CurrentHealth NetPolicy N/A

Short-Term Post-Hospitalization Housing (STPHH) — Coverage Criteria

Defines eligibility, authorization, documentation, limits, billing codes, and provider requirements for Short-Term Post-Hospitalization Housing for members discharged from inpatient or residential facilities in North Carolina.

Policy Summary

PayerHealth Net

PolicyShort-Term Post-Hospitalization Housing (STPHH) — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionObtain required authorization and submit the Short-Term Post-Hospitalization Housing Referral Form with supporting clinical documentation.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

7-daypresumptive authorization period

Up to 90 daysinitial authorization duration

6 monthsmaximum Room & Board per 12 mo

H0043 U3billing code + modifier

Coverage Criteria

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General Eligibility Criteria

Covered when ALL of the following are met

Eligibility - institutional exit and homelessness: Member is exiting an institution (recuperative care facility, inpatient hospital (acute or psychiatric or Chemical Dependency and Recovery hospital), residential substance use disorder or mental health treatment facility, correctional facility, or nursing facility) AND is experiencing or at risk of homelessness per modified HUD definition

HUD definition modifications included in policy

Priority clinical conditions: Member meets one or more of the following: receiving Enhanced Care Management; has one or more serious chronic conditions; has serious mental illness; is at risk of institutionalization or requiring residential services due to a substance use disorder

Ongoing needs: Member has ongoing physical or behavioral health needs as determined by a qualified health professional that would otherwise require continued institutional care if not for receipt of STPHH

Qualified health professional determination required

Authorization Criteria

Authorization rules

Authorization periods: STPHH has a 7-day presumptive authorization pending Plan approval and required documentation; initial authorization may be approved for up to 90 days; reauthorization requires submission of a reassessment by a licensed professional and may be approved up to the remaining days within the service limit

Presumptive authorization period is not reimbursable if final authorization is denied; member does not assume financial responsibility

Providers must demonstrate appropriate experience and expertise in delivering housing-related services and supports in a culturally and linguistically appropriate manner. Providers who do not meet these provider qualifications or who accept members who have already exhausted the global service maximum will not be eligible for reimbursement. Providers must confirm prior authorizations and days remaining in the provider portal before submitting authorization requests.

Services provided beyond the six-month global cap — 182 calendar days (6 months) per rolling 12-month period — are ineligible for reimbursement. In addition, services provided to members who do not meet the STPHH eligibility criteria (including HUD-based homelessness or at-risk modifications and clinical admission requirements) are not eligible for reimbursement.

Admission Criteria for STPHH

interim housing / STPHH

Admission: Exiting an institution AND experiencing or at risk of homelessness AND meeting one of the priority clinical conditions AND having ongoing physical or behavioral health needs that would otherwise require continued institutional care

Required documentation: Short-Term Post-Hospitalization Housing Referral Form and supporting documents (history and physical and discharge summary for physical recovery; history and physical with specified details and discharge summary for behavioral health recovery)

Continued Stay Criteria

STPHH continued stay

Continued stay: Reassessment by a licensed professional supports continued need for STPHH AND member has not exceeded the 182-calendar-day (six-month) rolling 12-month service limit182 calendar days per rolling 12 months

Reauthorization requires submission of reassessment documentation with authorization request; extensions may be approved up to remaining days in service limit

Discharge Criteria

Discharge should occur when the member no longer requires ongoing supports for recuperation and recovery or has transitioned to permanent housing or another appropriate placement. Continued stay beyond what is clinically necessary should be avoided; reauthorization requires a licensed professional reassessment and must align with the remaining days in the 182-day service limit. Providers must document transition plans and confirm that the member’s needs no longer require STPHH supports before discharge.

