Community Supports are medically appropriate and cost-effective alternative services. Federal regulation allows states to offer Community Supports as an option for Medicaid-managed care organizations, and CenCal Health has elected to offer some Community Support services. Community Supports are designed to help avert or substitute traditional medical services and settings, including but not limited to hospital or nursing facility admissions, discharge delays, and emergency department use when provided to eligible members. Community-based organizations and providers will typically provide Community Supports. ECM Providers may also serve as Community Supports Providers, if they have appropriate experience.
CenCal Health must determine eligibility for pre-approved Community Supports using the DHCS Community Supports definitions, containing specific eligibility criteria for each Community Supports program. CenCal Health is also expected to determine that a Community Supports is a medically appropriate and cost-effective alternative to a Medi-Cal Covered Service. When making such determinations, CenCal Health must apply a consistent methodology to all members within a particular county.
Please download the Provider Community Supports FAQs to learn more!
Community Supports are optional services for CenCal Health and offer the following services for members:
Medically Tailored Meals
Effective July 1, 2022 in Santa Barbara & San Luis Obispo County Medically Tailored Meals help individuals achieve their nutrition goals at critical times to help them regain and maintain their health. Results include:
- Improved member health outcomes.
- Lower hospital readmission rates.
- A well-maintained nutritional health status.
- Increased member satisfaction.
Need to refer a member for services? Enhanced Care Management providers, Community Supports providers, Primary Care providers, and Specialty providers can submit an authorization request TAR (50-1) through the Provider Portal. The authorization request must include the following documentation:
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Recuperative Care
Effective July 1, 2022 in Santa Barbara & San Luis Obispo County Recuperative Care is short-term residential care for individuals who:
- Do not need to be in the hospital, but still need to heal from an injury or illness (including behavioral health conditions).
- Are in a condition that would be exacerbated by an unstable living environment.
Need to refer a member for services? Please fill out the Recuperative Care Information and Referral Form. After completion, submit the form with the referral to a contracted Recuperative Care Provider or secure fax (805) 681-3039. Please reference CenCal Health's Provider Directory to find a list of these contracted providers.
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Housing Transition Navigation Services
Effective January 1, 2023 in Santa Barbara & San Luis Obispo County Housing Transition Navigation Services acts as a quick and effective pathway to permanent housing through a low-barrier approach by assisting members with obtaining housing. CenCal Health member eligibility is based off those at risk of homelessness, having significant barriers to housing stability and meet one of the following:
- Have one or more chronic conditions
- Have a Serious Mental Illness (SMI)
- Risk of institutionalization
- Receiving Enhanced Care Management
- Are Transitioned Aged Youth with significant barriers to housing stability
Are you a Medical, Behavioral Health, or Community Based Organizational provider looking to refer a member? If so, please submit the Housing Transition and Navigation Service Informational and Referral Form and send it over to a contracted Housing Provider. Please reference CenCal Health's Provider Directory to find a list of these contracted providers.
Are you a contracted Housing Provider that would like to refer a member or received a referral request? Complete (or receive) the Housing Transition and Navigation Service Informational and Referral Form, submit a 50-1 (TAR) authorization through our provider portal (including the REQUIRED Information), and receive an authorization decision from CenCal Health. If the authorization is approved the Housing Provider will provide services for the allowed amount of time.
Once approved, the Housing Provider will complete the Housing Transition Navigation Services Tenant Screening and Housing Assessment Form and the Housing Transition Navigation Services Individualized Housing Support Plan to collect information and assist the member in developing a support plan to identify and achieve attainable housing goals.
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Housing Deposits
Effective January 1, 2023 in Santa Barbara & San Luis Obispo County Housing Deposits assist with identifying, coordinating, securing or funding a one-time service and modifications necessary to allow a person to establish a basic household. Housing Deposits refer to services that do not constitute room and board.
Are you a contracted Housing Provider and need to submit a request for housing deposits? Please complete the Housing Deposits Informational and Referral Form and submit a 50-1 (TAR) authorization through our provider portal (including the REQUIRED Information), and receive an authorization decision from CenCal Health. If not submitted via the Provider Portal, you may fax this form to (805) 681-3038.
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Housing Tenancy and Sustaining Services
Effective January 1, 2023 in Santa Barbara & San Luis Obispo County. Housing Tenancy and Sustaining Community Supports services helps to maintain safe and stable residency once housing is secured for members who had been experiencing homelessness and are now newly housed.
Are you a contracted Housing Provider and need to submit a request for Housing Tenancy and Sustaining services? Please complete the Housing Tenancy and Sustaining Service Information and Referral Form and submit a 50-1 (TAR) authorization through our provider portal (including the REQUIRED Information), and receive an authorization decision from CenCal Health. If not submitted via the Provider Portal, you may fax this form to (805) 681-3038.
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Sobering Centers
Effective January 1, 2023 in Santa Barbara & San Luis Obispo County Sobering Centers are alternative destinations for individuals who are found to be publicly intoxicated (due to alcohol and/or other drugs) and would otherwise be transported to the emergency department or jail. Sobering centers provide these individuals, primarily those with unstable living situations, with a safe, supportive environment to become sober.
Are you a Hospital/SNF, Medical Provider, Law Enforcement, ECM or other provider looking to refer a member? If so, please submit the Sobering Center Informational and Referral Form and fax it over to (805) 681-3038 or submit your request via the Provider Portal.
Referrals for Community Supports may be made by a physician, a CenCal Health member or their caregiver, a community service agency, a hospital or health care provider, or an ECM or Community Supports provider. CenCal Health staff will utilize the information received on the referral and other data sources to determine eligibility. The authorization process entails eligibility screening, completion of a Member Care Plan by the ECM Provider (if receiving ECM services), and decision-making by CenCal Health. If approved after CenCal Health’s assessment, the member may receive Community Supports.
Some Community Supports may require periodic reauthorization by submitting an Authorization Request to the Utilization Management Department and any necessary documentation for review. Documentation for the reauthorization may be submitted through the ECM/Community Supports referral and fax line (805) 681-3038 or CenCal Health’s Provider Portal. For any questions, please call the Community Supports Unit at (805) 562-1698.
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