Provider Alerts

Enhanced Care Management and Community Supports

Starting in January of 2022, new benefits and services called Enhanced Care Management (ECM) and Community Supports (CS) became available for Medi-Cal members in San Joaquin County. They will be implemented in Stanislaus County effective July 1, 2022.

Enhanced Care Management (ECM)

The ECM benefit is designed to provide a whole-person approach to care that addresses both clinical and non-clinical needs for high need Medi-Cal beneficiaries. It is a collaborative and interdisciplinary approach to providing intensive and comprehensive care management services to individuals. ECM offers no-cost services to qualifying members to:

• Improve care coordination and integrating services
  • Person-centered, goal oriented and culturally relevant to ensure members receive needed services in a supportive, effective, efficient, timely and cost-effective manner
  • Face-to-face member visits, when possible, to coordinate all primary, acute, behavioral, developmental, oral, and long-term services and supports
  • Keep doctors updated on member health needs and wishes
  • Understand medication needs and how to access refills
• Address social determinants of health
• Connect members to needed community and social services through assessment and referral to CS as appropriate

Current ECM populations of focus being treated (Link to DHCS website: California Advancing and Innovating Medi-Cal (CalAIM) Enhanced Care Management)

• Populations experiencing homelessness and
  • Have at least one complex physical, behavioral, or developmental health need with inability to successfully self-manage
• Adult high utilizers
  • Five or more avoidable emergency room visits in a six-month period; AND / OR
  • Three or more preventable unplanned hospital and / or short-term skilled nursing facility stays in a six-month period.
  • Individuals with a pattern of very high utilization
• Adult with Serious Mental Illness (SMI) and / or Substance Use Disorder (SUD) and
  • Are actively experiencing at least one complex social factor influencing their health (e.g., lack of access to stable housing, history of Adverse Childhood Experiences (ACEs) AND
  • Meet one or more of the following criteria: are at high risk for institutionalization, overdose and/or suicide. Use crisis services, emergency rooms, urgent care, or inpatient stays as the sole source of care

Community Supports (CS)

Community Supports (CS), previously known as In Lieu of Services or ILOS, are medically
appropriate and cost-effective services. CS services are optional for members, and they are not required to use them.

HPSJ has the option to offer Community Supports from a list of services pre-approved by the Department of Health Care Services (DHCS) and may add or remove services as needed. HPSJ has elected to offer all 14 services over time.

HPSJ is rolling out CS in phases.

• San Joaquin County effective January 1, 2022, and Stanislaus County effective July 1, 2022
  • Housing Transition Navigation Services
  • Housing Deposits
  • Housing Tenancy and Sustaining Services
  • Short-term Post-Hospitalization Housing
  • Recuperative Care (Medical Respite)
  • Meals / Medically Tailored Meals
  • Sobering Centers
• San Joaquin County and Stanislaus County effective July 1, 2022
  • Asthma Remediation
  • Environmental Accessibility Adaptations (Home Modifications)

ECM members may qualify for CS however CS is not restricted solely to members receiving ECM,
and other members may be eligible. ECM and CS will continue to be made available to
additional populations through July 2023.

Important Reminders

• For ECM, primary care providers should participate in coordination efforts as a member of the interdisciplinary care team.
• ECM and CS referrals should be made following HPSJ ECM and CS referral and authorization guidelines.
  • Faxes sent to 209.942.6302
  • Refer through provider portal

Information on ECM and CS is available in HPSJ’s Provider Manual (Pages 12-21) here
https://www.hpsj.com/provider-manual/. If you have questions or need assistance, please call our Provider Services team at (209) 942-6340. You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan of San Joaquin and our services is always available on our website https://www.hpsj.com/.