CurrentmhnPolicy N/A

Authorization Guide for Housing Tenancy and Sustaining Services

Policy governing authorization, eligibility, and service provisions for Housing Tenancy and Sustaining Services to help members maintain stable tenancy after housing is secured; applies to members and Community Support providers in North Carolina.

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 (CS) Housing Navigation and Tenancy Referral Form for initial authorization; initial approval is for 12 months.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

12 monthsinitial authorization duration

6 monthsmaximum reauthorization increment

1total lifetime maximum

Per Diemunit of service

T2041 U6billing code

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

inv-01: Coverage criteria

Covered when ALL of the following are met

Eligibility: Member meets one of the listed eligibility pathways: received Housing Transition Navigation Services in counties offering this service; prioritized for permanent supportive housing or rental subsidy via Coordinated Entry or similar system for highly vulnerable individuals; meets the HUD definition of homeless (24 CFR 91.5) and is receiving enhanced care management or has one or more serious chronic conditions/serious mental illness/is at risk of institutionalization due to substance use disorder or exiting incarceration; or meets the HUD definition of at risk of homelessness (24 CFR 91.5).

See chunk 2 and chunk 9 for HUD definitions and eligibility pathways.

Service necessity and provider: Services are identified as reasonable and necessary in the individual's individualized housing support plan and are provided by allowable community support providers with appropriate experience. Community supports shall supplement and not supplant services received through other state, local, or federally funded programs.

See chunk 4.

Authorization timing and limits: Initial authorization is for 12 months; services are available from initiation until the housing support plan determines they are no longer needed. The service is covered once per lifetime but may be approved one additional time if documentation demonstrates changed conditions that would support success on a second attempt. Extensions after the initial 12 months may be requested in increments up to six months based on need.

See chunks 3, 4, and 7.

Do not use HCPCS code T2040 for Housing Tenancy and Sustaining Services. Bill per diem using T2041 U6 as the appropriate HCPCS code for these services.

These services are limited to a single lifetime occurrence: covered once per lifetime. A second course of Housing Tenancy and Sustaining Services may only be approved if the provider submits documentation demonstrating changed conditions that would support success on a subsequent attempt.

Coding and Billing

Covered CPT/HCPCS Codes and restrictionsHCPCSCovered

T2041 U6	Support brokerage, self-directed; per service.
T2040	Do not use T2040.

Initial authorization duration

Initial authorization period12 months

When services endFrom initiation until the individual's housing support plan determines they are no longer needed

Lifetime limitServices available for a single duration in the individual's lifetime (one-time), with possible one additional approval if documentation shows changed conditions

Reauthorization increment

Reauthorization incrementUp to 6 months per extension

When to requestExtensions can be requested after the initial 12 months based on need

Documentation for extensionRequires updated referral and individualized housing support plan as part of authorization process

Provider Actions and Authorization

Prior Authorization

Authorization and billing summary

Initial authorization requires submission of the Community Supports (CS) Housing Navigation and Tenancy Referral Form; initial authorization is approved for 12 months and billed per diem with code T2041 U6. Extensions require the updated referral form and the member's updated individualized housing support plan.

Billing unit: per diem; covered code: T2041 U6 (see coding table).

Step Therapy

Concurrent services limitation

Except for the first month when the member is housed, the member should not receive Housing Tenancy and Sustaining Services and Housing Transition Navigation Services in the same month.

Documentation Required

Required documentation for initial authorization and extensions

Initial authorization requires the Community Supports (CS) Housing Navigation and Tenancy Referral Form. Authorization extensions require the Community Supports (CS) Housing Navigation and Tenancy Referral Form plus the member's updated individualized housing support plan.

Prior Authorization

Authorization periods and reauthorization increments

Initial authorization period is 12 months. Extensions can be requested after the initial 12 months in increments of up to six months based on need; services continue only while the individual's housing support plan determines they are needed.

Denial Risk

Single lifetime coverage limitation

Services are available for a single duration in the individual's lifetime; they can be approved one additional time only with documentation explaining what conditions have changed to support success on a second attempt.

Background

Housing Tenancy and Sustaining Services assist members in maintaining safe, stable tenancy after housing is secured by addressing barriers such as lease compliance, landlord disputes, benefits advocacy, habitability and health/safety issues, and independent living skills. Services are billed per diem using the community supports code T2041 U6 and are provided while the individualized housing support plan determines they are needed; initial authorization is for 12 months and services are available for a single duration in the individual's lifetime (with limited exception for reapproval when changed conditions are documented).

Definitions

HUD homeless / at-risk definitions

Reference regulationHUD definitions per Section 91.5 of Title 24 of the Code of Federal Regulations

Homeless examplesIncludes individuals exiting institutions, lacking sufficient resources/support networks, or living in unstable/overcrowded housing

At-risk examplesIncludes low income (below 30% of area median), recent moves for economic reasons, living in someone else’s home due to hardship, or notified of impending housing termination within 21 days

Treatment Modalities / Service Components

inv-15: Housing tenancy supports

Service components: Services include early identification and intervention for behaviors that may jeopardize housing; education and training on tenant and landlord roles/rights/responsibilities; coaching to develop and maintain relationships with landlords/property managers; assistance with annual housing recertification; coordinating review and updates to the housing support and crisis plan; coordination with landlords and case managers; assistance resolving disputes and developing repayment plans or identifying funding for back rent or damages; advocacy and linkage to community resources to prevent eviction; benefits advocacy and assistance with documentation/SSI application support; ongoing lease compliance support and household management activities; health and safety visits and unit habitability inspections; independent living and life skills training including budgeting and financial literacy; and other prevention/early intervention services identified in the crisis plan.

See chunks 4 and 5 for full list of service components.