CurrentHealth NetPolicy N/A

Housing deposit and household items for members

This document lists example eligible household and adaptive items that may be covered as part of a member's housing support plan when the items are reasonable, necessary, and the member cannot otherwise meet the expense. It affects providers and care planners arranging housing support for Health Net members in North Carolina.

Policy Summary

PayerHealth Net

PolicyHousing deposit and household items for members

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionObtain any payer-required authorization and document that the item is included in the member's individualized housing support plan and that the member is unable to meet the expense.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

5top-level item categories

~40example line-items

1payers named

Coverage Criteria for Housing and Household Items

Eligibility criteria for housing items

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In housing support plan: Item is identified as reasonable and necessary in the member's individualized housing support plan

Directly supported by policy statement

Financial need: Member is unable to meet such expenses

Coverage limited to members unable to afford the items

Item relevance: Item is an example eligible item listed (adaptive aids, kitchen, bedroom, bathroom, livingroom) or otherwise determined reasonable and necessary

List is not all-inclusive; other items may be covered if justified

Provider Actions and Prior Authorization

Prior Authorization

Prior Authorization Required

Coverage is contingent on the item being documented as reasonable and necessary in the member's individualized housing support plan. Items are only available when the member is unable to meet the expense through other resources or supports (evidence of financial need required).

Item must be specified in the member's individualized housing support plan as reasonable and necessary
Available only when member cannot otherwise pay for the item (documented inability to pay)

Documentation Required

Required Documentation

Providers must supply documentation that demonstrates both medical/social necessity and the member's financial need for the item. Acceptable documentation includes the individualized housing support plan showing the item and justification, and supporting financial records or attestations that the member cannot meet the expense.

Include plan excerpt identifying the item and rationale
Include evidence of financial need (e.g., income documentation, benefits status, attestation)

Denial Risk

Reasonable/Necessary and Inability-to-Pay Requirement

Items must be identified as reasonable and necessary in the member's plan and are only covered when the member is unable to otherwise meet the expense. Failure to document reasonable/necessary status and inability to pay may result in claim denial.

Coverage limited to items explicitly listed and justified in the individualized housing support plan
Lack of evidence of inability to pay or plan justification = denial risk

Note

Inventory Alert

(Provider-facing alert) Confirm the housing support plan includes the item, the justification for its necessity, and evidence of financial need before submitting prior authorization or claims to avoid processing delays.

Background and Scope

This grouping organizes household and adaptive items that may be provided to support a member's ability to live safely in housing. Medically necessary adaptive aids (for example, bedside commode, Hoyer lift, hospital bed, shower chair) directly support activities of daily living and mobility; other household items address basic furnishing and functioning of living spaces when the member cannot otherwise afford them.

Definitions

inv-08: Medically Necessary Adaptive Aids — definition / examples

DefinitionMedically necessary adaptive aids: items that directly support activities of daily living and mobility and are provided when identified as reasonable and necessary in the member's individualized housing support plan.

Examples - Toileting/MobilityBedside commode and Hoyer lift (supports safe toileting and transfers).

Examples - Sleep/PositioningHospital bed (supports medical needs for positioning, pressure relief, or complex care).

Examples - BathingShower chair (supports safe bathing and personal hygiene).

Coverage conditionAvailable only when the item is identified as reasonable and necessary in the member's individualized housing support plan and the member is unable to meet the expense.