Beginning January 1, 2026, Hawaii’s Med-QUEST Division expanded the Community Integration Services (CIS) program into Community Integration Services Plus (CIS+), introducing an important new benefit known as Medical Respite. One of the most significant additions for behavioral health providers is Psychiatric Respite, a short-term Medicaid benefit designed to help eligible members safely recover from acute psychiatric or behavioral health conditions while avoiding unnecessary hospitalization and homelessness.
For behavioral health organizations across Hawaii, CIS+ Psychiatric Respite represents an opportunity to provide a much-needed level of care while helping members transition successfully into stable community living.
What Is CIS+ Psychiatric Respite?
Psychiatric Respite is part of Hawaii Medicaid’s Medical Respite benefit under the Section 1115 Demonstration Waiver. Rather than remaining in a hospital or returning to homelessness after discharge, eligible Medicaid members may temporarily reside in a clinically supportive setting where they receive ongoing behavioral health support, wellness monitoring, medication assistance, housing stabilization, and care coordination.
The program recognizes something behavioral health professionals have known for years:
Recovery is significantly more successful when patients have safe housing, daily support, and coordinated healthcare.
Instead of relying solely on inpatient psychiatric units or emergency departments, Psychiatric Respite creates an intermediate level of care that promotes recovery while reducing avoidable readmissions.
Who Qualifies?
Members generally must:
- Be enrolled in Hawaii QUEST Integration Medicaid
- Be homeless or at risk of homelessness
- Have a qualifying behavioral health or physical health condition
- Meet the medical necessity requirements established by the member’s Medicaid health plan
- Voluntarily consent to participate in the program
Behavioral health eligibility commonly includes individuals experiencing:
- Serious Mental Illness (SMI)
- Acute psychiatric stabilization needs
- Substance Use Disorders
- Co-occurring mental health and substance use conditions
- Members requiring continued recovery following psychiatric hospitalization
Three Levels of Medical Respite
Although many providers refer broadly to “Psychiatric Respite,” the CIS+ program actually includes three distinct Medical Respite benefits.
1. Short-Term Pre-Procedure Housing
Designed for members who require temporary housing before or immediately after a planned medical treatment or procedure.
Examples include:
- Electroconvulsive Therapy (ECT)
- Chemotherapy
- Surgical procedures
- Colonoscopy preparation
- Short-term psychiatric medication stabilization before treatment
Generally limited to:
Up to 3 days following treatment
Up to 7 days before treatment
2. Short-Term Recuperative Care
This is the level most behavioral health providers associate with Psychiatric Respite.
Members receive:
- Temporary housing
- Daily wellness monitoring
- Medication support
- Care coordination
- Behavioral health services
- Recovery-focused support
A member may remain for up to 90 consecutive days, provided medical necessity continues and the overall Medical Respite benefit limit has not been exceeded.
3. Short-Term Post-Hospitalization Housing
This benefit assists members immediately following discharge from:
- Psychiatric hospitals
- Acute care hospitals
- Residential treatment
- Other qualifying institutional settings
The objective is to prevent unnecessary readmission by providing housing and continued clinical support during recovery.
What Services Must Providers Deliver?
Medical Respite is much more than temporary housing.
Participating providers are expected to deliver a comprehensive package of services, including:
- Safe private sleeping accommodations
- Three meals daily
- Medication support
- Daily wellness checks
- Care coordination
- Transportation coordination
- Linkage to primary care
- Behavioral health coordination
- Housing stabilization planning
- Community resource referrals
- Person-centered service planning
- Discharge planning
The emphasis is on helping members recover physically and emotionally while preparing for long-term community integration.
Required Documentation
Like every Medicaid benefit, documentation is critical.
Before billing CIS+ Medical Respite services, providers should maintain complete documentation, including:
- CIS+ Referral Form
- Medical Respite Authorization Form
- Member Consent
- CIS+ Assessment
- CIS+ Action Plan
- Person-Centered Service Plan
- Daily progress documentation
- Wellness monitoring records
- Medication support documentation
- Discharge planning documentation
Incomplete documentation may place reimbursement at risk during payer audits.
Billing CIS+ Psychiatric Respite
Unlike traditional outpatient behavioral health billing, Medical Respite uses per diem bundled reimbursement.
Current HCPCS codes include:
| Service | HCPCS Code |
|---|---|
| Pre-Procedure Housing | S5151-SC |
| Post-Procedure Housing | S5151-SE |
| Short-Term Recuperative Care | S9125-22 |
| Short-Term Post-Hospitalization Housing | S9125-SC |
Current Hawaii Med-QUEST reimbursement is $274 per authorized member per day for Medical Respite services, subject to health plan authorization and applicable program requirements.
Unlike fee-for-service outpatient billing, the bundled rate includes the required housing and support services associated with the Medical Respite benefit.
Prior Authorization Is Required
Medical Respite cannot be billed without authorization.
A qualified clinician—including a physician (MD/DO), nurse practitioner, or physician assistant—must complete and sign the Medical Respite Authorization Form. The member’s Medicaid health plan then reviews eligibility, medical necessity, and authorizes the appropriate level of Medical Respite before services begin.
Why This Matters for Behavioral Health Providers
Psychiatric hospitals, crisis stabilization programs, community mental health centers, and behavioral health organizations have long struggled with members who are clinically stable enough for discharge but lack a safe place to recover.
Without appropriate transitional support, these members often:
- Return to homelessness
- Miss medications
- Experience psychiatric relapse
- Visit emergency departments repeatedly
- Require avoidable inpatient readmissions
CIS+ Psychiatric Respite helps bridge that gap by combining housing with structured behavioral health support, creating a more stable environment for recovery while improving continuity of care.
How Access Revenue Hawaii Can Help
Successfully implementing CIS+ Medical Respite requires much more than understanding billing codes. Providers must navigate eligibility requirements, prior authorizations, documentation standards, care planning, payer expectations, and ongoing compliance.
Our team works with behavioral health organizations throughout Hawaii to support:
- CIS+ implementation planning
- Medical Respite billing workflows
- Prior authorization strategies
- Documentation and compliance reviews
- Medicaid enrollment and contracting
- Revenue cycle management
- Claims submission and denial management
- Staff education and operational readiness
Whether you’re launching a new Psychiatric Respite program or strengthening an existing service line, Access Revenue Hawaii can help you build compliant workflows that support both quality care and sustainable reimbursement.
Complimentary Revenue Cycle Assessment
If your organization is considering offering CIS+ Psychiatric Respite services—or is already providing them—we invite you to schedule a Complimentary Revenue Cycle Assessment.
We’ll review your workflows, identify potential compliance or reimbursement risks, and provide practical recommendations to help maximize operational success under Hawaii’s evolving Medicaid landscape.
Now, through our website launch, new behavioral health clients also receive 50% off our one-time onboarding fee.