Recuperative Care Program (RCP) — Coverage Criteria
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Defines CareOregon's Recuperative Care Program for low-income and homeless adults needing post-discharge medical recuperation and transitional housing with intensive case management; affects hospitals, referring providers, and program staff coordinating referrals and placement.
No material clinical or coverage changes in this revision.
Recuperative Care — Coverage Criteria
Admission Criteria
Covered when ALL of the following are met
The policy implies that eligible patients must be willing to engage in care and able to keep and administer their own medications. These expectations function as operational capability requirements: staff should confirm and document the member’s willingness to participate in the program and their ability to self-manage medications prior to placement. Providers should treat inability or unwillingness to meet these functional requirements as a barrier to admission unless a pre-established care plan or supporting services demonstrate safe medication administration.
Admission Requirements for RCP
Residential Admission
Referral to RCP originates from a hospital or an outpatient community health setting.
Continued Stay / Ongoing Eligibility
Residential Continued Stay Criteria
Continued stay supports transition planning, follow-up monitoring, and assistance securing medically appropriate placement or treatment.
Discharge Criteria
Program discharge is oriented toward resolution of the acute medical condition and linkage to ongoing care and housing resources. Typical RCP services — transitional housing, intensive case management, primary care access, and transition planning — support follow-up monitoring and assistance securing medically appropriate placement or treatment at exit. Documented outcomes in the program include high rates of primary care engagement and transition to stable housing, which should be referenced in discharge planning and communicated to receiving providers.
Referrals, Documentation, and Notification
Referral/placement notification — call program contact
Call the program contact at 503-517-0321 to request placement at Evergreen Crossing (8225 NE Wasco, Portland, OR). Referrals are submitted by telephone to the site; no separate prior-authorization code is specified in the policy.
- Placement location: Evergreen Crossing
- Program phone: 503-517-0321
Source and content of referral must meet program requirements
Ensure the referral originates from an authorized source and include all required clinical and social information; referrals not originating from an approved source risk operational denial or non-placement.
- Referral source must be a hospital or an outpatient community health setting
- Include clinical details supporting RCP admission criteria (see documentation requirements block)
Documentation requirements for referral and placement
Document key eligibility and clinical details in the medical record and referral packet: the patient’s age (18 or older), lack of medically stable housing, willingness to engage in care, ability to keep and administer medications, and specified post-discharge medical needs.
- Patient age: single adult, 18 or older
- Housing status: lacks medically stable housing
- Engagement/function: willing to engage in care and independence in ADLs per Oregon Administrative Rules
- Medication management: must be able to keep and administer own medications
- Post-discharge needs: infusion, PT/OT, wound care, non-weight bearing status, post-surgery recovery, linkage with primary care, etc.
- Record referral date and the program contact (503-517-0321) and destination (Evergreen Crossing)
Source-of-referral requirement — hospital or outpatient community health setting
Referrals must originate from a hospital or an outpatient community health setting; failure to originate from these sources may result in denial of placement.
- Confirm and record the referring setting (hospital or outpatient community health setting) when submitting the referral
Program Definitions
Background and Program Overview
Recuperative care provides short-term medical recuperation combined with transitional housing and intensive case management for low-income or homeless adults recently discharged from hospitals. The model pairs medical recuperation services (for example, support for infusion, wound care, PT/OT, or post-surgical recovery) with secure transitional housing and a multidisciplinary team — including RN care managers, patient navigators, housing support, and limited MD oversight — to address social determinants of health and improve recovery. Since 2005 the program has reported >65% resolution of acute medical conditions, >90% linkage with primary care on exit, and >60% transition into stable housing.
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