加州推進和創新 Medi-Cal (CalAIM)

加強護理管理和社區支持

加州力求為有復雜需求以及面臨困難的生活和健康狀況的人們改進 Medi-Cal 計劃。 這些新服務的重點是提供傳統醫療服務以外的幫助。 它們旨在解決人們生活中影響健康的健康和其他因素。 增強型護理管理 (ECM) 和社區支持 (CS) 是兩項新的全州 Medi-Cal 服務的名稱。

以下部分在您的承保證明手冊.

前往社區支持

加強護理管理

增強型護理管理 (ECM) 是一項免費提供給有復雜需求的 HPSJ 會員的福利。 它提供額外服務,幫助您獲得保持健康所需的護理。 它協調您從不同醫生那裡獲得的護理。

ECM 幫助協調:

  • 初級衛生保健
  • 急性護理
  • 行為健康
  • 發育健康
  • 口腔健康
  • 基於社區的長期服務和支持 (LTSS)
  • 推薦可用的社區資源

Services covered under ECM include:

  • 外展和參與
  • 綜合評估和護理管理
  • 加強護理協調
  • 促進健康
  • 全面的過渡期護理
  • 會員和家庭支持服務
  • 協調和轉介社區和社會支持

Who qualifies for ECM?

2022 年 1 月 1 日

聖華金縣

  • 無家可歸的成年人及其家人
  • 有使用可避免的醫院或急診室 (EDO) 風險的成年人(以前稱為“高使用率”)
  • 有嚴重心理健康和/或物質使用障礙 (SUD) 需求的成年人
  • 從監禁過渡的個人(一些全人關懷 (WPC) 縣)
  • 有智力或發育障礙 (I/DD) 的成年人
  • 孕婦或產後成人
2022 年 7 月 1 日

斯坦尼斯勞斯縣

  • 無家可歸的成年人和家庭
  • 面臨可避免的住院或急診就診風險的成年人
  • 有嚴重心理健康和/或 SUD 需求的成年人
  • 有智力或發育障礙 (I/DD) 的成年人
  • 孕婦或產後成人
2023 年 1 月 1 日
  • 生活在社區中並面臨長期護理 (LTC) 制度化風險的成年人
  • 成人護理機構居民過渡到社區
2023 年 7 月 1 日
  • 沒有受撫養子女的成年人/與他們一起生活的無家可歸者
  • 關注的兒童和青少年人群
    • 無家可歸的家庭或無人陪伴的兒童/青少年無家可歸
    • 面臨可避免的住院或急診就診風險的兒童和青少年
    • 有嚴重心理健康和/或 SUD 需求的兒童和青少年
    • 參加加州兒童服務 (CCS) 或 CCS 完整兒童模式 (WCM) 且有超出 CCS 條件的額外需求的兒童和青少年
    • 參與兒童福利的兒童和青少年
    • 懷孕或產後青年
2024 年 1 月 1 日
  • 受種族和族裔差異影響的孕婦和產後個體面臨不良圍產期結果的風險
2024 年 1 月 1 日
  • 從監禁過渡的個人


什麼是首席護理經理?

在 ECM 註冊後,您的 ECM 提供者將為您指派一名首席護理經理。 他們是您的護理團隊的一部分。 他們幫助協調以下人員之間的護理:

  • 你的醫生
  • 專家
  • 藥劑師
  • 個案經理
  • 社會服務提供者
  • 他人

首席護理經理還可以幫助您尋找和申請社區中的其他服務。

Transitional Care Services (TCS)

Health care transitions happen when someone has a visit to a place where they get medical help and then returns home or to a different care center.

What is the purpose of TCS?

TCS is intended to:

  • TCS can help to make sure that a person who moves from one type of care to another gets the right support. As a member, you can get help from a TCS Care Manager. This is someone from your health plan who will assist you during your transition of care.
  • With Transitional Care Services (TCS), our goal is to:
    • Help you stay safely in your preferred home setting.
    • Ensure you make and keep follow-up visits to stay healthy and prevent repeat visits to hospitals and emergency rooms.
    • Teach you about your health condition and how to manage it.
    • Connect you with the resources you need to stay healthy and safe.

