22-1017m Respite Services: Provide Temporary Relief for Primary Caregivers
Date: 11/30/22
Support is available for caregivers of members
Respite services are available to caregivers of members who require intermittent temporary supervision. The services are provided on a short-term basis due to the absence or need for relief of the caregiver. These services are distinct from medical respite/recuperative care and provide rest for the caregiver only.
The service limit is up to 336 hours per calendar year. The service is inclusive of all in home and in-facility services. Exceptions to the limit of 336 hours per calendar can be made when the caregiver experiences an episode that leaves the member without their caregiver. Respite support provided during these episodes can be excluded from the 336 hour annual limit.
Eligibility and services
Members are eligible for caregiver respite services if they live in the community and are compromised in their Activities of Daily Living (ADLs) and dependent on a qualified caregiver who provides most of their support. Said caregiver requires caregiver relief to avoid institutional placement of the member.
Members may also qualify for caregiver respite services if they are:
- Children who previously were covered for respite services under the Pediatrics Palliative Care Waiver.
- Foster care program beneficiaries.
- Members enrolled in California Children’s Services or Genetically Handicapped Persons Program (GHPP), and
- Members with complex care needs.
Services are provided to the member in his or her own home or another location being used as the home.
Respite services should be made available when it is useful and necessary to maintain a person in their own home and to preempt caregiver burnout.
Billing service codes
Billing for respite services must use service codes H0045, S5151, or S9125 with modifier U6.
Authorization Guide
For more information on Community Supports (CS) authorization guides and eligibility criteria, access Health Net’s provider website at CalAIM Resources> Forms & Tools, under Community Supports (CS) Authorization Guides.
Additional information
Providers are encouraged to access Health Net*’s provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email within 60 days, by phone or through the Health Net provider website.
This information applies to Community Supports (CS) Providers.
For Medi-Cal, this information applies to Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties.