Services
Housing Navigation
Helping clients find affordable housing within their budget in the area they live. This will include utilizing resources that are already available and collaborating with Coordinated Entry in the area, the county, and other community-based organizations. This service almost always ties in with ECM (therapy services). People who most need housing, might include
A. Previously incarcerated
B. Those who have recently lost a loved one
C. Youth coming out of the system
D. Indigent clients with financial troubles
E. Dual Diagnostic clients
Housing Deposits
Once a client who was under housing navigation for a while, has been able to find gainful employment, or obtain financial backing for rental, through SSI, disability etc. The client maybe eligible for a housing deposit. Requirements below:
A. Make 2.5x’s the amount of monthly rent
B. Have at least a month worth of paycheck stubs to prove income – some require 2 months
C. Show the progress you have made in the program prior to requesting the Housing Deposit
D. Realize this is a once in a lifetime benefit.
E. This money will come from the Community Based Organization upfront, and the organization will request a refund through the Authorization process.
F. To be authorized the CBO will provide a housing plan showing past progress, a copy of the lease agreement, a copy of the requested deposit amount, a copy of the utilities expected down payment to start services, a copy of the water/garbage/sewer to start services. They will not cover phone/TV/Internet. However if a client is receiving Cal Fresh benefits they will qualify for internet through the county/DHCS. They can ask their case worker with the county they are in for help with that.
Housing Tenancy and Sustaining Services
Helping clients find affordable housing within their budget in the area they live. This will include utilizing resources that are already available and collaborating with Coordinated Entry in the area, the county, and other community-based organizations. This service almost always ties in with ECM (therapy services). People who most need housing, might include
A. Previously incarcerated
B. Those who have recently lost a loved one
C. Youth coming out of the system
D. Indigent clients with financial troubles
E. Dual Diagnostic clients
Short-Term Post-Hospitalization Housing
Short-Term Post-Hospitalization Housing provides Medi-Cal and D-SNP Persons who do not have a residence and who have high medical or behavioral health needs with the opportunity to continue their medical/psychiatric/substance use disorder recovery immediately after exiting an institution.
Short-Term Post-Hospitalization Housing provides individuals with ongoing supports necessary for recuperation and recovery such as gaining (or regaining) the ability to perform activities of daily living, receiving necessary medical/psychiatric/substance use disorder care, case management, and beginning to access other housing supports such as Housing Transition Navigation.
A. This is a once in a lifetime benefit for up to 6 months only
B. The facility the CBO uses for this service must be provided by the CBO
Recuperative Care (Medical Respite)
A. Short-term residential care for homeless individuals who no longer require hospitalization but still need to heal from an injury or illness (including behavioral health conditions) and whose condition would be exacerbated by an unstable living environment.
B. Recuperative care allows individuals to continue their recovery and receive post-discharge treatment while obtaining access to primary care, behavioral health services, case management, and other supportive social services.
C. Recuperative Care is primarily used for individuals who are experiencing homelessness or those with unstable living situations who are too ill or frail to recover from an illness (physical or behavioral health) or injury in their usual living environment, yet are not otherwise ill enough to be in a hospital or qualify for another safe option.
D. Program Overview :
• Recuperative Care allows recovery and oversight after acute medical in-patient hospitalization or skilled nursing facility care in order to improve health outcomes of our Persons.
• It provides our Persons the opportunity to access medical and supportive services needed to assist their recuperation.
• It improves the lives of our most vulnerable population.
Day Habilitation Programs
Assist the Member in self-help, socialization, and adaptive Provided in a Member’s home or an out-of-home, non-facility setting Often considered peer mentoring when provided by an unlicensed caregiver with the necessary training and supervision.
Day habilitation services reimbursement does not include reimbursement for the cost of the activities in which the participant is participating when they receive skills training, such as the cost to attend a community event or a camp.
Reimbursable activities include:
• Person-centered monitoring, training, education, demonstration, or support to assist the participant with the acquisition and retention of skills in the following areas:
• Leisure activities and community/public events (i.e. integrated camp settings);
• Educational activities; Hobbies; Unpaid work experience (i.e. volunteer opportunities); and Maintaining contact with family and friends.
• Training and education in self-direction designed to help participants achieve one or more of the following outcomes:
• Develop self-advocacy skills.
• Exercise civil rights.
• Acquire skills that enable the ability to exercise self-control and responsibility over services and supports received or needed
• Acquire skills that enable the participant to become more independent, integrated or productive in the community.
Activities Not Allowed:
• Services that are available under the Rehabilitation Act of 1973 or PL 94-142.
