CurrentmhnPolicy N/A

Authorization Guide for Day Habilitation Programs

Governs authorization, eligibility, allowable services, providers, documentation, and billing for Day Habilitation Programs that assist members with self-help, socialization, and adaptive skills to support community residence. Affects members eligible for Community Supports and providers delivering day habilitation services in non-facility settings in North Carolina.

Policy Summary

Payermhn

PolicyAuthorization Guide for Day Habilitation Programs

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

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

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

90 daysinitial authorization period

90 daysauth extension

T2020 U6billing code

8 hrs/daydaily max hours

NCstate

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coverage Criteria for Day Habilitation Programs

Coverage criteria for Day Habilitation Programs

Covered when ALL of the following are met:

Core coverage conditions

Eligibility options: 1) Experiencing homelessness; 2) Exited homelessness and entered housing in the last 24 months; 3) At risk of homelessness or institutionalization whose housing stability could be improved through participation in a Day Habilitation Program.
Authorization limits: Initial authorization up to 90 days; extensions may be authorized for up to 90 additional days based on need.90 days
Provider must document ongoing need for extensions.
Billing constraints: Bill per hour using code T2020 U6; services not to exceed 8 hours per day.8 hours/day
Services may be provided continuously or intermittently, individually or in groups.

Continued authorization: Continued need must be documented for renewals; services can continue as long as necessary within authorization periods and hourly limits.

Authorization renewals permitted for up to 90 days at a time based on ongoing need.

There is no explicit overall time limit on Day Habilitation services; they are available for as long as necessary. Service provision must follow established authorization periods and billing constraints: initial authorizations may be approved for up to 90 days with extensions authorized in additional increments of up to 90 days, and billing is limited to the hourly code with a daily maximum (see Coding and Provider Actions).

Services may be delivered continuously or intermittently and in individual or group settings; however, authorization durations and the daily maximum of 8 hours must be observed when scheduling and billing services.

Services are not authorized unless the member meets one of the program eligibility conditions. Covered eligibility options require that the member is either: experiencing homelessness, has exited homelessness and entered housing within the last 24 months, or is at risk of homelessness or institutionalization where participation in Day Habilitation could improve housing stability.

If the member does not meet any of these listed conditions, Day Habilitation services should not be authorized.

Authorization, Documentation, and Billing Requirements

Billing Rule

Authorization periods and billing

Initial authorization: Up to 90 days, based on needs. Authorization extension: Up to 90 days, based on need. While receiving Day Habilitation Program services, members who need assistance with housing-related services and supports should be referred for the Housing Transition/Navigation, Housing Deposits, Housing Tenancy and Sustaining Services, and may also be referred for Transitional Rent.

Initial authorization: up to 90 days
Authorization extension: up to 90 days
Refer to Housing Transition/Navigation, Housing Deposits, Housing Tenancy and Sustaining Services, and Transitional Rent as appropriate

Documentation Required

Required documentation

Submit the Community Supports (CS) Day Habilitation Referral Form as required documentation. Also ensure referrals to the Housing Transition/Navigation Services CS and the Housing Tenancy and Sustaining Services CS when indicated.

Community Supports (CS) Day Habilitation Referral Form required
Refer to Housing Transition/Navigation Services CS
Refer to Housing Tenancy and Sustaining Services CS

Denial Risk

Eligibility-based denials

Members must meet one of the eligibility criteria below. If the member does not meet any of these, services may be denied as not eligible.

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

Billing Rule

Provider billing code

Provider action: use billing code T2020 U6 billed per hour. Do not exceed 8 hours per day.

T2020 U6 — per hour
Not to exceed 8 hours per day

Program Background

Day Habilitation Programs provide training and assistance to help members acquire, retain, and improve self-help, socialization, and adaptive skills needed to live successfully in their natural environment. Services focus on community integration, daily living skills, interpersonal relationships, and coordination with other supports such as housing and healthcare.

The program supports community participation through activities and training that can include transportation assistance, personal skills development, daily living skill building, community resource awareness, housing-related assistance, and coordination with health and behavioral health services. Services may be provided individually or in groups and can be continuous or intermittent depending on member needs.

These programs are intended specifically to support members who meet the eligibility criteria tied to homelessness or risk of homelessness and to improve housing stability and community residence outcomes.

Key Definitions

Experiencing or at risk of homelessness (definition)

Definition sourceBased on HUD definitions with three modifications as detailed in Appendix C of the CS Policy Guide Volume 2

Experiencing homelessnessMember currently experiencing homelessness per HUD-based definition with policy modifications

Recently exited homelessnessMember exited homelessness and entered housing in the last 24 months

At risk of homelessness or institutionalizationMember at risk of homelessness or institutionalization whose housing stability could be improved through participation in Day Habilitation

Day Habilitation / Community Support Criteria

Day Habilitation / Community Support

Criteria for determining level of care for Day Habilitation / Community Support:

Admission eligibility: Member meets one of: 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 Day Habilitation.

HUD definitions with modifications apply

Authorization and ongoing need: Initial authorization may be approved for up to 90 days based on needs; extensions may be authorized for up to 90 additional days based on ongoing need.90 days

Provider must document ongoing need for extensions

Service delivery constraints: Services can be provided continuously or intermittently, in individual or group settings, and must adhere to hourly billing limits (T2020 U6, not to exceed 8 hours/day).8 hours/day

Day Habilitation Activities

Day habilitation activities

Allowable day habilitation activities include (examples):

Service types: Training and assistance focused on transportation skills (e.g., use of public transportation); personal skills development including conflict resolution; community participation and interpersonal relationship building; daily living skills (cooking, cleaning, shopping, money management); community resource awareness (police, fire, local services); housing-related assistance (selecting/moving into a home, locating housemates, settling landlord disputes); financial advocacy and benefits assistance; recruiting and managing personal attendants; coordination with managed care plan for linkage to CS/ECM, health, mental health, and substance use services; referrals to non-CS housing resources when appropriate.

Examples listed are not exhaustive