TRANSITION COORDINATION SERVICES PROVIDER IN MINNESOTA

SUPPORTING INDIVIDUALS WITH DISABILITIES IN TRANSITIONING FROM INSTITUTIONAL CARE TO COMMUNITY LIVING

Transition Coordination Services in Minnesota assist individuals with disabilities in moving from institutional settings, such as nursing homes or long-term care facilities, to community-based living arrangements. These services help ensure a smooth and successful transition, promoting independence and community integration. Transition Coordination Services are available under Minnesota’s Home and Community-Based Services (HCBS) Waivers.

1. GOVERNING AGENCIES

• Agency: Minnesota Department of Human Services (DHS)

  • Role: Administers Medicaid programs, including transition coordination services under HCBS Waivers

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

  • Role: Provides federal oversight and ensures waiver compliance

2. TRANSITION COORDINATION SERVICE OVERVIEW

Transition Coordination Services support individuals in planning and preparing for a successful move from institutional to community living. Services are personalized according to the Individual Transition Plan (ITP) or Person-Centered Plan (PCP) and may include:

• Assessment of individual needs and preferences

• Identification of community-based housing options

• Assistance with setting up housing and basic utilities

• Coordination of healthcare, social, and support services

• Training in daily living skills and community navigation

• Follow-up and ongoing support after transition

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business with the Minnesota Secretary of State

• Obtain EIN from the IRS and NPI (Type 2)

• Enroll as a Medicaid provider with the Minnesota Department of Human Services

• Maintain liability insurance and staff qualification records

• Obtain certification as a Transition Coordinator if required

4. MEDICAID PROVIDER ENROLLMENT PROCESS

Step 1: Pre-Application Contact

• Contact the Minnesota Department of Human Services for provider requirements related to transition coordination

Step 2: Application Submission

• Submit business registration, certification, liability insurance, and service descriptions

Step 3: License Verification

• Verify compliance with state regulations regarding transition coordination

Step 4: Approval and Medicaid Number Assignment

• Once approved, receive a Medicaid provider number and authorization to deliver services

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business Name Registration

• IRS EIN Letter

• NPI confirmation

• Transition Coordinator Certification (if applicable)

• Liability insurance certificate

• Policy & procedure manual including:

  • Client intake and assessment protocols

  • Service planning and coordination guidelines

  • Housing and utility setup procedures

  • Safety planning and risk management documentation

  • Staff training logs and follow-up support records

6. STAFFING REQUIREMENTS

Role: Transition Coordinator / Program Manager

• Requirements: Experience in social work, case management, or community integration

Role: Support Specialist / Housing Navigator

• Requirements:

  • Background in human services or rehabilitation

  • CPR/First Aid certification

  • Background check and TB clearance

Training Requirements:

• Person-centered planning and transition coordination

• Housing access and community resource navigation

• Client safety and risk management

• Documentation and follow-up care coordination

7. MEDICAID WAIVER SERVICES

Transition Coordination Services in Minnesota are available through:

• 1915(c) HCBS Waiver for the Elderly and Disabled

• Community Access for Disability Inclusion (CADI) Waiver

• Brain Injury (BI) Waiver

Approved providers may deliver:

• Pre-transition planning and skills training

• Housing identification and coordination

• Post-transition support and follow-up care

8. TIMELINE TO LAUNCH

Phase: Business Formation

• Timeline: 1–2 weeks

Phase: Medicaid Provider Enrollment

• Timeline: 60–90 days

Phase: Staff Hiring and Training

• Timeline: 30–45 days

Phase: Community Partnership Development

• Timeline: 2–4 weeks

9. CONTACT INFORMATION

Minnesota Department of Human Services (DHS)

• Website: https://mn.gov/dhs

WAIVER CONSULTING GROUP'S START-UP ASSISTANCE SERVICE — MINNESOTA TRANSITION COORDINATION SERVICES PROVIDER

We support agencies and entrepreneurs in launching compliant Transition Coordination Services across Minnesota under the HCBS Waiver models.

Scope of Work:

• Business registration and licensing assistance

• Medicaid provider enrollment

• Policy & procedure manual for transition coordination operations

• Templates for transition plans, client intake, and housing setup

• Website, domain, and email setup

• Staff credentialing and training documentation

• Client intake packet and transition assessment forms

• Risk management and community integration planning

• Referral networking with housing agencies and social support organizations

Continue To Our Client Portal To Get Started

Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements.