Department of Aging (ODA)

Website: https://aging.ohio.gov

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — OHIO TRANSITION AND SUPPORT SERVICES PROVIDER

WCG supports agencies in launching Medicaid-compliant Transition and Support Services in Ohio, offering:

Scope of Work:

Business registration, Medicaid enrollment, and waiver credentialing
Policy and procedure manual development for person-centered transition planning
Staff training templates, competency checklists, and documentation tools
Medicaid billing setup and audit-ready documentation systems
Branding, website creation, and stakeholder engagement support
Quality assurance tracking for transition outcomes and community stability
Collaboration with case managers, housing partners, and peer support organizations