Who qualifies for TCS?

  • Anyone who experiences a health care transition can qualify for help from a TCS Care Manager

TOC Contacts

  • We are here to help you with the transition from one place of care to a different place. To learn more about Transitional Care Services, call 1-888-936-PLAN (7526) TTY 711

What can a TCS Care Manager assist with?

  • Learning and staying informed about your health needs.
  • Scheduling medical visits and arranging transportation for medical appointments.
  • Learning about your health plan benefits and services.
  • Finding community services for things such as housing, food, and more.

社區支持

社區支持是 Medi-Cal State Plan 涵蓋的服務或環境在醫療上適當且具有成本效益的替代服務或環境。 這些服務對於會員來說是可選的。 如果您符合條件,這些服務可能會幫助您更獨立地生活。 它們不會取代您已經根據 Medi-Cal 獲得的福利。

加州力求為有復雜需求以及面臨困難的生活和健康狀況的人們改進 Medi-Cal 計劃。 這些新服務的重點是提供傳統醫療服務以外的幫助。 它們旨在解決人們生活中影響健康的健康和其他因素。 增強型護理管理 (ECM) 和社區支持 (CS) 是兩項新的全州 Medi-Cal 服務的名稱。

The information below is further mentioned within your 承保證明手冊.

HPSJ 提供以下社區支持:

  • Housing Transition Navigation Services: assistance to obtain housing. This may include assistance with searching for housing or completing any housing applications if appropriate and authorized by HPSJ.
  • Housing Deposits: HPSJ to provide one-time funding to establish basic housing, including assistance with security deposits to obtain a lease or assisting with first month’s coverage of utilities or rent.
  • Housing Tenancy and Sustaining Services: assistance helping residents keep safe and stable housing once housing is secured.
  • Short-Term Post Hospitalization Housing: provides those that do not have a residence, and who have a high medical or behavioral health needs, a place to recover after a hospital or facility stay.
  • Recuperative Care (Medical Respite): short term housing for those who no longer require hospitalization but need to heal from an injury or illness.
  • Medically Tailored Meals/Medically-Supportive Food: meals that are delivered to the home that are tailored to meet members dietary needs.
  • Sobering Center: an alternate, short-term location to sober for those who are found to be under the influence in public and would otherwise be transported to emergency services or jail.
  • Asthma Remediation: physical changes to the home that are necessary to help members live in the home without environment or asthma-related triggers.
  • Environmental Accessibility Adaptations (Home Modifications): physical changes to the home to allow individual to function with greater independence and not require care in a nursing facility.
  • Day Habilitation Programs: Programs designed to provide the member in obtaining and improving self-help, social skills, and adaptive skills to live successfully in a natural environment.
  • Personal Care and Homemaker Services: Services provided to individuals who need assistance with activities of daily life like bathing, dressing, feeding, housekeeping, or grocery shopping.
  • Respite Services: Short-term services provided to caregivers of those who require occasional temporary supervision to give relief to the caregiver.
  • Nursing Facility Transition/Diversion to Assisted Living Facilities: Services to help members live in the community and avoid nursing facility stays when possible.
  • Community Transition Services/Nursing Facility Transition to a Home: Services to help members live in the community and avoid further institutionalization by providing non-recurring set up expenses for individuals transitioning from a licensed facility to a living arrangement in a private residence.

ECM/CS 推薦

我如何獲得 ECM 或 CS 推薦?

  • 可以自行參考
  • 可能會就 ECM/CS 服務與您聯繫
  • 與您的醫療保健提供者交談,他們可以了解您是否有資格獲得 ECM/CS 以及何時以及如何獲得。
  • 您也可以致電 HPSJ 了解您是否以及何時可以收到 ECM/CS。

 

如果您對 ECM 或社區支持有任何疑問,請聯繫您的醫療保健提供者或 HPSJ,網址為888.936.7526,TTY 711。

Posted on January 17th, 2023 and last modified on December 7th, 2023.

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