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Community Supports (CS)

CS are optional services or settings offered through the CalAIM initiative to eligible Medi-Cal and CareAdvantage members in place of services or settings covered under Medi-Cal. Rather than a benefit, CS are medically appropriate and cost-effective alternative services.

The goal of CS is to improve members’ health outcomes and quality of life by addressing their social determinants of health (SDOH). 

Eligibility and service options

A member may be eligible for Community Supports if they meet the following basic qualifications:

  • Active HPSM Medi-Cal or CareAdvantage member.
  • Engaged with a Care Manager.
  • Willing to receive Community Supports services.

Members who are eligible for the Enhanced Care Management benefit will be eligible for Community Supports. Members may already be authorized to a Community Supports provider and may have received a letter notifying them of their qualification for these services. All HPSM members continue to have access to HPSM’s care coordination support care management team. For detailed information and service-specific eligibility criteria, please see DHCS' Community Supports Policy Guide.

Service options

HPSM offers nine CS service options to qualified members:

provides coordination of services to qualified members. Coverage includes (but is not limited to) nonrecurring home setup expenses for eligible members who are able to transition from a licensed facility into the community. This helps prevent further institutionalization based on each members’ individual needs.

Criteria
  • Residing in a skilled nursing facility (SNF) or medical respite setting for more than 60 days. 
  • Wants to live in the community. 
  • Willing and able to safely reside in a community (home) setting with appropriate supports.
Units per CS service option
CPT Code Service Option Max Units Paid per Auth. Days/Quantity
T2038 U5Community Transitions / Nursing Facility to Home Up to 12 units 1 unit = 1 month

Environmental Accessibility Adaptations

provides physical adaptations to members’ homes that are necessary to avoid institutionalization and increase independence or ensure health, welfare and safety.

Criteria
  • Received physical therapy (PT) or occupational therapy (OT) evaluation supporting medical necessity. 
  • Has primary care provider (PCP) or other health professional prescription or order for medically necessary equipment or service.
Units per CS service option
CPT Code Service Option Max Units Paid per Auth.Days/Quantity
S5165 Environmental Accessibility Adaptations Up to 1 unit 1 unit = $7,500 lifetime max
S5165, U5 Asthma Remediation Up to 1 unit 1 unit = 3 months

identify, coordinate, secure or fund one-time services and modifications to a person’s home that are necessary to enable them to establish a basic household (except room and board) based on their individualized needs.

Criteria
  • Received Housing Transition Navigation services. 
  • Prioritized for permanent supportive housing or rental subsidy through San Mateo County or another resource. 
  • Experiencing homelessness or at risk of experiencing homelessness. 
  • Receiving ECM.
Units per CS service option
CPT Code Service Option Max Units Paid per Auth. Days/Quantity
H0044 Housing Deposits Up to 1 unit 1 unit = 3 months

provide supports that include (but are not limited to) advocacy, housing search and coordination of resources based on the member’s individualized needs.

Criteria
  • Experiencing homelessness or at risk of experiencing homelessness. 
  • Prioritized for permanent supportive housing or rental subsidy through San Mateo County or another resource. 
  • Receiving ECM.
Units per CS service option
CPT Code Service Option Max Units Paid per Auth. Days/Quantity
H0043 Housing Navigation / Transition Services 1 unit per month, up to 6 units 1 unit = 1 month

provides tenancy and sustaining services including (but not limited to) advocacy, coordination, resource referrals, life-skills coaching and health/safety visits with a goal of maintaining stable tenancy once housing is secured based on the member’s individualized needs.

Criteria
  • Received Housing Transitions Navigation services. 
  • Prioritized for permanent supportive housing or rental subsidy through San Mateo County or another resource. 
  • Receiving ECM.
Units per CS service option
CPT Code Service Option Max Units Paid per Auth. Days/Quantity
T2050, U6 Housing Tenancy – Financial Management (per diem) 1 unit per month, up to 12 units 1 unit = 1 month

provides medically tailored home-delivered meals for members with chronic conditions to help achieve their nutrition goals at critical times and help them regain and maintain their health.

Criteria
  • Has chronic conditions or a disabling mental/behavioral health disorder. 
  • Hospital or SNF discharge in the last 60 days or planned for discharge. 
  • Receiving ECM or has extensive care coordination needs.
Units per CS service option
CPT Code Service Option Max Units Paid per Auth. Days/Quantity
S5170 Medically Tailored Meals Up to 168 units 1 unit = 1 meal

provides coordination of services to facilitate nursing facility transition back into a home-like, community setting and/or prevent skilled nursing admissions for members with an imminent need for nursing facility level of care (LOC). Members have the choice of residing in an ALF as an alternative to long-term placement in a nursing facility when they meet eligibility requirements.

