CurrentPHC CaliforniaPolicy UM 61.1

PHC-CA Utilization Management of Transitional Rent Community Support

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This policy governs how PHC California determines enrollee eligibility, authorizes, monitors, and discontinues Transitional Rent Community Support, including housing support plans, authorization timeframes, Room and Board limits, and county behavioral health coordination.

Policy Summary

PayerPHC California

PolicyPHC-CA Utilization Management of Transitional Rent Community Support

Policy CodePolicy N/A

Change TypeRevision

Effective DateJanuary 1, 2026

Next Review DateN/A

Key ActionObtain an approved Housing Support Plan before authorizing Transitional Rent.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

6 monthsStandard authorization term

6 months/12 monthsRoom and Board cap

5 business daysNon-urgent decision

72 hoursUrgent decision

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CurrentPHC CaliforniaPolicy UM 61.1

PHC-CA Utilization Management of Transitional Rent Community Support

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Policy Summary

PayerPHC California

PolicyPHC-CA Utilization Management of Transitional Rent Community Support

Policy CodePolicy N/A

Change TypeRevision

Effective DateJanuary 1, 2026

Next Review DateN/A

Key ActionObtain an approved Housing Support Plan before authorizing Transitional Rent.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

6 monthsStandard authorization term

6 months/12 monthsRoom and Board cap

5 business daysNon-urgent decision

72 hoursUrgent decision

Foster-care age limit

NoneSobriety requirement

Eligibility and Authorization Criteria

Initial eligibility

Covered when all required eligibility elements are met.

Core eligibility

Clinical risk: The enrollee has a qualifying clinical risk factor.
PHC California deems all of its enrollees to meet this requirement because all enrollees have an AIDS diagnosis, and qualifying clinical risk factors include serious chronic physical health conditions.
Social risk: The enrollee is experiencing or at risk of homelessness.
At least one qualifying population status
- Transitioning population: The enrollee is transitioning out of an institutional or congregate residential setting, carceral setting, interim housing, recuperative care or short-term post-hospitalization housing, or foster care.
  Except for foster-care transitions, eligibility under the transitioning-population criteria is generally within six months of the transition event. An enrollee who aged out of foster care on or after the 18th birthday may be authorized through the 26th birthday if other requirements are met.
- Unsheltered homelessness: The enrollee is experiencing unsheltered homelessness.
- Full-Service Partnership: The enrollee is eligible for Full-Service Partnership.

Authorization duration and continuation

Continued authorization is subject to the service-period and global-cap requirements.

Authorization duration and continuation: Transitional Rent is authorized for a term of six months, subject to a combined Room and Board limit of six months per enrollee within a rolling twelve-month period.6 months within a rolling 12-month period

The combined limit includes Transitional Rent, Short-Term Post-Hospitalization Housing, and Recuperative Care Community Supports. Eligibility generally is not reassessed while the enrollee is receiving Transitional Rent; however, coverage may be discontinued if the enrollee no longer requires the service or meets a discontinuation condition. If Transitional Rent ends before six months and the enrollee later seeks to use it again, eligibility must be reassessed before reauthorization.

Housing Support Plan and behavioral health coordination

Authorization requires an approved Housing Support Plan and applicable county behavioral health coordination.

Housing coordination requirements

Approved Housing Support Plan: An approved Housing Support Plan must be in place before Transitional Rent is authorized.
The plan must address housing placement and, when the enrollee will transition to housing or a subsidy requiring the enrollee to pay a share of rent, the steps needed to prepare the enrollee for that responsibility.
Applicable behavioral health coordination
- Behavioral Health POF interim-setting placement: If the enrollee is in the Behavioral Health POF and is placed in an interim setting, the Health Plan must coordinate with the appropriate Los Angeles County agency to confirm that the enrollee is BHSA-eligible before authorizing Transitional Rent.
  The confirmation must be documented in the Housing Support Plan. The plan must also address the enrollee's anticipated transition to BHSA Housing Interventions when applicable.

The Health Plan does not authorize more than six months of combined Room and Board services per enrollee within a rolling twelve-month period. This global cap includes Transitional Rent, Short-Term Post-Hospitalization Housing, and Recuperative Care Community Supports. Coverage may be discontinued when the cap is reached.

Authorization, Documentation, and Discontinuation Actions

Prior Authorization

Confirm Eligibility

Verify that the enrollee is actively enrolled with PHC California and meets the required clinical and social risk criteria and qualifying population status before authorization.

PHC California deems all enrollees to have the qualifying clinical risk factor of an AIDS diagnosis.
Confirm and document that the enrollee is experiencing or at risk of homelessness.
Confirm and document at least one qualifying population: transitioning population, experiencing unsheltered homelessness, or eligible for Full-Service Partnership.

Prior Authorization

Obtain Approved Housing Plan

Obtain and approve a Housing Support Plan before authorizing Transitional Rent. Coordinate behavioral health placement when the enrollee is in the Behavioral Health POF and will be placed in an interim setting.

The plan must address housing placement and ensure Transitional Rent covers the full cost of rent when applicable.

Transitional Rent Community Support

Transitional Rent Community Support is a housing-related service for eligible PHC California enrollees who are experiencing or at risk of homelessness and meet specified clinical or behavioral health transition criteria. The service supports housing stability and helps address risks associated with prolonged institutional stays, readmission, and other immediate health needs. Transitional Rent is coordinated with Enhanced Care Management, the Housing Trio, and applicable county behavioral health housing interventions.

Key Terms

Full-Service Partnership (FSP)

Program descriptionA comprehensive behavioral health program for individuals living with significant mental health and/or co-occurring substance use conditions who have demonstrated a need for intensive wraparound services.

Eligibility criteria through June 30, 2026Eligibility criteria are set forth in CCR Title 9, section 3620.05.

