Introduction to Community Integration Services (CIS)

Program Introduction

Community Integration Services (CIS) - Supportive Housing Services are the MEDICAID REIMBURSABLE SUPPORTIVE SERVICES available to eligible Medicaid members, that when paired with affordable housing are a cost-effective way to:

• Engage members experiencing homelessness
• Help reduce homelessness
• Increase housing stability

Supportive Housing is an evidence-based practice that combines affordable housing with supportive services that help eligible individuals access housing resources and remain successfully housed

Our aim is that eligible members remain successfully housed

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Program Introduction

CIS funds supportive housing services including pre-tenancy and post-tenancy support services intended to help members attain and maintain safe, affordable housing.

• CIS does not cover most housing expenses.
• CIS does not have an inventory of housing units.

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More importantly, CIS seeks to engage the member in self-care and personal management by establishing a personalized housing support plan that is holistic and reflective of his or her preferences and goals.

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CIS assists eligible Medicaid members with becoming fully integrated members of the community as well as achieving improved health outcomes and life satisfaction.

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Eligibility Criteria

SECTION ONE

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Eligibility Criteria

Any Medicaid eligible member who is homeless or is at risk of becoming homeless can be referred to the member’s QI health plan to receive a CIS screening.

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There are no restrictions on who can make the referral.

The DHS is expecting referrals to come from a variety of sources including but not limited to:

• Self
• Family members
• Homeless services providers
• Other community-based organizations
• Healthcare providers

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Eligibility Criteria

There are (3) three criteria required to meet eligibility for CIS services:

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Eligibility Criteria

#1

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Eligible Members must be

18 years or older.

Eligibility Criteria

#2

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Eligible Members must have

specific health needs.

Eligibility Criteria

#3

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Eligible Members must have

specific risk

factors.

Health Need - Based Criteria

In addition to being 18 years old or older, the member meets at least ONE of the following health needs-based criteria and is expected to benefit from CIS:

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Behavioral Health Need, where individual is assessed to have a behavioral health need which is defined as one or both of the following criteria:

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Mental Health Need, where there is a need for improvement, stabilization, or prevention of deterioration of functioning (including ability to live independently without support) resulting from the presence of a serious mental illness; and/or

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Substance Use Need, where an assessment indicating the need for intensive outpatient treatment for a Substance Use Disorder.

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Complex Physical Needs

Member assessed to have a complex physical health need, which is defined as a long continuing or indefinite physical condition requiring improvement, stabilization, or prevention of deterioration of functioning (including the ability to live independently without support).

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Eligibility Criteria Summary

To be eligible for CIS Services a member must be:

• 18 years old or older
• meet a health need-based criteria AND a risk factor

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18 years or older

HEALTH NEEDS

Mental Health Need

Complex Physical Health Need

Substance Use Need

RISK FACTORS

Homelessness

At Risk of Homelessness

CIS Provider Roles and Responsibilities

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CIS Provider Roles & Responsibilities

Identification of Potential CIS Members

CIS Referral and Eligibility Verification

CIS Member Consent / Assessment / Action Plan

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Documentation – Progress Notes

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Service Settings

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Monthly Supports

• Pre-Tenancy Services
• Tenancy Services

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CIS Referral Form

The Health Plan will assign the following CIS authorizations as appropriate for program services.

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• Referral form: for newly identified members for the program for initial outreach and initial CIS documents; form must be completed and turned into health plan

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• Once health plan receives referral and eligibility has been confirmed, initial authorization will be sent to the provider

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CIS Provider Changes

• The health plan may decide to change CIS providers as needed if doing so would be in the best interest of the CIS member.

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• Any time there is a change in the CIS provider for a given member, the health plan shall support the transition of care through warm hand-offs.

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Opt-Out

• Members enrolled in CIS will have the option to opt-out of the CIS program at any time.

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• This opt-out option shall only be initiated by the member.

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• Member may inform the CIS provider or the health plan when exercising the opt-out option.

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• Members who opt out and are disenrolled from the CIS program shall have the option to re-enroll after the member is reassessed and is determined to be eligible for the CIS program.

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Disenrollment Criteria

Members may be disenrolled from the CIS program.

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Possible Disenrollment Reasons

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The member:

• Requested voluntary disenrollment - option to “opt out” of the CIS program
• Moved into a licensed/certified HCBS (Home and Community –Based Services) home, therefore no longer meets criterion for CIS services
• Lost Medicaid eligibility
• Is lost to follow-up
• Has been stably housed for at least 12 months without incident, and the member and health plan mutually agree that CIS services are no longer needed

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Re-Enrollment Criteria

Nothing shall prevent a currently enrolled Medicaid member who was formerly enrolled in the CIS program from again enrolling in the CIS program if the CIS CONSENT and MEMBER REQUIREMENTS FORM is signed by the member and the member meets eligibility criteria.

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Thank You.