Day Limits and Service Maximums

STPHH / Room & Board services — Service maximum

Service maximum (days)182 calendar days (6 months) per rolling 12-month period

ScopeGlobal cap across Short-Term Post-Hospitalization Housing, Recuperative Care, and Transitional Rent

Provider actionConfirm prior authorizations and days remaining in provider portal before submitting authorization

Service maximum limit

Maximum duration182 calendar days (6 months) per rolling 12 months

NotesMay be authorized for a shorter period based on individual needs; subject to the six-month global cap on Room & Board services

ConsequenceProviders will not be reimbursed for members who have already exhausted the 182-day service maximum

Coding and Billing

Covered HCPCS/ModifierHCPCS | ModifierCovered

H0043	Behavioral health services, short-term post-hospitalization housing (as listed)
U3	Modifier indicated for STPHH billing

Service maximum limit (coding/key info)

Service maximum (duplicate)182 calendar days (6 months) per rolling 12 months

Global cap descriptionCombined limit across STPHH, Recuperative Care, and Transitional Rent within any rolling 12-month period

Provider verificationConfirm member's previous authorizations and number of days remaining in provider portal prior to authorization submission

Provider Actions and Requirements

Prior Authorization

Presumptive Authorization and Denial Consequence

STPHH has a seven-day presumptive authorization period. Presumptive authorization is contingent on Plan approval of eligibility, submission of required documentation, and confirmation the member has not exceeded the six-month (182-day) global cap. If the presumptive authorization is later denied, the presumptive period is not eligible for reimbursement; the member is not financially responsible.

Presumptive authorization period: 7 days
If denied: presumptive period ineligible for reimbursement; member not financially responsible

Prior Authorization

Authorization Timing, Initial and Reauthorization Rules

Initial authorization may be requested for up to 90 days based on individual needs. Reauthorization requires submission of a reassessment by a licensed professional and confirmation of prior authorizations/days remaining in the provider portal. Providers must confirm remaining days before submitting an extension; extensions may be approved up to the remaining days in the 182‑day service limit.

Initial authorization: up to 90 days
Reauthorization: licensed professional reassessment required
Providers must confirm prior authorizations and days remaining in the provider portal before requesting extensions
Maximum service limit: 182 days (6 months) per rolling 12 months

Documentation Required

Required Documentation

Required documentation for initial authorization and reauthorization must include the Short-Term Post-Hospitalization Housing Referral Form plus supporting clinical documentation as applicable.

Short-Term Post-Hospitalization Housing Referral Form (required)
For recovery from physical illness/injury: history and physical; discharge summary from recovery program
For recovery from behavioral health condition: history and physical (including diagnoses, high-risk diagnoses, medications, comorbidities, psychosocial risk factors); discharge summary from recovery program

Denial Risk

Denial Risk When Service Maximum Is Exhausted

If a member does not meet eligibility criteria or has already exhausted the 182-day maximum, providers who accept such members will not be reimbursed. Confirm eligibility and remaining service days prior to admission and billing.

Providers must verify member eligibility and remaining days before admission and authorization submission
No reimbursement if member has exhausted 182 calendar days/6 months per rolling 12 months

Note

Immediate Provider Actions

Provider action — immediate: confirm member eligibility, submit the Short-Term Post-Hospitalization Housing Referral Form with required supporting clinical documentation, and verify prior authorizations/days remaining in the provider portal before requesting authorization or admitting the member.

Immediately confirm HUD-based homelessness/at-risk criteria modifications where applicable
Submit referral form + supporting documentation at time of authorization request
Check provider portal for prior authorizations and remaining days

Definitions

STPHH definition

DefinitionShort-Term Post-Hospitalization Housing (STPHH): interim private or shared housing with supports for recuperation and recovery following discharge from an inpatient or residential facility.

PurposeProvides a safe, supportive environment to continue recovery from medical, psychiatric, or substance use treatment immediately after discharge.

Supports providedAssistance with activities of daily living, medical/behavioral care, case management, and linkage to housing supports.

Eligibility contextIntended for members exiting institutions who have ongoing physical or behavioral health needs that would otherwise require continued institutional care.

Background

Short-Term Post-Hospitalization Housing (STPHH) provides a safe, supportive interim environment for members to continue recovery immediately after discharge from inpatient or residential treatment. STPHH settings offer assistance with activities of daily living, required medical/psychiatric/substance use care, case management, and connections to housing supports to facilitate recuperation and transition to stable housing. Eligibility requires ongoing physical or behavioral health needs, as determined by a qualified health professional, that would otherwise require continued institutional care.

Revision History

policy_publication/updateLatest

Establishes authorization rules for Short-Term Post-Hospitalization Housing (STPHH): 7-day presumptive authorization, initial authorization up to 90 days, reauthorization requires licensed professional reassessment, and services subject to a six-month (182-day) global cap per rolling 12-month period.