CurrentHealth NetPolicy N/A

Authorization Guide for Housing Transition Navigation Services

Defines eligibility, covered activities, authorization lengths, documentation, restrictions, and provider requirements for Housing Transition Navigation Services for eligible members in California (CalViva Health/Health Net network). Affects Community Supports providers and care managers who authorize or deliver these services.

Policy Summary

PayerHealth Net

PolicyAuthorization Guide for Housing Transition Navigation Services

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionSubmit Community Supports Housing Navigation and Tenancy Authorization Form for initial authorization and include the member's individualized housing support plan for extensions.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

12 monthsinitial authorization period

up to 6 monthsauthorization extension increments

no time limittotal lifetime maximum

H0043 U6billing code

Room & Boardservice exclusions

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coverage criteria for Housing Transition Navigation Services

Coverage criteria for authorization and delivery

Covered when ALL required eligibility and documentation conditions are met; services must be listed in the member's individualized housing support plan and do not cover room and board or rental assistance.

ALL of the following

Member meets at least ONE of the following eligibility pathways:
- (1) Social + Clinical risk
  - Social Risk Factor Requirement: Experiencing or at risk of homelessness.
  - Qualifying clinical risk factors (one or more):
    Meets the access criteria for Specialty Mental Health Services (SMHS).
    Meets the access criteria for Drug Med-Cal (DMC) or Drug Medical Organized Delivery System (DMC-ODS).
    One or more serious chronic physical health conditions.
    One or more physical, intellectual, or developmental disabilities.
    Individuals who are pregnant up through 12 months postpartum.
- (2) Transitional Rent eligibility: Member is determined eligible for Transitional Rent (these individuals are automatically eligible for Housing Tenancy and Sustaining Services).
- (3) Coordinated Entry prioritization: Member is given priority for permanent supportive housing or a rental subsidy through the local homeless Coordinated Entry System or a similar system (prioritized as highly vulnerable).
ALL of the following
- Initial authorization requires submission of the Community Supports Housing Navigation and Tenancy Authorization Form.
- Authorization extensions require the same authorization form plus the member's updated individualized housing support plan to demonstrate ongoing need and what services will be provided.
ALL of the following
- All services provided through Housing Transition Navigation Services must be listed in the member's housing support plan as reasonable and necessary.
- Housing Transition Navigation Services do not cover the cost of room and board or pay for rental assistance.

Authorization period and concurrency restrictions are addressed in provider guidance (see authorization section).

Eligibility — member must meet at least one criterion

Eligibility pathwaysMember must meet at least ONE of the following: (A) social risk (experiencing or at risk of homelessness) plus one or more qualifying clinical risk factors (SMHS access, DMC/DMC-ODS access, serious chronic physical health condition, physical/intellectual/developmental disability, or pregnant up through 12 months postpartum); (B) determined eligible for Transitional Rent (automatic eligibility for Housing Tenancy and Sustaining Services); (C) prioritized for permanent supportive housing via Coordinated Entry or similar system.

Social risk requirementExperiencing or at risk of homelessness (per HUD-based definition with CalAIM modifications).

Clinical risk requirementMust have one or more qualifying clinical risk factors: SMHS access criteria, DMC/DMC-ODS access, serious chronic physical health condition, physical/intellectual/developmental disability, or pregnancy up to 12 months postpartum.

Applicable billing and code guidance

Applicable service codesmixedCovered

H0043 U6

Supported housing

Do not usemixedNot Covered

H2016

Do not use - Comprehensive Community Support services

Coding restrictions

Do not use codeH2016 - Comprehensive Community Support services should not be used for these services.

Covered supported housing codeH0043 U6 - Supported housing (use for covered supported housing activities).

ReferenceSee Codes section in authorization guide for coding guidance and related appendices.

Authorization, documentation, and provider requirements

Prior Authorization

Authorization period

Initial authorization: Authorizations are granted for an initial period of 12 months.

Initial authorization period: 12 months.

Prior Authorization

Authorization extensions and concurrency restriction

Extensions are allowed in increments of up to six months based on need. Concurrency restriction: Except for the first month after the member moves into housing, members should not receive both Housing Tenancy and Sustaining Services and Housing Transition Navigation Services during the same month.

Extension increments: up to 6 months.
Concurrency restriction: Members should not receive both Housing Tenancy and Sustaining Services and Housing Transition Navigation Services during the same month, except the first month after move-in.

Service definition and eligibility details

Services included in Housing Transition Navigation

Assessment and planAssess the member's housing needs, preferences, and barriers; create an individualized housing support plan documenting needed services and supports.

Search and applicationsAssist with housing searches, review options, complete applications, and gather required documentation (e.g., Social Security card, birth certificate).

Advocacy and linkageProvide advocacy (e.g., with landlords, identification, SSI applications) and link to resources such as Transitional Rent, vouchers, and other assistance programs.

Move planning and one-time fundsSupport move planning, arrange/fund non-emergency transportation, and provide limited one-time move-related funds (deposits, moving costs, accessibility modifications) as needed.

Tenancy sustainment and crisis planningProvide tenancy sustainment supports including landlord engagement, crisis planning for when housing is at risk, and procedures to help the member keep housing.