Community Supports (CS), previously known as In Lieu of Services or ILOS, are medically appropriate and cost-effective services.
ECM members may qualify for CS however CS is not restricted solely to members receiving ECM, and other members may be eligible.
What community supports does HPSJ offer?
HPSJ is offering the following community supports in San Joaquin and Stanislaus counties:
Nursing Facility Transition/Diversion to Assisted Living Facilities (Effective July 2023)
Community Transition Services/Nursing Facility Transition to a Home (Effective July 2023)
For members delegated to Kaiser, Kaiser will maintain responsibility to provide Community Supports for Kaiser members. Please refer to Kaiser Evidence of Coverage for available community supports. If a Kaiser-assigned member wishes to receive other community supports offered by HPSJ and not offered by Kaiser; they may access by choosing reassignment to HPSJ by contacting Customer Service at 1.888.936.PLAN (7526), TTY/TDD 711.
Referrals for ECM or Community Supports may come from multiple sources, such as:
ECM Providers or Community Support Providers
Primary Care Providers or Community Based Organizations
Member Self or Family Referrals
Hospitals and Facilities
Referrals for Community Supports
ECM Providers or Community Support Providers* follow the process outlined during training. For any questions, please call HPSJ Customer Service at 888.936.7526.
Primary Care Providers or Community Based Organizations*- please complete the CSS Referral Form and fax it to HPSJ Case Management Department at 209.762.4720.
Member, Family, or Caregiver* may call HPSJ Customer Service at 888.936.7526.
Hospitals and Facilities* may request a Community Support Service through the standard communications with their HPSJ Concurrent Review nurse or Transition of Care staff.