CurrentHealth NetPolicy N/A

Authorization Guide for Housing Transition Navigation Services

Defines eligibility, required documentation, authorization periods, provider qualifications, covered activities, and billing codes for Housing Transition Navigation Services for Health Net members in North Carolina.

Policy Summary

PayerHealth Net

PolicyAuthorization Guide for Housing Transition Navigation Services

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionSubmit the Community Supports (CS) Housing Navigation and Tenancy Referral 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 18 monthsmax authorization

H0043 U6covered billing code

Per diemunit of service

Coverage and Eligibility

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.

Eligibility and Coverage Criteria

Covered when ANY of the following eligibility groups are met and services are documented as reasonable and necessary in the individualized housing support plan:

Prioritization by Coordinated Entry or similar system: Individuals prioritized for a permanent supportive housing unit or rental subsidy resource through the local homeless Coordinated Entry System or similar system designed to identify highly vulnerable individuals with disabilities and/or one or more serious chronic conditions and/or serious mental illness, institutionalization or requiring residential services because of a substance use disorder, and/or those exiting incarceration.

HUD homeless definition with additional risk: Individuals who meet the U.S. Department of Housing and Urban Development (HUD) definition of homeless per 24 CFR 91.5 (including those exiting institutions) AND who are receiving Enhanced Care Management, or who have one or more serious chronic conditions and/or serious mental illness or are at risk of institutionalization or requiring residential services due to a substance use disorder.

HUD at-risk of homelessness: Individuals who meet the HUD definition of at risk of homelessness per 24 CFR 91.5 (examples include: annual income below 30% of area median as determined by HUD; imminent loss of housing within 21 days; moved for economic reasons two or more times in prior 60 days; living doubled-up; staying in hotels/motels not paid by charities or government; exiting publicly funded institutions; overcrowded or otherwise unstable housing as defined by HUD).income < 30% of area median (where specified)

Children, youth, and special populations: Children or youth who do not qualify as homeless under HUD definitions but qualify under alternate federal homelessness statutes (e.g., Runaway and Homeless Youth Act, Head Start Act, Violence Against Women Act, Child Nutrition Act, McKinney-Vento) and transition-age youth with significant barriers to housing stability (examples: conviction history, foster care history, juvenile or criminal justice involvement, serious mental illness, victims of trafficking or domestic violence).

Authorization, Documentation, and Billing Rules

Prior Authorization

Authorization period and required form

Initial authorizations are approved for 12 months. Extensions may be granted to allow coverage up to 18 months (the initial 12‑month authorization plus a single 6‑month extension), with review and extension processed in 6‑month increments as needed. For initial requests the provider must submit the Community Supports (CS) Housing Navigation and Tenancy Referral Form.

Initial authorization period: 12 months.
Maximum authorization with extension: up to 18 months (12 months + 6‑month extension).
Extensions reviewed/processed in 6‑month increments.
Initial authorization requires the CS Housing Navigation and Tenancy Referral Form.

Step Therapy

Mutual exclusivity with other housing services

Except for the first month when the member is housed, a member must not receive both Housing Tenancy and Sustaining Services and Housing Transition Navigation Services in the same month.

First-month exception applies only when the member is housed.

Documentation Required

Required authorization documentation

Initial authorization must include the Community Supports (CS) Housing Navigation and Tenancy Referral Form. Authorization extension requests must include the CS Housing Navigation and Tenancy Referral Form plus the member's updated individualized housing support plan.

Initial authorization: Community Supports (CS) Housing Navigation and Tenancy Referral Form.
Authorization extension: CS Housing Navigation and Tenancy Referral Form and the member's updated individualized housing support plan.

Denial Risk

Reasonable and necessary requirement

Services must be documented as reasonable and necessary in the individual's individualized housing support plan; failure to demonstrate this may result in denial of Housing Transition/Navigation services.

Include clear identification in the individualized housing support plan that the Housing Transition/Navigation service is reasonable and necessary.

Service Background

Housing Transition Navigation Services help members obtain and retain housing by assessing tenancy barriers, developing individualized housing support plans with measurable goals, assisting with applications and documentation, searching for housing, coordinating resources and transportation, engaging landlords, and providing move-in supports and reasonable accommodations.

Services must be documented as reasonable and necessary in the individual's individualized housing support plan and are delivered to address identified barriers to successful tenancy and stabilize housing.

Eligibility and Homelessness Definitions

Eligibility/Homeless or At‑Risk Definitions

Prioritized via Coordinated EntryIndividuals prioritized for permanent supportive housing or rental subsidy through local Coordinated Entry or similar systems that identify highly vulnerable people with disabilities, serious chronic conditions, serious mental illness, institutionalization or need for residential services due to substance use disorder, or those exiting incarceration.

HUD homeless definition (24 CFR 91.5)Individuals who meet HUD's definition of homeless per 24 CFR 91.5 (including those exiting institutions) — especially those receiving Enhanced Care Management or who have one or more serious chronic conditions or serious mental illness or are at risk of institutionalization due to substance use disorder).

HUD at‑risk of homelessness (24 CFR 91.5)Individuals or families with annual income below 30% of area median and one or more qualifying conditions (e.g., insufficient resources/support networks, multiple recent moves for economic reasons, written notice to vacate within 21 days, living doubled‑up, staying in hotels/motels not paid by charities/government, exiting publicly funded institutions, overcrowded or otherwise unstable housing).

Children/youth special definitionsChildren or youth who do not meet this section's homeless definition but qualify under other federal definitions (Runaway & Homeless Youth Act, Head Start Act, Violence Against Women Act, Child Nutrition Act, McKinney‑Vento) and their parents/guardians as applicable.

Transition‑age youth and other high‑barrier groupsTransition‑age youth with significant barriers (e.g., convictions, foster care history, justice involvement, serious mental illness, victims of trafficking/domestic violence) and individuals with serious emotional disturbance, substance use disorder requiring residential services, or those receiving Enhanced Care Management are eligible when these barriers threaten housing stability.