CalAIM

ECM is intended to:

• Improve care coordination and integrate services through:
  • Person-centered, goal oriented and culturally relevant care 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 and connect members to needed community and social services through assessment and referral to CS as appropriate

To refer a patient for ECM services, see, ECM Referrals tab. To request ECM services, complete ECM Eligibility Verification Form. To submit an authorization request, please login to our provider portal or click here to submit by fax.

January 1, 2022 San Joaquin County	Adults and their Families Experiencing Homelessness Adults At Risk for Avoidable Hospital or Emergency Department (EDO) Utilization (formerly “High Utilizers) Adults with Serious Mental Health and/or Substance Use Disorder (SUD) Needs Individuals Transitioning from Incarceration (some Whole Person Care (WPC) counties) Adults with Intellectual or Developmental Disabilities (I/DD) Pregnant or Postpartum Adults
July 1, 2022 Stanislaus County	Adults and Families Experiencing Homelessness Adults at Risk for Avoidable Hospital or ED Utilization Adults with Serious Mental Health and/or SUD Needs Adults with Intellectual or Developmental Disabilities (I/DD) Pregnant or Postpartum Adults
January 1, 2023	Adults Living in the Community and At Risk for Long Term Care (LTC) Institutionalization Adults Nursing Facility Residents Transitioning to the Community
July 1, 2023	Adults without Dependent Children/Youth Living with Them Experiencing Homelessness Children and Youth Populations of Focus Homeless Families or Unaccompanied Children/Youth Experiencing Homelessness Children and Youth At Risk for Avoidable Hospital or ED Utilization Children and Youth with Serious Mental Health and/or SUD Needs Children and Youth Enrolled in California Children’s Services (CCS) or CCS Whole Child Model (WCM) with Additional Needs Beyond the CCS Condition Children and Youth Involved in Child Welfare Pregnant or Postpartum Youth
January 1, 2024	Pregnant and Postpartum Individuals At Risk for Adverse Perinatal Outcomes who are subject to racial and ethnic disparities
2024 (Date TBD)	Individuals Transitioning from Incarceration

ECM providers assign members a Lead Care Manager. They are a part of their care team. They help coordinate care between:

• Members
• Their doctors
• Specialists
• Pharmacists
• Case managers
• Social Services providers
• Others

A Lead Care Manager can also help members find and apply for other services in the community.

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
• Download Adult ECM Referral Form
• Download Child ECM Referral Form

Referrals for ECM

• 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 ECM 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* request an ECM referral through the standard communications with their HPSJ Concurrent Review nurse or Transition of Care staff.

*Members must meet specific criteria to be eligible for these services. The ECM Referral Form includes a summary of criteria.
DHCS Enhanced Care Management Policy Guide

HPSJ is offering the following community supports in San Joaquin and Stanislaus counties:

• Housing Transition Navigation Services
• Housing Deposits
• Housing Tenancy and Sustaining Services
• Short-Term Post Hospitalization Housing
• Recuperative Care
• Medically Tailored Meals/Medically-Supportive Food
• Sobering Center
• Asthma Remediation
• Environmental Accessibility Adaptations (Home Modifications)
• Day Habilitation Programs
• Personal Care and Homemaker Services
• Respite Services
• 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.

*Members must meet specific criteria to be eligible for these services.
DHCS Community Supports Policy Guide

You can download the Community Support Services Referral Form using the link below:
Community Support Services Referral Form