Enhanced Case Management
For Medi-Cal members with complex care needs.
Goal
Coordinate all primary, acute, behavioral, development, oral, social needs, and long term services and supports including participating in care planning.
About
Enhanced Care Management (ECM) providers appoint a lead care manager who creates a care plan addressing medical and social needs. The lead care manager coordinates care with the members’ current providers and helps coordinate benefits and other available resources aimed at improving health outcomes. These services are voluntary.
ECM serves HPSM'a most at-risk Medi-Cal members
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Adults, unaccompanied youth and children, and families experiencing homelessness.
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Adults, youth, and children who are at risk for avoidable hospital or emergency department care.
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Adults, youth, and children with serious mental health and/or substance use disorder needs.
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Adults living in the community and at risk for long-term care institutionalization.
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Adult nursing facility residents transitioning to the community.
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Children and youth enrolled in California Children’s Services (CCS) or CCS Whole Child Model with additional needs beyond their CCS condition(s).
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Children and youth involved in child welfare (foster care).
Intensive care coordination and services across multiple systems to help address both clinical and non-clinical needs
What can ECM help with?
Each member in ECM has a Care Manager who talks with them as well as their care team. This makes sure everyone works together to get the member the care they need.
Healthcare
Find doctors and get appointments for health-related services they may need.
Medications
Better understand and keep track of their medications.
Transportation
Set up rides to and from health care visits.
Community Services
Find and apply for community-based services based on their needs. This includes housing supports or meals to fit health needs.
Follow-up Care
Get follow-up care after they leave the hospital.
Core Service Components
ECM activities should be integrated with other care coordination. In most cases, ECM Providers should assume primary responsibility of coordination of members’ needs, including collaborating with other coordinators
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Outreach and engagement
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Comprehensive assessment and care management plan
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Enhanced coordination of care
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Health promotion
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Transitional care services
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Member and family supports
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Community and social support services coordination and referrals
Who's part of the Care Team?
Each member in ECM has a Care Manager who talks with them as well as their care team. The care team can include their doctors, mental health providers, specialists, pharmacists, case managers, social services providers and others
Eligibility
Adults (21 or older)
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Experiencing homelessness and have at least one complex physical, behavioral or developmental need.
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Have serious mental health and/or substance use disorders (SUD) with additional specific criteria.
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Living in the community at risk of long term care (LTC) institutionalization.
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At risk for avoidable hospital or emergency department (ED) utilization with additional specific criteria.
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Nursing facility residents transitioning to the community.
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Pregnant or postpartum individuals who are subject to racial and ethnic disparities.
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Transitioning from incarceration.
How can members get ECM?
There are two ways members can get ECM:
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HPSM offers to enroll members who qualify for ECM based on member health records.
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Members who want to enroll in ECM can call HPSM Member Services at 650-616-2133. If they are not eligible, HPSM can help them find other supports.
Refer a Patient
To refer a patient for ECM services, an ECM Referral form must be completed accurately and completely by a provider
Completed ECM Referral forms may be submitted to HPSM Integrated Care Management via any of the following methods:
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Fax: 650-829-2047
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Secure email: CareCoordinationRequests@hpsm.org
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Authorization decisions will be provided within five working days for routine submissions and within 72 hours for urgent submissions.
ECM Provider List
Bridges to Wellness
Healthcare in Action
StarVista Insights -- Currently closed to applicants
Upward Health
For more information about Medi-Cal benefits, refer to the Medi-Cal Member Handbook / Evidence of Coverage.