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 U5 | Community Transitions / Nursing Facility to Home | Up to 12 units | 1 unit = 1 month |
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 = 3 months |
S5165, U5 | Asthma Remediation | Up to 1 unit | 1 unit = $7,500 lifetime max |
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.
NPI: 1376797035
Phone: 888-324-6225
Fax: 888-522-6796
200 N. Pacific Coast Hwy
Suite 300
El Segundo, CA 90245
- Service option: Personal Care and Homemaker Services
- CPT Code: S5130, U6
- Capacity: Download the CS Provider List for current capacity
- Service option: Respite Care
- CPT Code: S5151, U6
- Capacity: Download the CS Provider List for current capacity
NPI: 1609290030
Phone: 650-573-3900
Fax: 833-522-0986
801 Gateway Blvd.
Suite #400
South San Francisco, CA 94080
- Service option: Personal Care and Homemaker Services
- CPT Code: S5130, U6
- Capacity: Download the CS Provider List for current capacity
- Service option: Respite Care
- CPT Code: S5151, U6
- Capacity: Download the CS Provider List for current capacity
- Service option: Community Transition Services / Nursing Facility Transition to a Home
- CPT Code: T2038, U5
- Capacity: Download the CS Provider List for current capacity
NPI: 1396400891
Phone: 408-998-5865
Fax: 408-998-0578
1469 Park Ave.
San Jose, CA 95126
- Service option: Asthma Remediation
- CPT Code: S5165, U5
- Capacity: Download the CS Provider List for current capacity
NPI: 1356687354
Phone: 415-618-0012
Fax: 877-320-8164
1390 Market St.
San Francisco, CA 94102
- Service option: Housing Transition Navigation Services
- CPT Code: H0043
- Capacity: Download the CS Provider List for current capacity
- Service option: Housing Deposits
- CPT Code: H0044
- Capacity: Download the CS Provider List for current capacity
- Service option: Housing Tenancy – Financial Management
- CPT Code: T2050, U6 (per diem)
- Capacity: Download the CS Provider List for current capacity
- Service option: Environmental Accessibility Adaptations
- CPT Code: S5165
- Capacity: Download the CS Provider List for current capacity
NPI: 1255730222
Phone: 628-239-3565
Fax: 650-963-4699
3575 Geary Blvd.
San Francisco, CA 94118
- Service option: Environmental Accessibility Adaptations
- CPT Code: S5165
- Capacity: Download the CS Provider List for current capacity
- Service option: Nursing Facility Transition / Diversion to Assisted Living Facilities
- CPT Code: T2038, U4
- Capacity: Download the CS Provider List for current capacity
- Service option: Community Transition Services / Nursing Facility Transition to a Home
- CPT Code: T2038, U5
- Capacity: Download the CS Provider List for current capacity
NPI: 1073678793
Phone: 650-257-8816
Fax: 650-507-4071
2686 Spring St.
Redwood City, CA 94063
- Service option: Housing Transition Navigation Services
- CPT Code: H0043
- Capacity: Download the CS Provider List for current capacity
- Service option: Housing Tenancy – Financial Management
- CPT Code: T2050, U6 (per diem)
- Capacity: Download the CS Provider List for current capacity
- Service option: Housing Deposits
- CPT Code: H0044
- Capacity: Download the CS Provider List for current capacity
NPI: 1114674546
Phone: 650-218-0555
Fax: 650-281-0012
303 Vintage Park Dr.
Suite 250
Foster City, CA 94404
- Service option: Housing Tenancy – Financial Management
- CPT Code: T2050, U6 (per diem)
- Capacity: Download the CS Provider List for current capacity
NPI: 1093834020
Phone: 888-701-5279
Fax: 866-942-7873
3210 SE Corporate Woods Dr.
Ankeny, IA 50021
- Service option: Medically Tailored Meals
- CPT Code: S5170
- Capacity: Download the CS Provider List for current capacity