Medicaid 1915i: Community Living and Support (CLS)

• Clinical Coverage Policy 8H-5

Submission Requirements

Care Managers (not the provider of the service) submit ALL requests for 1915i services.

Member must be determined eligible for 1915i services.

Initial and Concurrent:

• Service Authorization Request (SAR)
• Person Centered Service Plan with Signed Service Order

Codes:

• T2012 U4- Community Living and Supports Individual (only in community, non-EVV)
• T2013 TF HQ U4 – Community Living and Supports Group (subject to EVV)
• T2012 GC U4 – Community Living and Supports relative as provider lives in home (non-EVV)
• T2013 TF U4 – Community Living Supports – Individual (subject to EVV)

Service Definition Authorization Parameters

• 1 unit = 15 minutes of CLS
• A beneficiary who is in school is eligible for up to 15 hours (or 60 units) a week when school is in session and up to 28 hours (or 112 units) a week when school is not in session.
• For those ages 22 and older, CLS can be authorized up to 28 hours (112 units)/week.
• For those ages 18+ who have graduated (degree indicated standard or occupational course of study, GED, Certificate of completion or proof of exhausting their educational course of study), CLS would be authorized at the up to 28 hours (112 units)/week. This is the same benefit as those ages 22+.
• 1915(i) CLS and 1915(i) Supported Employment (SE) are available as a meaningful day option. 1915(i) CLS and SE cannot exceed a combined limit of 40 hours per week. (If a beneficiary is receiving 1915(i) Community Living and Supports (CLS) for 25 hours per week then Supported Employment (SE) cannot exceed 15 hours per week). A beneficiary 16 years of age and older can access 1915(i) Supported Employment based on the limits outlined in the appropriate policy for 1915i Supported Employment.