CurrentHealth NetPolicy N/A

Day Habilitation Programs (Community Supports)

Defines authorization, eligibility, services, provider types, documentation, coding, limits, and referral expectations for Day Habilitation Programs provided in-home or in non-facility community settings to support members experiencing or at risk of homelessness.

Policy Summary

PayerHealth Net

PolicyDay Habilitation Programs (Community Supports)

Policy CodePolicy N/A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionSubmit the Community Supports (CS) Day Habilitation Referral Form to Housing Transition/Navigation Services and obtain initial authorization (up to 90 days) and extensions as needed.

POLICY UPDATE CHANGES

No material clinical or coverage changes.

8Daily maximum hours

90Initial auth days

90Extension days

1Required referral form

Coverage Summary

Day Habilitation Programs support members in acquiring, retaining, and improving self-help, socialization, and adaptive skills to enable successful residence in their natural community environment. Services are provided in the member's home or in out-of-home, non-facility community settings and are intended for members experiencing homelessness, who have recently exited homelessness, or who are at risk of homelessness or institutionalization. The policy scope defines authorization (initial and extensions), eligible populations, covered activities, provider types, documentation, coding, limits (including a daily time limit of not to exceed 8 hours), and referral expectations to housing and other supports.

Eligibility, Services, and Authorization Criteria

Eligibility

The member must meet ONE of the following:

Experiencing homelessness
Exited homelessness and entered housing in the last 24 months
At risk of homelessness or institutionalization whose housing stability could be improved through participation in a Habilitation Program

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Covered Services / Clinical Criteria

Day Habilitation Program services are covered when they assist the member in acquiring, retaining, and improving self-help, socialization, and adaptive skills necessary to reside in the person's natural environment. Services are provided in the member's home or in an out-of-home, non-facility setting. Covered activities include, but are not limited to:

Training in use of public transportation
Personal skills development including conflict resolution
Community participation
Daily living skills (cooking, cleaning, shopping, money management)
Developing and maintaining interpersonal relationships
Community resource awareness (police, fire, local services) to support independence
Assistance with selecting and moving into a home

Authorization

Initial authorization: Up to 90 days, based on needsUp to 90 days
Duration determined by assessed need
Authorization extension: Up to 90 days, based on need (may be renewed multiple times)Up to 90 days
May be renewed multiple times as clinically necessary
Services are available for as long as necessary; may be continuous or intermittent, individual or group
While receiving Day Habilitation Program services, members needing housing-related services should be referred for Housing Transition/Navigation, Housing Deposits, Housing Tenancy/Sustaining, and may be referred for Transitional Rent

Required Provider Actions

Documentation Required

Required referral form

Submit Community Supports (CS) Day Habilitation Referral Form to the Housing Transition/Navigation Services CS_1Refer as required for authorization/documentation.

Required form: Community Supports (CS) Day Habilitation Referral Form (CS_1Refer)

Prior Authorization

Authorization required

Obtain initial authorization (up to 90 days) and request extensions as needed; authorization is based on assessed needs.

Applies to codes: T2020 U6
Initial auth: up to 90 days
Extensions: up to 90 days, may be renewed

Billing Rule

Hourly billing and daily cap

Bill per hour using HCPCS T2020 U6; do not exceed 8 hours billed per member per day.

Bill with HCPCS T2020 U6
Daily cap: 8 hours/day

Background and Definitions

Day Habilitation Programs are designed to assist members in acquiring and maintaining self-help, socialization, and adaptive skills and to promote community integration and daily living competence. Covered services include training in the use of public transportation; personal skills development such as conflict resolution; community participation; daily living skills (cooking, cleaning, shopping, money management); developing and maintaining interpersonal relationships; and community resource awareness (police, fire, local services). Programs also focus on housing-related linkage and supports, including assistance selecting and moving into a home, locating housemates and furnishings, settling disputes with landlords, managing personal finances, accessing governmental agencies, coordinating with managed care plans to link members to Community Supports (CS) or Enhanced Care Management (ECM), and providing referrals to non-CS housing resources when appropriate. Authorization is typically initially up to 90 days with extensions up to 90 days as needed, and services are billed using HCPCS T2020 U6 per hour with a maximum of 8 hours billed per member per day.

Definitions:

Individual experiencing or at risk of homelessness — Based on HUD definitions with three modifications as detailed in Appendix C in the CS Policy Guide Volume 2.