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CCT Transition Coordination

This page has useful information for Transition Coordinators and Transitions Options Teams to access while coordinating the transition of a CCT client from a nursing facility into the community. 


Training Process for Transition Coordinators and Intensive Case Managers PowerPoint presentation - April 5, 2013.


Department staff have the ability to verify the social security number of client's who are submitting a HUD application, but do not have a social security card.  You can learn about this process in  DAL SSN verfication form and  SSN verification form.



Transition Coordination Agencies March 11, 2014 



In order to enroll a client in to Colorado Choice Transitions the forms in this section must be completed.


Transition Referral Information Form

Community Transition Participant Risk Agreement

Informed Consent Form

Emergency Planning Guide
Authorization for Release of Information Community Transition Plan
Community Transition Assessment Authorization Request Cost Report
Risk Mitigation Plan Community Transition Report






These tools and guides have been created for transition coordinators and clients to use while planning the transition from a nursing facility to the community.  It is highly suggested that clients and transition coordinators refrence these during the transition planning phase of the process.


     Refrences & Tools                                                        Guides

Community Living Options Process Check List Self-Reflection Guide
Community Living Options Process Diagram Plan for Community Living Guide
Service Referral Tool Planning a Successful Move Guide




Community Transition Services Documents CTS Monthly Referral Log Transition Coordinator Job Description
Third Party User Access Form Third Party Modification/Revocation Form  



Regional Transition Committees


Regional Transition Committees (RTC) are forming across the state.  These groups develop a strategic plan that integrates the regions resources and expertise to promote transitions and community-based living through a collaborative effort.  Members of RTCs may include, for example, transition coordinators, case managers, service providers, advocates, local housing authorities, consumers and family members.  If you are interested in participating in the RTC in your region contact the CCT Community Liaison, Kathy Cebuhar 303-866-2649.

Map of Regional Transition Committees


Minimum Data Set 


The Minimum Data Set (MDS), is a mandatory comprehensive clinical assessment given to all residents in all nursing facilities regardless of payer source. As of 2010, nursing facilities are required to ask the Section Q return to community question “Do you want to talk to someone about the possibility of leaving this facility and returning to live and receive services in the community”. The purpose of this question is to support the residents’ right to making an informed choice for their health care; when a “Yes” response is given a referral is placed to a local contact agency and an options counselor, who will then provide them information on community living supports and programs to transition back into the community. The CCT program uses the response from the MDS Section Q as a tool to provide referrals for nursing facility residents who might be interested in the Colorado Choice Transitions program.   Contact the CCT Section Q Analyst, Rene Hickman 303-866-4065 for more information. 



More information from the Centers of Medicare and Medicaid Services on MDS Section Q is available here