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Pennsylvania Keystones of Health Section 1115 Demonstration Approval Period: December 26, 2024 through December 31, 2029 Page 20 of 90 i. Housing supports without room and board, including: 1. Pre-tenancy navigation services (e.g., finding and securing housing). 2. One-time transition and moving costs other than rent, to assist with identifying, coordinating, securing, or funding one-time necessary services and modifications to help a person establish a basic household (e.g., security deposit, application and inspection fees, utilities activation fees and payment in arrears as necessary to re-establish utility service (capped at a total of six months of total arrear and prospective payments), movers, relocation expenses, pest eradication, pantry stocking (up to 30 days of food), cooking supplies, and the purchase of household goods and furniture). Allowable utilities include water, garbage, sewage, recycling, gas, electric, internet, and phone services. This does not include clothing. 3. Tenancy and sustaining services (e.g. eviction prevention, tenant rights education). ii. Utility assistance, capped at six months per demonstration period for total prospective/retrospective payments (utility assistance provided as a one-time transition service under STC 6.2.b.i.2 is included in this limit), including activation expenses and back payments to secure utilities, limited to individuals receiving housing supports with or without room and board as described in this STC. Allowable utilities include water, garbage, sewage, recycling, gas, electric, internet, and phone services. iii. Room and board-only supports (also referred to as “rent-only” supports or interventions), limited to a clinically appropriate amount of time, including: 1. First month’s rent as a transitional service. 2. Short-term rental assistance with room alone or with room and board together, without clinical services included in the rental assistance payment. c. Nutrition interventions (standalone, outside of joint room and board interventions): i. Nutrition interventions with provision of food, including: 1. Home delivered meals or pantry stocking (also referred to as grocery provisions), appropriate for the beneficiary’s health condition or status as a child or pregnant person. 2. Medically tailored meals to individuals with nutrition-sensitive conditions (e.g., pregnant individuals, individuals with diabetes), as specified in STC 6.6. 6.3. HRSN Intervention Duration and Frequency. a. Housing interventions with room and board.