Page 34

Pennsylvania Keystones of Health Section 1115 Demonstration Approval Period: December 26, 2024 through December 31, 2029 Page 21 of 90 i. Housing interventions that are classified as room and board-only support, as described in STC 6.2.b.iii, may be covered for a qualifying beneficiary up to a combined 6 months per household per demonstration period. ii. For this 6-month cap, coverage will be permitted in one or more spans or episodes, as long as the total duration remains under the cap for the demonstration period. b. Nutrition interventions with provision of food. i. HRSN nutrition interventions with provision of food (full board, i.e., 3 meals/day or any other complete nutritional regimen) are limited to a duration of 6 months, renewable while the beneficiary continues to meet qualifying criteria. ii. HRSN nutrition interventions with provision of food are not available to the extent that that benefit, together with any other service payments that include payment for food made on behalf of the beneficiary, would exceed full board for the beneficiary, as the HRSN nutrition benefit or payment would be duplicative. For example, medically tailored meal delivery is not available for an individual who is receiving short-term rental assistance for a stay in a facility that provides 3 meals per day included in the payment to the facility, and pantry stocking or nutrition prescriptions are not available for an individual who is receiving a full board regimen of medically tailored meals. c. The state will define other HRSN service duration limitations in Attachment F, subject to CMS approval as indicated in STC 6.7. 6.4. Excluded Services. Excluded items, services, and activities that are not covered as HRSN services include, but are not limited to: a. Construction (bricks and mortar) except as needed for approved medically necessary home modifications specified in STC 6.2; b. Capital investments; c. Room and board outside of specifically enumerated care or housing transitions or beyond 6 months, except as specified in STC 6.2 and 6.3; d. Research grants and expenditures not related to monitoring and evaluation; e. Services furnished to beneficiaries for which payment is not available under the inmate payment exclusion in the matter following the last numbered paragraph of section 1905(a) of the Act except case management of HRSN services provided as part of an approved reentry demonstration initiative; f. Services provided to individuals who are not lawfully present in the United States;