Members of Community First STAR, STAR Kids, STAR+PLUS plans who are receiving or are prescribed treatment for behavioral health or substance use disorders, have the right to receive medically necessary in lieu of services (ILOS). You also have the right to decline these services.
What are ILOS?
ILOS are different services that you or your child can get to treat a behavioral health condition or substance use disorder in a setting approved by Texas Health and Human Services Commission (HHSC) in lieu of (instead of) a hospital. ILOS may work better for you or your child and your personal health care needs.
These services include:
- Partial Hospitalization Program (PHP) – an outpatient program that offers a structured day of behavioral health services, like group therapy, medication management, and nursing services.
- Intensive Outpatient Program (IOP) – an outpatient program that offers structured therapy, educational services, and life skills training.
- Coordinated Specialty Care (CSC) – a team-based approach to treat people with a newly diagnosed psychosis disorder.
How can I get these services?
If your behavioral health provider recommends ILOS, they can refer you to a qualified provider once the request is approved.
Note: ILOS do not replace regular services or specific treatments covered by Community First. However, if you think ILOS would be a better option for you or your child, please talk to your provider.