Recuperative Care (Medical Respite): Short‑term residential care for beneficiaries who no longer require hospitalization, but still need to recover from injury or illness.

Short-Term Post Hospitalization Housing: Setting in which beneficiaries can continue receiving care for medical psychiatric, or substance use disorder needs immediately after exiting a hospital.

• Exiting recuperative care or at-risk of hospitalization or are post-hospitalization; and

• Meets the HUD definition of homeless.

Respite Services: Short‑term relief provided to caregivers of beneficiaries who require intermittent temporary supervision.

• Live in the community and are compromised in their Activities of Daily Living; and
• Require caregiver relief to avoid institutional placement and provide support.

Sobering Centers: Alternative destinations for beneficiaries who are found to be intoxicated and would otherwise be transported to an emergency department or jail.

• Individuals ages 18 and older who are intoxicated (appropriate for sobering centers); and
• Transported/present to the emergency department or a jail.

Asthma Remediation: Physical modifications to a beneficiary’s home to mitigate environmental asthma triggers.

• Has poorly controlled asthma in the past 12 months: An emergency department visit, hospitalization, two sick or urgent care visits, or a score of 19 or lower on the asthma control test.

Day Habilitation: Programs provided to assist beneficiaries with developing skills necessary to reside in home‑like settings, often provided by peer mentor‑type caregivers. These programs can include training on use of public transportation or preparing meals.

• Experiencing homelessness; or
• Exited homelessness and entered housing in the last 24 months; or
• At-risk of homelessness or institutionalization whose housing stability could be improved.

Environmental Accessibility Adaptation: Physical adaptations to a home to ensure the health and safety of the beneficiary. These may include ramps and grab bars.

• At-risk for institutionalization in a nursing facility.

Meals/Medically Tailored Meals: Meals delivered to the home that are tailored to meet beneficiaries’ unique dietary needs, including following discharge from a hospital.

• Has chronic conditions; and
• Discharged from the hospital or skilled nursing facility, or at high risk of hospitalization, nursing facility placement or extensive care coordination needs.

Nursing Facility Transition/Diversion to Assisted Living Facility: Services provided to assist beneficiaries transitioning from nursing facility care to community settings or to prevent beneficiaries from being admitted to nursing facilities.

Community Transition Services/Nursing Facility Transition to Home: Services provided to assist beneficiaries transitioning from nursing facility care to home settings in which they are responsible for living expenses.

• Has resided in a nursing facility for 60+ days.
• Is willing to live in an assisted living setting as an alternative to a nursing facility.
• Can reside safely in an assisted living facility with support.

OR

• Is interested in remaining in the community.
• Is willing and able to reside safely in an assisted living facility with support.
• Must be currently receiving necessary nursing facility services or meet the minimum criteria to receive nursing facility services.

Personal Care and Homemaker Services: Services provided to assist beneficiaries with daily living activities, such as bathing, dressing, housecleaning and grocery shopping.

• At-risk for hospitalization or institutionalization in a nursing facility; or
• Individuals with functional deficits and no other support system; or
• Individuals approved for In‐Home Supportive Services.

Eligibility

Eligibility criteria for the community support.

Authorization

Length of time the CS service is offered for the initial authorization and reauthorization (as applicable).

Required Documentation

Documentation that must be submitted to the health plan for authorization approval.

Codes

Healthcare Common Procedure Coding System (HCPCS) codes that must be used for documenting the rendering of ECM and CS services.