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Community Supports Recuperative Care

Recuperative care is also referred to as medical respite care. It is short-term residential care for homeless individuals who no longer require hospitalization. These individuals still need to heal from an injury or illness (including behavioral health conditions), and their condition would be exacerbated by an unstable living environment.

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

Program Overview

  • Allows recovery and oversight after acute medical in-patient hospitalization or skilled nursing facility care in order to improve health outcomes of our members
  • Provides members the opportunity to access medical and supportive services needed to assist their recuperation
  • Improves the lives of the most vulnerable population

Eligibility Criteria and Exclusion Criteria

Eligibility Criteria

In order to qualify, Members must: 

  • Be an active, homeless* L.A. Care MCLA or CMC member; AND
  • Be in a post-hospitalization or post-skilled nursing facility; AND
  • Have one of the following:
    1. A defined home health skilled need, such as: Physical therapy, occupational therapy or speech therapy
    2. Ongoing IV antibiotics
    3. Wound Care  

OR 

  • Be in the midst of, or in need of, an outpatient treatment that if interrupted or delayed would cause undue harm.

 

*Homeless is defined as:

  • Members who meet the HUD definition of homelessness or
  • Members who are exiting an institution (such as jail, hospital, or SNF) after more than 90 days and would become homeless immediately upon release   
Exclusion Criteria

Members are not eligible if any of the following apply: 

  1. Member is unable or unwilling to independently complete ADLs
  2. Member is dependent for medication administration;
  3. Member is incontinent
  4. Member is gravely disabled;
  5. Members must be medically and psychiatrically stable
  6. Member is cognitively impaired
  7. Member has been recently combative, aggressive and/or threatening towards staff or other individuals
  8. Member has a peripherally inserted central catheter (“PICC Line”) and is on IV medications depending on other factors
  9. Member is unable to live independently
  10. Member has tested positive for Covid-19 within the last 10 days and/or is still exhibiting symptoms
  11. Active Tuberculosis/C-DIFF/MRSA
  12. Members are generally ineligible with limited exceptions if member is oxygen dependent, has stage 3 or 4 decubitus, is actively detoxing or is quadriplegic

Referral Process

Who can refer?

  1. Anyone can refer to the program, no wrong door.
  2. However, our recuperative care referral form requires extensive information, including member history, clinical documentation, and a plan for follow-up services, so it's best to coordinate referral submission with someone who can provide this information.
  3. Initial referral and transfer request can be submitted using the referral form.

How can I submit a referral?

  1. Referrers can submit the referral form via secure fax to 1.213.536.0634.
  2. Eventually, referrers will be able to submit via the SyntraNet provider portal.

Please refer to the our Quick Reference Guide for more information, including timeline and responsibilities.

Discharge Process

When is a member discharged from recuperative care?

  1. Member does not meet extension criteria. In order to qualify for an extension in recuperative care, a member must continue needing medical oversight and continued care. Additionally, a member may not exceed the 90 day approval period. 
  2. 90 day stay completed.
  3. Recuperative care is limited to two continuous durations per 12-month period.

Discharge process

  1. Discharge planning should begin day one (1).
  2. Extensions must be requested 10 days prior to authorization expiring. 
  3. L.A. Care holds the authority to approve or deny these extensions. 

How is a member discharge reported to L.A. Care?

  1. Recuperative Care provider must notify L.A. Care of discharge via SyntraNet and must attach members discharge summary to system. 
Contact L.A. Care's Recuperative Care Team

Send us a message if you have questions.

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Resources

L.A. Care Request for Recuperative Care Extension
L.A. Care Recuperative Care Community Supports Program Reference Guide
L.A. Care Recuperative Care Prior Authorization Request