New York - Transitional Assistance Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The New York State Department of Health (DOH) funds one-time community setup expenses through Community Transitional Services (CTS) under the Nursing Home Transition and Diversion (NHTD) 1915(c) Medicaid Waiver. Providers coordinate and bill for essential furnishings, security deposits, and moving expenses to transition Medicaid beneficiaries out of nursing facilities into independent community settings.

Prospective providers cannot apply directly to the state Medicaid portal; they must first submit a Letter of Intent (LOI) to their local Regional Resource Development Center (RRDC) and pass a regional interview to secure a recommendation. Only after the RRDC approves the LOI and issues a formal recommendation letter can the agency submit a formal enrollment application to eMedNY.

1. Service Definition and Scope

New York DOH defines this service as Community Transitional Services (CTS) within the NHTD waiver. It covers non-recurring setup expenses for individuals transitioning from a nursing home to a community residence where they are directly responsible for their own living expenses.

The service is designed to remove financial barriers to independent living by funding the physical requirements of establishing a household.

• Target Population: Medicaid beneficiaries enrolled in the NHTD waiver transitioning from a nursing facility.
• Covered Expenses: Security deposits, broker's fees, moving expenses, and essential furnishings.
• Excluded Settings: Adult foster care homes or assisted living residences.
• Funding Cap: Capped at a specific lifetime or per-transition amount as defined in the approved participant Service Plan.

2. Regulatory and Oversight Agencies

The NYS DOH Office of Health Insurance Programs (OHIP) Division of Long Term Care administers the NHTD waiver. Regional oversight and provider network management are contracted to Regional Resource Development Centers (RRDCs).

Medicaid enrollment and claims processing are handled by eMedNY, while compliance is monitored by the Office of the Medicaid Inspector General (OMIG).

• NYS Department of Health (DOH): Administers the NHTD waiver (https://www.health.ny.gov/facilities/long_term_care/nhtd).
• Regional Resource Development Centers (RRDC): Manages regional provider networks and approves LOIs (https://www.health.ny.gov/facilities/long_term_care/nhtd).
• eMedNY: Processes Medicaid provider enrollment and claims (https://www.emedny.org).
• Office of the Medicaid Inspector General (OMIG): Conducts compliance audits (https://omig.ny.gov).

3. Gatekeeping Prerequisites: Who Can Even Apply

New York strictly controls NHTD provider network entry through regional gatekeepers. An applicant cannot simply enroll in eMedNY as a CTS provider without prior regional authorization.

The RRDC acts as the primary gatekeeper, assessing regional need and provider capacity before allowing an application to proceed to the state level.

• Letter of Intent (LOI): Required submission to the regional RRDC detailing the agency's capacity to provide CTS.
• RRDC Interview: Mandatory face-to-face or virtual interview with the RRDC Lead Agency.
• RRDC Recommendation: The RRDC must issue a formal recommendation letter before eMedNY will process the enrollment.
• Business Entity: Must be established and registered to do business in New York State.

4. Licensure and Certification Requirements

New York does not issue a distinct facility or agency license specifically for Community Transitional Services. Instead, providers are certified through the NHTD waiver approval process.

Because CTS does not involve direct clinical care, providers are exempt from standard medical licensure but must meet waiver-specific administrative standards.

• Licensure Exemption: No specific DOH LHCSA or OPCHSM license is required solely for CTS.
• Waiver Certification: Authorized strictly through the DOH NHTD waiver provider enrollment process.
• Agency Types: Often fulfilled by Independent Living Centers, neighborhood preservation companies, or existing certified HCBS agencies.
• Service Area: Certification is granted on a county-by-county basis as approved by the RRDC.

5. Medicaid Provider Enrollment

Once the RRDC recommendation is secured, providers apply through eMedNY. The application requires specific forms, disclosures, and an application fee.

Providers must ensure all corporate information matches exactly across the RRDC recommendation, IRS documents, and the eMedNY application.

