Provider Manual | Section 10
At the Health Plan of San Mateo (HPSM) we believe that healthy is for everyone. We offer a variety of resources to help our members learn how to live well and be healthy. Topics include asthma, diabetes, weight management, pregnancy, and smoking cessation.
No action of notice by Health Plan of San Mateo shall require a participating physician to provide to the Member, or order on behalf of the Member, Covered Services which, in the professional opinion of the physician, are not medically necessary. Participating physicians may freely communicate with Members who are patients about their treatment, regardless of benefit coverage and limitations. When a physician determines that a Member-requested service is not medically necessary, and if the Member does not agree with the PCP’s decision, the Physician shall inform the Member of their appeal rights through Health Plan of San Mateo.
Members recently diagnosed with diabetes or who are having difficulty following diabetes health guidelines can contact the Health Education department at 650-616-2165 for information about classes or other resources available. To get more information about diabetes, members can go to our Health Education Guide online at www.hpsm.org/healthinformation/diabetes.
Baby + Me
Our prenatal and postpartum care program has been expanded and rebranded to the Baby+Me program. The program will continue to include our incentive for timely prenatal and postpartum care, we will also provide information on how mothers and their babies can receive more comprehensive care. The program will help connect our members to resources and education around:
- Maternal mental health.
- Gestational diabetes.
- Smoking cessation during pregnancy.
- Well care visits.
For more information, call the Health Education department at 650-616-2165.
HPSM members who are interested in physical activity are referred to San Mateo County Park and Recreation Department programs. For more information, contact our Health Education department at 650-616-2165.
Tobacco Cessation Services
Providers are required annually to identify and track all tobacco for each adolescent and adult member. They are also encouraged to refer members to the California Smokers Helpline. The Helpline educates and guides members through a process to help them quit and provides techniques to make their efforts successful. For the California Smokers Helpline, dial 800-NO-BUTTS (800-662-8887).
Nicotine Replacement Therapies
HPSM covers all FDA-approved tobacco cessation medications for adults who use tobacco products. HPSM provides a 90-day supply of treatment medications without other requirements. This includes over-the-counter medications with a prescription from the provider. At least one FDA-approved tobacco cessation medication must be available without prior authorization. HPSM does not require members to receive a particular form of tobacco cessation service as a condition of receiving any other form of tobacco cessation service. HPSM does not require members to provide proof of counseling to a pharmacist, or other Medi-Cal provider to obtain tobacco cessation medications.
Call the Health Education department at 650-616-2165 or see Tobacco Prevention and Cessation Documents and Resources at www.hpsm.org/provider/resources/provider-qi-toolkit.
Health Education Materials
At HPSM, we place a great emphasis on primary prevention in all our work because we believe preventing a disease is the most effective way to keep a person healthy. Our Health Education Guide online offers a wide variety of health information and tips for staying healthy. Members can access our Health Education Guide online at www.hpsm.org/health-information.
Topics covered include:
- Addiction and Recovery.
- Alcohol and Drugs.
- Alternative Care.
- Child Health.
- Heart Disease and Stroke.
- HIV and AIDS.
- Older Adults.
- Oral Health.
- Preventive Care.
- Quitting Smoking/Vaping.
- Self-Management Tools.
- Sexual Health.
- Teen Health.
- Weight Management.
For more information call the Health Education department at 650-616-2165.
Health Matters is HPSM’s biannual member newsletter. It includes articles on a variety of topics to help keep our members healthy. To view current and past issues of Health Matters, visit www.hpsm.org/member/resources/newsletter.
Culturally and Linguistically Appropriate Services (CLAS)
The Health Plan of San Mateo (HPSM) is committed to delivering culturally and linguistically appropriate services to all eligible members with limited English proficiency (LEP) or sensory impairment. Understanding these requirements will help you provide quality care to our members and meet federal and state requirements.
HPSM contracted providers (including dental providers after 1/1/2022) are required to provide linguistically appropriate services to members with limited English proficiency (LEP) or with a hearing impairment. HPSM therefore offers free phone, video and (in certain circumstances) in-person interpreter services provided by professionally trained interpreters. Understanding these services will help you meet state and federal regulatory requirements and provide quality care to your patients.
