CurrentmhnPolicy N/A

Authorization Guide for Housing Tenancy and Sustaining Services

Defines eligibility, required documentation, authorization periods, covered activities, provider requirements, exclusions, and billing codes for Housing Tenancy and Sustaining Services for Medi-Cal enrollees served by CalViva Health/Health Net Community Solutions.

Policy Summary

Payermhn

PolicyAuthorization Guide for Housing Tenancy and Sustaining Services

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionSubmit the Community Supports Housing Navigation and Tenancy Authorization Form for initial authorization.

SourceLink

POLICY UPDATE CHANGES

No material changes

12 monthsInitial authorization duration

6 monthsMaximum extension increment

T2041 U6Primary billing code

T2040Prohibited code

Coverage Summary

Defines eligibility, required documentation, authorization periods, covered activities, provider requirements, exclusions, and billing codes for Housing Tenancy and Sustaining Services for Medi‑Cal enrollees served by CalViva Health/Health Net Community Solutions. The policy covers members who meet specified social and clinical risk factor pathways (including those experiencing or at risk of homelessness, those eligible for Transitional Rent, or those prioritized for permanent supportive housing) and establishes the purpose of helping members maintain safe, stable housing through individualized activities recorded in a housing support plan.

Eligibility and Authorization Criteria

Eligibility (Member must meet at least ONE of the following)

Covered when ANY of the following eligibility pathways are met:

ANY of the following

Individuals who meet the following social and clinical risk factor requirements (both A and B)
- A. Social Risk Factor Requirement: Experiencing or at risk of homelessness (per HUD-based definition with plan-specific modifications).
- B. Clinical Risk Factor Requirement
  - i: Meets the access criteria for Specialty Mental Health Services (SMHS).
  - ii: Meets the access criteria for Drug Medi-Cal (DMC) or Drug Medi-Cal Organized Delivery System (DMC-ODS).
  - iii: One or more serious chronic physical health conditions.
  - iv: One or more physical, intellectual, or developmental disabilities.
  - v: Individuals who are pregnant up through 12-months postpartum.
Transitional Rent eligibility: Individuals who are determined eligible for Transitional Rent (these individuals are automatically eligible for Housing Tenancy and Sustaining Services).
Priority via Coordinated Entry System: Individuals given priority for a permanent supportive housing unit or rental subsidy through the local homeless Coordinated Entry System or a similar system (systems identify people who are highly vulnerable, e.g., disabilities, serious chronic health conditions, serious mental illness, history of institutionalization, need for residential services due to substance use disorder, or those leaving incarceration).

Authorization / Duration

Coverage duration and extension rules:

Authorization / Duration rules

Initial authorization period is for 12 months.
Extensions: Authorization extensions allowed in increments of up to six months, based on need.
Concurrent service restriction: Except for the first month after the member moves into housing, members should not receive both Housing Tenancy and Sustaining Services and Housing Transition Navigation Services during the same month.
No overall limit: No limit on service duration or the number of times an eligible member may receive Housing Tenancy and Sustaining Services; service can continue as long as needed.

What Providers Must Do

Prior Authorization

Initial authorization form required

Submit the Community Supports Housing Navigation and Tenancy Authorization Form for initial authorization.

Prior Authorization

Authorization extension documentation

Submit the Community Supports Housing Navigation and Tenancy Authorization Form plus the member's housing support plan for authorization extensions.

Documentation Required

Housing support plan required

Only services identified as reasonable and necessary in the member's housing support plan are provided; the housing support plan must record personalized assessment and selected activities.

Billing Rule

Concurrent service restriction

Members generally should not receive both Housing Tenancy and Sustaining Services and Housing Transition Navigation Services during the same month except for the first month after move-in.

Denial Risk

Exclusion of rental payments

Claims for room and board or rental assistance payments are not covered and will be denied if billed as Housing Tenancy and Sustaining Services.

Background & Definitions

Housing Tenancy and Sustaining Services are intended to help members maintain stable housing through individualized activities documented in a housing support plan. Covered activities include tenant education, landlord coordination, dispute resolution, benefits advocacy, life skills and household management training, health and safety visits, and ongoing tenancy support. Providers delivering these services must be experienced and skilled in housing-related services and offer support that is culturally and linguistically appropriate; they must follow best practices and provide only services identified as reasonable and necessary in the member's housing support plan. Initial authorizations require the Community Supports Housing Navigation and Tenancy Authorization Form, and extensions require that form plus the member's housing support plan.

Definitions

ANY of the following

Experiencing or at risk of homelessness: Based on HUD definitions with three modifications as detailed in the Community Supports (CS) Policy Guide Volume 2 Appendix C.
Clinical Risk Factor Requirement: Includes meeting access criteria for SMHS, DMC/DMC-ODS, having serious chronic physical health conditions, having physical/intellectual/developmental disabilities, or being pregnant up through 12-months postpartum (see CS Policy Guide Volume 2 Appendix D).

OpenPayer

Authorization Guide for Housing Tenancy and Sustaining Services

Coverage Summary

Eligibility and Authorization Criteria

Billing and Codes

What Providers Must Do

Background & Definitions

Revision History