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MMP 24-27: Targeted Case Management - Recuperative Care
Effective date
Sep 1, 2024
Identified
Jun 20, 2026
Summary
Michigan Medicaid covers Recuperative Care (RC), a short-term transitional program under Targeted Case Management, for Medicaid beneficiaries 18 years and older who are homeless, discharging from an inpatient hospital admission, and too ill or frail to return to their living environment. RC coverage does not exceed 90 days per hospital discharge, and RC providers must be Medicaid-enrolled and meet the National Institute for Medical Respite Care standards. Implementation is contingent upon CMS approval of a State Plan Amendment.
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What to do
Action · 11 steps
01Already effective September 1, 2024 for dates of service on or after that date, contingent upon CMS approval of a State Plan Amendment: Before the start of RC services, obtain prior authorization from the MDHHS Program Review Division for every beneficiary by calling the PRD Recuperative Care phone line at 844-732-8764 for a telephonic request.
02For Medicaid fee-for-service beneficiaries, obtain prior authorization for care coordination (G9002) and room and board (S9976).
03For Medicaid Health Plan beneficiaries, obtain prior authorization for room and board (S9976).
04Complete the Recuperative Care Prior Authorization Request Data Form (BPHASA-2427) before requesting prior authorization and keep it in the beneficiary's record.
05Have the completed form, most recent history and physical, social work notes, hospital consultation reports, emergency department notes if applicable, the signed and dated plan of care, the signed and dated registered nurse assessment, PT and/or OT assessment, the hospital discharge plan completed within two days of the request, documentation that the beneficiary is homeless, and the anticipated admission and discharge dates available during the call.
06Bill the RC services as a professional claim with an approved RC HCPCS code: S9976 at 1 unit per visit per day and G9002 at 1 unit per visit per day, and record the PA number from the Medicaid Authorization Letter on the claim.
07Bill TCM-RC services to the MHP if the beneficiary is enrolled in an MHP, and to CHAMPS as a fee-for-service claim if enrolled in Medicaid FFS; submit room and board for both MHP and FFS enrollees through CHAMPS.
08Medicaid reimburses the day of admission if the beneficiary is in the facility before midnight and does not reimburse the day of discharge.
09Verify beneficiary eligibility monthly at a minimum, because MDHHS will not reimburse services provided and billed on a date the beneficiary is not eligible.
10Professional services and durable medical equipment and medical supplies are not covered by RC and must be billed by the appropriate enrolled provider.
11RC providers must enroll with a Type 2 (Organization) NPI and a CHAMPS application, complete the Michigan Recuperative Care Provider Attestation Form (BPHASA-2428) every three years, and revalidate every five years; failure to complete these requirements will result in termination as a Medicaid RC provider.
Codes mentioned
G9002S9976
Original notice
MMP 24-27: Targeted Case Management - Recuperative Care
michigan.gov · Always check the source before changing claims.