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TEAMKY Demonstration

Approval Period: January 1, 2025 through December 31, 2029

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EXHIBIT 1: Breakdown of HRSN Services The following reflects breakdown of HRSN services comprehensively, highlighting the nuanced categories and requirements, specifically the structure for both pre-procedure and post-transition housing under the program. 1. Short-Term Pre-Procedure Housing Table 2. Short-Term Pre-Procedure Housing Description/Definition Frequency Duration Detailed Setting/Provider Requirements Minimum Eligibility Criteria Episodic housing interventions with clinical services with room and board, limited to a clinically appropriate amount of time, including:

 Short-term pre- procedure housing, where a provider has determined that preparatory steps are required for an upcoming procedure or treatment and integrated, clinically oriented recuperative or rehabilitative services and supports are provided.

Provided on an as-needed basis, depending on the individual’s pre- procedures preparation schedule and care plan.

Short term pre procedure housing services can be provided for more than one stay for up to 6 months in a rolling year if determined medically necessary and patient meets eligibility criteria Duration depends on the specific pre- procedure needs, typically ranging from 1 to 7 days prior to the procedure.

Short term pre procedure housing services can be provided for more than one stay, not to exceed6 months in a rolling year, if determined medically necessary and patient meets Must be a recuperative care facility with:  24/7 staffing by clinical professionals, allied health professionals, and/or paraprofessional staff.  Daily wellness checks, vital sign monitoring, and pain management.  Medication monitoring and secure double- locked storage.  Capability to provide 3 meals per day.  Capability to arrange for transportation for follow-up appointments, and access to  Must be Medicaid eligible.  At least 18 years of age.  Have a primary medical diagnosis requiring a planned procedure.  Must be independently mobile, with or without assistive devices.  Capable of performing basic ADLs.  Demonstrates risk of hospitalization or other adverse outcomes without housing support during the pre-