The bill establishes new provisions for the Medicaid home and community-based services elderly waiver program, focusing on transition planning and assisted living services. It mandates the Department of Health and Human Services (HHS) to adopt rules that enable case managers and care coordination teams to collaborate with skilled nursing facility residents, their families, and staff to initiate transition planning before discharge. This planning is aimed at facilitating a smooth transition to the elderly waiver program for eligible residents, including those determined capable of moving to a lower level of care. Additionally, the bill expands the definition of the targeted population for case management services to include adults aged 65 or older residing in nursing facilities.

Furthermore, the bill requires HHS to define assisted living services as personal care and supportive services provided to elderly waiver participants in a non-institutional setting, ensuring 24-hour on-site response capability for member safety. It specifies that assisted living services cannot be reimbursed if they coincide with any services under a consumer-directed attendant care agreement. The rules will also outline billing requirements, including documentation of service encounters and the necessity for the member's presence in the facility for billing purposes.