Eligibility criteria beginning July 1, 2026Eligibility criteria are set forth in W&I Code section 5887(d).

Housing Trio

Housing Transition and Navigation ServicesOne of three interrelated Community Supports in the Housing Trio.

Housing DepositsOne of three interrelated Community Supports in the Housing Trio.

Policy Summary

PayerPHC California

PolicyPHC-CA Utilization Management of Transitional Rent Community Support

Policy CodePolicy N/A

Change TypeRevision

Effective DateJanuary 1, 2026

Next Review DateN/A

Key ActionObtain an approved Housing Support Plan before authorizing Transitional Rent.

SourceLink

On This Page

No applicable county coordination: If the enrollee is not in the Behavioral Health POF or is not placed in an interim setting, the applicable county behavioral health confirmation is not required.

If the enrollee will transition to housing or a subsidy requiring a rent share, document steps to prepare the enrollee for that responsibility.

For an interim placement, confirm with the county behavioral health agency that the enrollee can transition to BHSA Housing interventions when Transitional Rent ends.

Prior Authorization

Urgent Authorization Timeframe

Decide urgent authorization requests within 72 hours after receipt. Notify the appropriate provider and enrollee of an approval within 24 hours of the decision; issue denial notification to both within 72 hours of receipt.

Prior Authorization

Non-Urgent Authorization Timeframe

Decide non-urgent authorization requests within five business days after receipt. Send initial approval notification to the provider within 24 hours and to the enrollee within two business days; send denial notification to both within two business days of the decision.

Prior Authorization

County Provisional Authorization

Honor a qualifying streamlined provisional authorization issued by the county behavioral health agency or other responsible county department unless providing Transitional Rent would cause the enrollee to exceed the Room and Board global cap.

The county must determine BHSA eligibility and commit to providing BHSA Housing interventions when Transitional Rent expires or the Health Plan denies coverage.
The county must send the referral and authorization request to the Health Plan timely, and at least within 14 days of its streamlined provisional authorization.
Authorize or deny within the shortest applicable timeframe, no later than five business days after receiving reasonably necessary information, and no later than 14 calendar days after receiving the county referral.

Documentation Required

Referral and Outreach Documentation

Document all referral and outreach efforts in the Care Management electronic medical record, including referrals received through secure email, secure fax, direct enrollee request, and outreach to potentially eligible enrollees.

Outreach may include internal identification and identification of enrollees receiving LACDMH specialty mental health services or LACDPH substance use disorder services.

Documentation Required

Eligibility Screening Documentation

Document the eligibility screening in the enrollee’s EMR, including active enrollment, qualifying risk factors, qualifying population status, and BHSA eligibility when applicable.

Confirm the enrollee is active in PHC California.
Document the AIDS diagnosis as the qualifying clinical risk factor and the enrollee’s experience of or risk for homelessness as the social risk factor.
Document whether the enrollee is in a transitioning population, experiencing unsheltered homelessness, or eligible for Full-Service Partnership.
For a Behavioral Health enrollee transitioning into an interim setting, document the outcome of outreach to the appropriate Los Angeles County agency confirming BHSA eligibility.

Documentation Required

Housing Support Plan

Maintain an approved Housing Support Plan as a condition of Transitional Rent authorization and update or implement the plan in collaboration with the Transitional Rent Provider.

Place the enrollee where the Transitional Rent payment is sufficient to cover the full rent cost when applicable.
Document steps preparing the enrollee to assume a rent share when transitioning to housing or a subsidy such as a HUD Housing Choice Voucher.
For Behavioral Health POF interim placements, confirm the planned transition to BHSA Housing interventions at the end of Transitional Rent.

Unsupported block type: documentation

Denial Risk

Eligibility Criteria Not Met

Deny Transitional Rent when required eligibility criteria are not met, including the absence of a qualifying social risk factor, qualifying population status, active enrollment, or other applicable DHCS requirements.

The enrollee must be experiencing or at risk of homelessness.
The enrollee must be transitioning, experiencing unsheltered homelessness, or eligible for Full-Service Partnership, in addition to the qualifying clinical risk factor.

Denial Risk

Room and Board Global Cap Exceeded

Deny or discontinue Transitional Rent when authorization or continued coverage would exceed the six-month combined Room and Board limit within a rolling 12-month period.

The global cap includes Transitional Rent, Short-Term Post-Hospitalization Housing, and Recuperative Care Community Supports.
A county streamlined provisional authorization need not be honored when it would cause the enrollee to exceed this global cap.

Denial Risk

Service No Longer Required or Maximum Reached

Deauthorize and discontinue Transitional Rent when the enrollee no longer requires the service, transitions to another housing program or permanent setting, or reaches an applicable maximum.

Discontinue when the enrollee has met the Room and Board global cap.
Discontinue when the household has received the maximum six months of Transitional Rent allowed under the BH-CONNECT demonstration period.
If Transitional Rent ended before six months and the enrollee later seeks it again, reassess eligibility before authorizing.

Housing Tenancy and Sustaining ServicesOne of three interrelated Community Supports in the Housing Trio.

RelationshipTogether, these three services comprise the Housing Trio.

Transitioning population

Institutional or congregate residential settingTransitioning out of an institutional or congregate residential setting, including an inpatient hospital, residential substance use disorder treatment facility, inpatient mental health facility, or nursing facility.

Carceral settingTransitioning out of a carceral setting.

Interim housingTransitioning out of interim housing.

Recuperative care or short-term post-hospitalization housingTransitioning out of recuperative care or short-term post-hospitalization housing.

Foster careTransitioning out of foster care; an enrollee who aged out on or after the 18th birthday may be authorized through the 26th birthday if other eligibility requirements are met.