• Skills training for any activity that is not identified as directly related to a participant habilitation outcome.
• Activities that do not foster the acquisition and retention of skills.
• Activities that would typically be a component of a person’s residential life or services, such as: shopping, banking, household errands, appointments, etc.
• Services furnished to a minor by parent(s), stepparents(s) or legal guardian.
• Services furnished to a participant by the participant’s spouse.
Nursing Facility Transition/Diversion to Assisted Living Facilities
Nursing Facility Transition/Diversion services assist individuals to live in the community and/or avoid institutionalization when possible. The goal is to both facilitate nursing facility transition back into a community setting, like an assisted
BETTER IN PERSON INC. dba BIP INC – 2024 COMMUNITY SUPPORTS OVERVIEW
living facility, and/or prevent nursing home placement for Persons with an imminent need for nursing facility level of care. Persons have a choice of residing in an assisted living setting as an alternative to long-term placement in a nursing home when they meet eligibility requirements.
The assisted living provider is responsible for meeting the needs of the Member, including assistance with Activities of Daily Living (ALDs), Instrumental ALDs (IALDs), meals, transportation, companion services, medication oversight, and therapeutic social and recreational programming provided in a home-like environment.
This includes 24-hour direct care staff on-site to meet scheduled unpredictable needs in a way that promotes maximum dignity and independence, and to provide supervision, safety, and security.
Eligibility and Exclusion Criteria
Nursing Facility Transition
To be eligible for Nursing Facility Transition Services, a person:
• Has resided in a nursing facility for 60 days or longer
• Is willing to live in an assisted living setting as an alternative to a nursing home
• Can a person reside safely in an assisted living facility with appropriate and cost-effective support?
Nursing Facility Diversion
To be eligible for Nursing Facility Diversion Services, a person must be:
• Interested in remaining in the community;
Willing and able to reside safely in an assisted living facility with appropriate and cost-effective supports and services
• Currently receiving a medically necessary nursing facility level of care or meeting the minimum criteria to receive nursing home services and in lieu of going into a facility, is choosing to remain in the community and continue to receive medically necessary services at an assisted living facility.
Personal Care and Homemaker Services
Personal Care and Homemaker Services (PCHS) are provided to individuals who need assistance with Activities of Daily Living (ADLs) such as bathing, dressing, toileting, ambulation, or feeding. These services may include:
• Domestic chores
• Personal care
• Paramedical assistance
• Other services
Personal Care and Homemaker Services aid individuals who could otherwise not remain safe in their homes and to avoid institutionalization.
Eligibility Requirements
• Persons who have applied for In-Home Supportive Services (IHSS) and are pending a decision may be eligible for PCHS during the application waiting period.
• Persons enrolled in IHSS and awaiting decision related to change in condition may be eligible for PCHS during the reassessment waiting period.
• Persons seeking additional IHSS hours beyond the Department of Public Social Services (DPSS)-approved hours may be eligible for PCHS.
• Persons denied or determined ineligible for IHSS may be eligible for PCHS.
Exclusions
• If a person receiving PCHS has any change in their current condition, they must be referred to IHSS for reassessment and determination of additional hours. Persons may continue to receive PCHS during this reassessment waiting period.
• Persons who have either been denied for IHSS or need Community Supports shall supplement and not supplant services received through other State, local, or federally funded programs.
Environmental Accessibility Adaptations
Environmental Accessibility Adaptations (EAAs, also known as Home Modifications) are physical adaptations to a home that are necessary to ensure the health, welfare, and safety of the individual, or enable the individual to function with greater independence in the home: without which the Member would require institutionalization. Examples of environmental accessibility adaptations include:
• Custom ramps and grab-bars to assist Persons in accessing the home
• Doorway widening for Persons who require a wheelchair
• Stair lifts
• Making a bathroom and shower wheelchair accessible (e.g., constructing a roll-in shower).
• Installation of specialized electric and plumbing systems that are necessary to accommodate the medical equipment and supplies of the Member
• Installation and testing of a Personal Emergency Response System (PERS) for Persons who are alone for significant parts of the day without a caregiver and who otherwise require routine supervision (including monthly service costs, as needed).
Eligibility Requirements
• Individuals at risk for hospitalization or institutionalization in a nursing facility.
Exclusions
• If Durable Medical Equipment (DME) is available and would accomplish the same goals of independence and avoiding institutional placement, that service should be used.
• Home Modifications should not exceed a total lifetime maximum of $7,500. The only exceptions to the $7,500 total maximum are if the Member's place of residence changes or if there are significant change(s) in the Member's condition that additional modifications are necessary to ensure the health and safety of the Member or to enable the Member to function with greater independence in the home and avoid institutionalization or hospitalization.
