CalAim Referral Package

Introduction

CalAIM Referral Package – Clear Path Care Solutions

Clear Path Care Solutions is a CalAIM Community Support (CS) Provider specializing in Skilled Nursing Facility (SNF) Diversion/Transition to Residential Care Facilities for the Elderly (RCFE) and Adult Residential Facilities (ARF) across Los Angeles, Ventura, Sacramento, San Diego, Orange, San Bernardino, and Riverside counties. We collaborate with various Managed Care Plans (MCPs) to assist in transitioning eligible members to appropriate residential care settings. For more information, please contact us for the full list of MCPs we work with.

CalAIM and the Community Support Program
For eligible members, MCPs cover the “assisted living” portion of RCFE/ARF care based on a tiered care level assessment. The member is responsible for paying the “room and board” portion, typically funded through SSI/SSD income (see Additional Eligibility Requirements below).

CalAIM CS Referral Process
To begin the process of transitioning a member, we have developed a CalAIM CS Referral Package, which is submitted to the MCP’s authorization request department. Once the member is authorized, Clear Path Care Solutions will initiate the referral process and help facilitate placements in RCFEs/ARFs for eligible members.

Eligibility for Community Support (CS)

SNF Transition to RCFE or ARF (This allows a current SNF resident to transition to an RCFE or ARF.)

  1. The member has resided in a SNF for at least 60 consecutive days (including a combination of Medicare and Medi-Cal days).
  2. The member is willing to live in an RCFE as an alternative to remaining in a SNF.
  3. The member is able to safely reside in an RCFE with appropriate, cost-effective supports and services.

SNF Diversion to RCFE or ARF (This helps a member who would otherwise need to reside in a SNF and transitions them to an RCFE or ARF.)

  1. The member wishes to remain in the community.
  2. The member is able to safely live in an RCFE with appropriate, cost-effective supports and services.
  3. The member must meet the criteria for SNF-level care, including requiring substantial assistance with activities of daily living (e.g., dressing, bathing, incontinence) or be at risk of premature institutionalization. The member must also meet the eligibility criteria for receiving services in an RCFE or ARF.

Additional Eligibility Requirements for SNF Diversion/Transition

  1. The member is responsible for paying the “room and board” portion of the RCFE costs, and the MCP will cover the “assisted living” portion of the care.
  2. For members receiving SSI/SSP and the 2025 Non-Medical Out of Home Care (NMOHC) payment, SSI/SSP will be increased to $1,599.07. The member will typically retain $179 for personal expenses, with the RCFE receiving the remaining balance of $1,420.07 for “room and board.” Example: If Mr. Johnson is eligible for NMOHC and receives $500/month, he will receive an NMOHC bump of $1,099.07 ($500 + $1,099.07 = $1,599.07). He will pay $1,420.07 for “room and board” and retain $179 for personal needs.
  3. Members not eligible for the NMOHC will still be responsible for the “room and board” portion, but the amount may vary based on the RCFE and assessed tier level.

Authorization and CS Referral Package

Once a member is referred, Clear Path Care Solutions will submit the CS Referral Package to the MCP’s authorization department. Authorization requests typically take 5-7 business days for approval or denial. If authorized, we will inform the member or responsible party and proceed with the referral process to connect the member with potential RCFEs/ARFs.

To Complete the CS Referral Package

  1. The member must be on Medi-Cal with an MCP participating in the CS program for SNF Diversion/Transition. Clear Path Care Solutions is a CS Provider for several MCPs; please contact us for more details.
  2. If the member’s current MCP does not participate in this program, they may need to switch to an eligible MCP. Changes to Medi-Cal coverage typically take effect at the beginning of the following month.
  3. The member must have the capacity to make their own healthcare and financial decisions, or a responsible party must have a Power of Attorney (POA) for Health and Financial Decisions. Both forms must be notarized. You can find a POA for Health [here] and a POA for Finance [here].
  4. Review the eligibility requirements for the “room and board” payment as mentioned above.

Combined package

Clear Path Care Solutions Combined Package Click Here

Individual forms

CalAIM Participant Liability Waiver  Click Here

CS Referral Package Member Summary Click Here

Declaration Elibility Click Here

Freedom of Choice Waiver Click Here

HIPAA AUTHORIZATION FORM Click Here

Room and Board Payment Obligation Click Here

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