How do I refer someone to Mana Respite?
Two state forms make a complete referral: the DHS 1214 Medical Respite Authorization, signed by a qualified health professional (MD, DO, NP, or PA), and the DHS 1211 CIS+ Member Consent, signed by the member. Fax the 1214 to the member’s health plan, then send a copy to Mana Respite at referrals@manarespite.org or fax (808) 309-6001 so we can hold a spot and coordinate placement. Both forms, the health plan fax numbers, and a step-by-step guide are on our Refer and Contact page.
Who can make a referral?
Hospital discharge planners, case managers, social workers, shelter and outreach staff, street medicine teams, emergency departments, community providers, health plan care coordinators, family members, and individuals themselves can all start a referral. The authorization form itself must be reviewed, approved, and signed by a qualified health professional who is free from conflicts of interest with Mana Respite.
Should I wait until the member is discharging to refer?
No. Refer as early as you can. Under the July 2026 guidance, Short-Term Recuperative Care is open both to members currently in institutional care and to members at risk of institutionalization, and the authorization form accepts referrals from institutions and from other sources such as community providers, street medicine teams, and emergency departments. Short-Term Post-Hospitalization Housing still requires the member to be in institutional care at the time of referral. Once the form reaches the health plan, the plan has up to seven days to determine eligibility, and for a member who is admitted somewhere the plan is expected to screen before discharge. Timing still matters.
Who can sign the referral?
The DHS 1214 authorization must be reviewed, approved, and signed by a qualified health professional, meaning a Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO), Nurse Practitioner (NP), or Physician Assistant (PA). Support staff, a discharge planner, or a coordinator may complete the form as long as the qualified health professional gives the final review, approval, and signature. The coordinator is listed separately on the form. For a new authorization, the signing clinician must be free from conflicts of interest with the medical respite provider, so Mana Respite cannot supply the signing clinician for an initial referral. We are glad to answer questions and help you screen. Extensions and the continued-stay forms are treated differently and may be signed by a qualified health professional affiliated with the respite provider.
Do I also need to send a CIS+ Referral Form?
No. If the Medical Respite Authorization Form is completed, a separate CIS+ Referral Form is not needed. The referral form exists so that people who are not qualified health professionals can still flag a member’s potential need to the health plan.
What medical respite service type does Mana typically provide?
Short-term recuperative care. Our members are usually leaving a psychiatric hospital, crisis unit, or other institution with ongoing mental health and substance use needs that still call for monitoring and recovery support. Recuperative care is the type built for that: clinically oriented recovery and monitoring of ongoing psychiatric needs, for up to 90 days. The other two service types fit different situations. Pre-procedure housing is tied to a planned medical procedure, and post-hospitalization housing is for lighter support after a discharge.
How long can a member stay under CIS+?
Length of stay is set by clinical need, not a fixed number. Short-Term Recuperative Care, the service Mana Respite most often provides, allows up to 90 consecutive days. Short-Term Pre-Procedure Housing is limited to seven days before a procedure and three days after. Short-Term Post-Hospitalization Housing has no separate cap of its own. Across all three types, the benefit is capped at a combined six months within a rolling 12-month period. For any stay longer than 30 days, a qualified health professional must submit an updated authorization form (Parts 1 through 3) every 30 days, and the plan then has 14 days to confirm the stay is still clinically appropriate.
Can the member choose Mana Psych Respite?
Members have the right to pick the CIS+ provider that delivers and monitors their services, and they affirm that right when they sign the DHS 1211 consent form. The consent form itself has no field for naming a provider, so make the preference known directly. Tell the health plan, and send us a copy of the referral, and we will coordinate from there. The health plan makes the final placement decision based on the member’s clinical needs and what a given provider can support.
Can a member come to Mana before the plan authorizes?
Sometimes. Medical respite providers may accept a member before authorization is issued, and the health plan then has seven days to complete a retroactive authorization back to the date of admission. The respite provider and the discharging hospital must agree in writing beforehand which party carries the financial risk if the plan ultimately denies the request. Talk with our intake team before arranging this.
Does Mana provide nursing or administer medications?
No. Mana Psych Respite is behavioral-health-focused respite for members who can manage their own daily activities and self-administer their medications. It does not provide skilled nursing, post-surgical or wound care, and staff don’t administer medications to members. Staff do coordinate and observe members taking their medications, record member medication compliance in an electronic medical record, and communicate and coordinate as needed with prescribers.
What happens after the forms are submitted?
The member’s health plan reviews the authorization and has up to seven days to determine eligibility, though in practice it is often shorter. This is why it matters to complete and submit the forms as soon as possible. The plan also arranges a person-centered service plan within three days of authorization. Members receiving recuperative care or post-hospitalization housing are automatically eligible for Housing Navigation supports, and the authorization form asks whether the member needs them. Our intake team reviews referrals and will reach out to the member and the referring contact to arrange placement.