• System: eMedNY Provider Services Portal.
• Application Fee: $750 enrollment fee required unless waived (e.g., already enrolled in Medicare or another state's Medicaid).
• Required Form: ETIN Certification Statement for new enrollments.
• Required Form: Electronic Funds Transfer (EFT) Authorization.
• Disclosure: Prior Conduct Questionnaire required if answering 'Yes' to disclosure questions.

6. Staffing, Training and Background Checks

CTS is primarily an administrative and coordination service, so clinical staffing is not required. Staff must understand local housing and community resources.

Agencies must ensure staff complete required waiver orientations and adhere to state compliance program mandates.

• Staff Qualifications: Must possess knowledge of community resources, housing, and vendor negotiation.
• Background Checks: Subject to standard NYS Medicaid exclusion checks (OMIG/OIG).
• Training: Must complete NHTD waiver basic orientation and CTS-specific training as outlined in the NHTD Program Manual.
• Compliance Program: Must adopt an effective compliance program pursuant to NYS Social Services Law section 363-d.

7. Documentation, Policies and Records

Providers must maintain strict financial records since CTS involves purchasing goods and paying deposits on behalf of the participant.

Auditors will look for a direct paper trail linking the approved Service Plan to the actual vendor receipts.

• Receipts: Original receipts for all purchased furnishings and paid deposits must be retained.
• Service Plan: Expenditures must be explicitly authorized in the participant's approved Service Plan.
• Record Retention: Records must be kept for a minimum of six years from the date of payment.
• Policy Manual: Must maintain agency policies detailing vendor selection and fraud prevention.

8. Billing, Rates and Claims

CTS is billed as a one-time or milestone-based service through eMedNY. It operates on a reimbursement model for approved expenses.

Providers cannot bill for items or amounts that exceed the authorization in the participant's Service Plan.

• Billing System: eMedNY Medicaid Management Information System (MMIS).
• Prior Authorization: All CTS expenses require prior approval from the RRDC and inclusion in the Service Plan.
• Claim Format: Billed using specific HCPCS procedure codes designated in the NHTD provider manual.
• Reimbursement: Providers are reimbursed for the actual cost of approved items/deposits up to the waiver limit.

9. Approval Sequence and Timeline

The end-to-end process requires sequential approvals from the regional entity before state processing.

Delays at the regional level will pause the entire timeline, as eMedNY cannot act without the RRDC recommendation.

• Step 1: Submit LOI to the regional RRDC (timeline varies by region).
• Step 2: Complete RRDC interview and receive recommendation (typically 30-60 days).
• Step 3: Submit eMedNY enrollment application with the $750 fee.
• Step 4: eMedNY processing and OMIG review (typically 45-90 days).

10. Common Denials and Survey Findings

Applications and claims are frequently delayed or denied due to missing documentation or bypassing the regional gatekeeper.

During audits, OMIG frequently recoups funds if the provider cannot produce original receipts for CTS purchases.

• Missing RRDC Approval: Submitting to eMedNY without the required RRDC recommendation letter results in immediate denial.
• Unapproved Expenses: Billing for items not explicitly listed in the approved Service Plan.
• Missing Receipts: Failure to produce original vendor receipts during an OMIG audit.
• Prior Conduct: Failure to complete the Prior Conduct Questionnaire if answering 'Yes' to disclosure questions on the eMedNY application.

11. Key Contacts and Resources

Primary resources for prospective CTS providers include the DOH waiver pages and the eMedNY portal.

Providers should regularly check the eMedNY provider manuals for updates to billing codes and enrollment forms.

• NHTD Waiver Information: https://www.health.ny.gov/facilities/long_term_care/nhtd
• eMedNY Provider Enrollment: https://www.emedny.org/info/providerenrollment/nursing_home_transition/
• NYS OMIG Compliance: https://omig.ny.gov/compliance/compliance
• NHTD Program Manual: https://www.health.ny.gov/health_care/medicaid/redesign/mrt90/mltc_policy/docs/draft_nhtd_waiver_manual.pdf

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