C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-91, subsec. 144-101-II-91.04

Current through 2024-51, December 18, 2024

Subsection 144-101-II-91.04 - MEMBER ELIGIBILITY FOR HOME SERVICES

There are three (3) HOME service tiers: Intensive, Stabilization, and Maintenance. Members shall first meet the Intensive Tier criteria to receive HOME covered services. Once Intensive Tier eligibility is established, the HOME Provider shall assess Members for meeting Stabilization and Maintenance Tier criteria to ensure appropriate reimbursement. The Member's service tier may cycle back and forth between each tier, as indicated by the eligibility criteria.

Documentation of the Member's criteria for movement between tiers shall be retained in the Member's record. The expected intensity level of the covered services differs in each tier, but the covered services remain the same.

To be eligible for any HOME Provider service Tier, Members must meet the below eligibility criteria for one of the tiers and have at least two (2) chronic conditions or one (1) chronic condition and be at risk for a second chronic condition, in accordance with 91.03-1 and 93.03-2.

91.04-1Intensive Tier: Member Eligibility

For HOME Provider Intensive Tier services, Members must:

1. Currently be homeless and have Long-term Homelessness; or

2. Currently be homeless and have previously been in the Intensive Tier.

91.04-2Stabilization Tier: Member Criteria

For HOME Provider Stabilization Tier services, Members must:

1. Be Housed; and

2. Have a Services Prioritization Decision Assistance Tool (SPDAT) or Youth Service Prioritization Decision Assistance Tool (Y-SPDAT) score of twenty (20) to sixty (60).

91.04-3Maintenance Tier: Member Criteria

For HOME Provider Maintenance Tier services, Members must:

1. Be Housed; and

2. Have a SPDAT or Y-SPDAT score of four (4) to nineteen (19).

C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-91, subsec. 144-101-II-91.04