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Revision 25-1; Effective Nov. 12, 2025
A complete transition packet for a person has:
- Form 1063, Individual Profile – Nursing Facility, refer to 5460.1, Individual Profile;
- Form 1053, Transition Plan; and
- Form 1042, Pre-Move Site Review, when completed, as described in 6530, Enrollment in HCS as an NF Transition, or 6700, Transitioning to a Community Medicaid Program other than the HCS Program.
Note: The habilitation coordinator develops and revises Form 1063, Individual Profile – Nursing Facility. If revisions to the person’s Form 1063 are necessary based on discussions during an SPT meeting, the habilitation coordinator must make the needed revisions. The habilitation coordinator shares the revised Form 1063 with the ECC coordinator and the other SPT members within 10 business days after the SPT meeting where it was revised.
The ECC coordinator must provide a copy of the person’s Form 1053, Transition Plan, to all SPT members within 10 business days after the SPT meeting where it was developed or revised, and upon request.
If an SPT member believes Form 1053, Transition Plan, does not accurately reflect SPT decisions, then:
- if the ECC coordinator agrees with the SPT member, the ECC coordinator corrects Form 1053 to accurately reflect the SPT decision; or
- if the ECC coordinator does not agree with the SPT member, the ECC coordinator presents the issue to the SPT to resolve the discrepancy.