CurrentHealth NetPolicy N/A

Short-Term Post-Hospitalization Housing Coverage Criteria

Governs authorization, eligibility, documentation, and limits for short-term housing support for members lacking a home following discharge from inpatient settings; applies to providers delivering housing transition/navigation and related supports in North Carolina.

Policy Summary

PayerHealth Net

PolicyShort-Term Post-Hospitalization Housing Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionObtain and submit clinical documentation confirming the member lacks housing and has medical/behavioral needs that put them at risk of re-hospitalization to support authorization.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

7-daypresumptive authorization period

6 monthsmaximum lifetime authorization

NCapplicable state

Coverage Criteria for Short-Term Post-Hospitalization Housing

Eligibility for Short-Term Post-Hospitalization Housing

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Eligibility precondition: Member is exiting an inpatient setting (including acute hospital, psychiatric or chemical dependency hospital, residential substance use disorder treatment or recovery facility, residential mental health treatment facility, correctional facility, nursing facility, or recuperative care facility) and does not have a home to continue recovery immediately after discharge.

supported by chunks 0 and 2

Member condition criteria: Member meets one or more of the following: meets the HUD definition of homeless and is receiving ECM services; has one or more serious chronic conditions and/or serious mental illness; is at risk of institutionalization; or requires residential services because of a substance use disorder.

supported by chunk 1

Members participating in duplicative state, local, or federally funded programs are restricted and may be excluded from Short-Term Post-Hospitalization Housing. Examples of potentially duplicative programs and services include inpatient and outpatient hospital services, emergency department services, emergency transport services, and skilled nursing facility services. Providers should verify member participation in other publicly funded housing or care programs prior to authorization to avoid overlap and potential denial.

Admission Criteria

residential — Admission criteria

Admission criteria: Member is exiting an inpatient/residential setting AND lacks housing to continue recovery AND clinical documentation shows medical or behavioral health needs that place them at risk of re-hospitalization or institutionalization.

supported by chunks 0, 1, and 2

Discharge Criteria

The policy does not define prescriptive discharge criteria for the residential Short-Term Post-Hospitalization Housing setting. Providers are expected to offer Housing Transition Navigation throughout the stay to prepare members for transition out of the setting and coordinate next-step housing supports and community resources.

Discharge decisions should be based on documented progress toward recovery goals, stabilization of the member's medical/behavioral needs, successful linkage to ongoing care and permanent or alternative housing, and completion of transition planning. Clinical reassessment and coordination with the member's care team are required to confirm readiness for discharge and to ensure safe continuity of care.

Authorization Periods and Day Limits

residential — Lifetime maximum authorization (up to 6 months)

Lifetime maximum authorizationInitial authorization and any reauthorizations combined may not exceed 6 months in an individual's lifetime.

Initial authorization typical lengthUp to six months, based on individual needs.

ScopeApplies to Short‑Term Post‑Hospitalization Housing (residential setting).

residential — Presumptive authorization period (7 days)

Presumptive authorization period7 days (seven‑day presumptive authorization).

Use during intakePresumptive authorization covers immediate short stay while clinical documentation is obtained for full authorization.

Relation to reauthorizationPresumptive period precedes initial authorization; initial authorization and reauthorization combined may not exceed 6 months lifetime.

Provider Actions, Authorization & Billing

Denial Risk

Duplicative Program Restriction

Short-Term Post-Hospitalization Housing: Lifetime maximum is six months. Participation in duplicative state, local, or federally funded programs may result in denial or non-payment.

Lifetime maximum: 6 months
Duplicative programs (state, local, federal) may lead to denial or non-payment; examples include inpatient/outpatient hospital services, ED services, emergency transport, skilled nursing facility services

Billing Rule

Billing Code Usage

When billing for Short-Term Post-Hospitalization Housing services, providers must use the service code listed in their provider contract agreement.

Use the code listed in the provider's contract agreement when submitting claims

Background

Short-Term Post-Hospitalization Housing provides temporary accommodation and supports for members who lack housing after discharge and have medical, psychiatric, or substance use needs that increase the risk of readmission. Services include assistance to regain or maintain activities of daily living, access to necessary medical/behavioral health care, case management, and connection to housing resources such as Housing Transition Navigation to prepare members for transition from the setting.

Definitions

HUD 'homeless' definition — 24 CFR §91.5 (selected criteria)

HUD citationDefinition from Section 91.5 of Title 24 CFR (HUD) — criteria describing who is considered homeless under HUD rules.

Imminent loss of housingHas been notified in writing that their right to occupy their current housing will be terminated within 21 days after the date of application for assistance (imminent loss).

Lack of resources/supportDoes not have sufficient resources or support networks; has income below 30% of area median; or is living in another's home due to economic hardship.

Unstable living conditionsLives in hotel/motel without third‑party payment; lives in overcrowded or substandard units; or otherwise lives in housing with characteristics associated with instability and increased risk of homelessness.

Exiting institutionIs exiting a publicly funded institution or system of care (e.g., health care facility, mental health facility, foster care, correctional program).