Criteria for SNF transition
  • Residing in SNF for more than 60 days. 
  • Willing and able to reside safely in an Assisted Living Facility (ALF) or Residential Care Facility for the Elderly (RCFE) in lieu of a SNF with appropriate supports in place. 
Criteria for SNF diversion
  • Wants to remain in the community. 
  • Meets minimum criteria for SNF level of care. 
  • Willing and able to reside safely in an ALF/RCFE in lieu of SNF with appropriate supports in place.
Units per CS service option
CPT Code Service Option Max Units Paid per Auth. Days/Quantity
T2038 Nursing Facility Transition / Diversion to Assisted Living Facilities Up to 12 units 1 unit = 1 month

provides assistance to members who could not otherwise remain in their homes. Helps with activities of daily living (ADLs) such as ambulation, bathing, dressing, toileting, grocery shopping, meal preparation, feeding and money management. Includes services provided through in-home supportive services (IHSS).

Criteria
  • At risk for hospitalization or institutionalization in a nursing facility. 
  • Has functional deficits and no other adequate support system. 
  • Approved for IHSS.
Units per CS service option
CPT Code Service Option Max Units Paid per Auth. Days/Quantity
S5130, U6 Personal Care and Homemaker Services N/A 1 unit = 15 minutes

provides non-medical, short-term services to members due to the absence of or need to relieve their caregivers to prevent burnout.

Criteria
  • Lives in the community and is compromised in their ADLs and are therefore dependent upon a qualified caregiver who provides most of their support.
  • Requires caregiver relief to avoid institutional placement.
Units per CS service option
CPT Code Service Option Max Units Paid per Auth. Days/Quantity
S5151, U6 Respite Care Up to 336 units 1 unit = 1 hour

Community Supports Provider List

This CS provider list should be used as a reference for referring patients. Before starting referrals, review capacity and eligibility.

24 Hour Home Care

NPI: 1376797035

Phone: 888-324-6225
Fax: 888-522-6796

200 N. Pacific Coast Hwy
Suite 300
El Segundo, CA 90245

Aging and Adult Services

NPI: 1609290030

Phone: 650-573-3900
Fax: 833-522-0986

801 Gateway Blvd.
Suite #400
South San Francisco, CA 94080

Breathe California

NPI: 1396400891

Phone: 408-998-5865
Fax: 408-998-0578

1469 Park Ave.
San Jose, CA 95126

Brilliant Corners

NPI: 1356687354

Phone: 415-618-0012
Fax: 877-320-8164

1390 Market St.
San Francisco, CA 94102

Institute on Aging

NPI: 1255730222

Phone: 628-239-3565
Fax: 650-963-4699

3575 Geary Blvd.
San Francisco, CA 94118

Mental Health Association

NPI: 1073678793

Phone: 650-257-8816
Fax: 650-507-4071

2686 Spring St.
Redwood City, CA 94063

MidPen Services

NPI: 1114674546

Phone: 650-218-0555
Fax: 650-281-0012

303 Vintage Park Dr.
Suite 250
Foster City, CA 94404

Mom’s Meals

NPI: 1093834020

Phone: 888-701-5279
Fax: 866-942-7873

3210 SE Corporate Woods Dr.
Ankeny, IA 50021

Refer a patient

To refer a patient for CS services, the HPSM Prior Authorization Request Form and the Community Supports Request Information Form must be completed accurately and completely.

To ensure a smooth process please read the instructions before completing the forms. Fax the completed forms to 650-829-2079.

  1. Include the available CS provider information for "Requesting Provider Name," "NPI", “Street Address”, "City", "State", "Zip", "Phone", and "Zip". Use the provider list to complete this request accurately.
  2. If you are not the provider who will be rendering the service, please include your name/facility/practice and NPI in the “Servicing Provider” section. To receive a notification of outcome HPSM must have your NPI number and adjoining fax number on record. If you are unsure if this is on record, state your fax number or email clearly in attached documents or in the optional comments box at the bottom of the form.
  3. HPSM has a unique CPT code for each CS service option. Use correct CPT Codes listed in the provider list
  4. Diagnosis Codes: include primary diagnosis that indicates population of focus or service option qualification (example: Z codes for housing).
  5. Attach any information, including recent appointment notes, care plan, summary of needs, or forms that demonstrate members qualifying criteria. If you do not include information that demonstrates qualifying criteria, the member may not be approved for services.
  6. CS referral forms should be returned with the Community Supports Request Information Form.
  7. “Requested Service Dates From” and “To” should not overlap any existing Authorization of the same type of services. Authorizations cannot exceed one year.
  8. For “Units of service” please enter numbers only and do not write any words in the box.
  9. See Units per CS Service Option for guidance on units per each CS service type. Dates of service Authorization Start and End Date is within 12 month span.

ECM & CS Resources

CalAIM Provider FAQs

CS Information for HPSM Members

ECM Information for HPSM Members

HPSM Care Coordination / Integrated Care Management

DHCS CS Policy Guide

Videos and Webinars

 
CS Housing Services
(54:22)

 
CS Medically Tailored Meals
(35:52)

 
CS Provider Onboarding
(46:48)