CurrentmhnPolicy N/A

Day Habilitation Programs – English (PDF)

Defines eligibility, services covered, authorization lengths, allowable providers, required documentation, service settings, and billing code/limits for Day Habilitation Programs (community-based non-facility habilitation to support housing stability and community skills).

Policy Summary

Payermhn

PolicyDay Habilitation Programs – English (PDF)

Policy CodePolicy N/A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionSubmit the Community Supports (CS) Day Habilitation Referral Form as required documentation for authorization.

SourceLink

POLICY UPDATE CHANGES

No material changes to clinical coverage or criteria.

1Auth period (initial, months approx.)

8Max hours per day

24 monthsHousing exit timeframe eligibility

Coverage Summary

Day Habilitation Programs are covered with criteria. These community-based, non-facility services help members acquire, retain, and improve self-help, socialization, and adaptive skills necessary to live successfully in their natural environment, support independence and community participation, and promote housing stability. Coverage is subject to eligibility and authorization requirements, including time limits and billing rules.

Key thresholds

Daily service limitNot to exceed 8 hours per day

Initial authorization lengthUp to 90 days (based on needs)

Authorization extension lengthUp to 90 days (based on need)

Housing exit timeframeEligible if exited homelessness and entered housing in the last 24 months

Auth period (brief stat)Auth period ≈ 1 month (initial) per stats

Max hours per day (brief stat)Maximum billed hours per day: 8