• Modifications are limited to direct medical or remedial benefit and exclude adaptations that are general home improvements or aesthetic embellishments.
• Written Homeowner consent is required before the start of a physical adaptation to the home. Recipients policy and the State are not responsible for maintenance, or repair of any modification, or for the removal of any modification if the Member moves from the residence.
Medically Tailored Meals
MTMs are healthy, home-delivered meals customized and fully prepared for individuals living with advanced illnesses, including diabetes, heart failure, end-stage renal disease, HIV and cancer. These meals help meet the specific dietary needs of program participants with health conditions such as heart disease, diabetes, and HIV.
A. Our program has a private chef that would prepare meals based on meal plan
B. Dietician or RN will have to provide an exact Diagnostic background with HX of allergies, medications and current RX’s, and ideal diet.
Outcome Expectations
A. A diabetic client will get his A1C levels under control
B. A morbidly obese client will start to lose weight
C. Our staff will deliver to client’s houses
D. This will improve the overall health and wellbeing of the client.
Sobering centers
Sobering centers present an intriguing, cost-effective alternative for providing care to persons with acute intoxication whose public alcohol or drug use puts themselves or others at risk. New interest in the decades-old approach has been sparked by California Advancing and Innovating Medi-Cal (CalAIM), which is a multiyear process led by the California Department of Health Care Services to improve the health outcomes and quality of life experienced by Medi-Cal patients. CalAIM will designate sobering centers as one of 14 reimbursable, nontraditional services available to augment, or supplant medical care. The reforms are designed to foster greater integration between physical health, mental health, and social services for all
Medi-Cal enrollees.
A sobering center is a short-term care facility designed to allow an individual who is intoxicated and nonviolent to safely recover from the debilitating effects of alcohol and, more recently, drugs. The centers typically operate 24 hours a day, seven days a week, and have lengths of stay ranging from four to just under 24 hours. They are also known as stabilization programs, recovery programs, diversion centers, and sobering stations. Sobering centers are separate and distinct from two other kinds of alcohol-related care facilities: detoxification centers, which support individuals in the gradual and complete cessation of alcohol consumption over a period of days, and sober living houses, which provide a group residential setting for those in recovery and abstinent from drugs and alcohol. In addition to providing a secure environment to recover from intoxication, sobering centers typically offer screenings for
A. Substance use disorders
B. Acute medical and mental health conditions
C. Injuries, and health care services eligibility well as brief interventions, including
motivational interviewing.
Asthma remediation modifications
Asthma remediation modifications are limited to those that are of direct medical or remedial benefit to members and exclude adaptations or general utility improvements to the home. Members cannot be part of a duplicate asthma remediation program. Required documentation When authorizing Asthma Remediation as a CS, the managed care plan must receive and document.
A. A current licensed health care provider’s order specifying the requested remediation for the member.
B. A brief written evaluation specific to the member describing how and why the remediation meets the needs of the individual.
C. That a home visit has been conducted to determine the suitability of any requested remediation for the member. Before commencement of a permanent physical adaptation to the home or installation of equipment in the home, the owner and member must be provided with written documentation that the modifications are permanent and that the state is not responsible for maintenance, repair or removal of any modification. Where to refer members for asthma remediation services Use the resources below to connect Medi-Cal members to housing services, financial assistance, food pantries, medical care and other no-cost or reduced-cost help
D. Use findhelp -- Search for CS programs that support members with social determinants of health needs. The platform makes it easy to refer members to CS providers and close the loop on referrals. Follow the steps below to search. - Go to https://communitysupportsecm.findhelp.com/- Enter a ZIP Code and search - Choose from the categories. Services vary by ZIP Code - Select the CS provider or service that best meets the member's needs.
E. Use the provider directory -- If you identify a member who qualifies for CS, use the provider directory to identify and contact a CS provider. The provider directory can be found on the CalAIM Resource Page, https://www.cahealthwellness.com/providers/resources/calaim-resources.html.
Program details
F. Total lifetime maximum: $7,500.
G. Coding: Healthcare Common Procedure Coding System (HCPCS) code S5165 U5.
H. Allowable providers: Providers must possess experience and expertise specific to these services. I. State services to avoid: Inpatient and outpatient hospital services and emergency department services. Health plan resources Health Net offers an Asthma Management Program where you can get help and support to manage your asthma. The program seeks to increase your knowledge and prevent emergency room visits. Through the program, you can receive:
J. Asthma education materials.
K. Outreach calls if you’re deemed high-risk.