HPSM’s CLAS Program complies with Title IV of the Civil Rights Act of 1964, which states, any agency, program, or activity that receives funding from federal government may not discriminate on the basis of race, color, national origin, creed, ancestry, religion, language, age, marital status, health status, disabilities, gender, sexual orientation, or gender identity.
Learn about our Language Assistance program at www.hpsm.org/provider/resources/languageservices.
HPSM provides free telephonic, video, in-person, and American Sign Language (ASL) interpreter services to help you communicate with your LEP patients.
- Telephonic interpreter services are provided through Certified Languages International (CLI) and are available in more than 200 languages 24 hours a day, 7 days a week.
- Video Remote Interpreter (VRI) services are also provided through CLI and are available on demand and by appointment through CLI’s online platform. The service includes ASL video interpreter services.
- In-person interpreter services are suspended for all languages other than ASL until further notice.
- In-person ASL interpreter services are available by appointment and should be requested at least 5 days in advance.
- All in-person ASL interpreter services should be scheduled by the provider through HPSM. Requests forms can be sent by secure email to firstname.lastname@example.org or faxed to 650-616-8235.
To learn how to access these services, visit www.hpsm.org/provider/resources/language-services.
Telephonic Interpreter Services for Office/Clinic & Telemedicine Visit
To access the service:
- Dial CLI at 800-225-5254.
- Provide the CLI operator with the following information:
- Access code: 64095.
- Language needed.
- Provider office name.
- HPSM member name.
- HPSM member date of birth (DOB).
- For an office visit, start conversation after the CLI operator connects you to an interpreter.
- For telemedicine visit, provide HPSM patient phone number. After you have briefed the interpreter, dial # to call the HPSM patient at the number you provided the CLI operator. Start conversation once you are connected to the HPSM patient.
Video Remote Interpreter Services for Office/Clinic & Telemedicine
Visit Ensure you have Wi-Fi at the office/clinic for online access to CLI platform. For a telemedicine visit, also ensure HPSM member has internet access to receive telemedicine appointment link.
To access the service:
- Using either Chrome, Firefox, or Safari web browser, go to CLI platform: hpsm.cli-video.com.
- Access code: 64095hpsm
- Follow prompts for clinic/provider name, HPSM patient’s full name and date of birth.
- Select language.
- Wait for interpreter to appear on the screen.
- For telemedicine visit, inform interpreter that you will be inviting your patient to the session.
- Click the button with the outline of a person and a + sign to send meeting link to HPSM patient via text or email. HPSM patient needs to click the link to join the video call.
Instructions and a video tutorial can be found at www.hpsm.org/provider/resources/languageservices/video-interpreters
In-person Interpreter Services
Suspended due to COVID-19 for all languages except ASL. If the request is not for an in-person ASL interpreter, please use our telephonic or video interpreter. All in-person ASL interpreter services should be scheduled through HPSM at least five days in advance.
To schedule an in-person ASL interpreter:
- Complete the In-Person Interpreter Request Form. You can find the form at www.hpsm.org/provider/resources/language-services
- Fax the completed form to HPSM at 650-616-8235 or send via secure email to email@example.com.
- Receive a confirmation from HPSM staff once your request is scheduled.
Services for Members with Disabilities
HPSM recognizes that our members with disabilities have specific needs in addition to their general medical needs. We provide services that are integrated within the daily activities of every department, such as:
- Access to TTY for our hard-of-hearing members.
- Large-print materials for our visually impaired members.
- Information on the physical accessibility of providers offices in our provider directory for our wheelchair-using members.
We also have a Care Coordination/Integrated Care Management unit in our Health Services Department to assist our members with complex chronic conditions to ensure they receive the care management they need to optimize their health outcomes. If you have HPSM members with disabilities who need additional services, please notify HPSM Care Coordination/Integrated Care Management unit at 650-616-2060.