CalAIM

• 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.

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

• 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

• ECM Providers or Community Support Providers* follow the process outlined during training. For any questions, please call Health Plan Customer Service at 888.936.7526.
• Primary Care Providers or Community Based Organizations*- please complete the ECM Referral Form and fax it to Health Plan Case Management Department at 209.762.4720.
• Member, Family, or Caregiver* may call Health Plan Customer Service at 888.936.7526.
• Hospitals and Facilities* request an ECM referral through the standard communications with their Health Plan Concurrent Review nurse or Transition of Care staff.

HPSJ-MVHP Justice Involved Liaison Triage Team
Direct Phone: 1-209-323-7653
E-mail: jiliaison@hpsj.com
Counties: San Joaquin, Stanislaus, El Dorado and Alpine County
Provider Directory: https://www.hpsj.com/find-a-provider/
*All calls and emails will be triaged accordingly in 24 hours during regular business hours, Monday – Friday, 8am – 5pm.

• 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 Health Plan.
• Housing Deposits: Health Plan 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

Learn More Here: DHCS Medi-Cal Fact Sheet

DHCS Document - Transformation of Medi-Cal: Community Supports

• ECM Providers or Community Support Providers
• Primary Care Providers or Community Based Organizations
• Member Self or Family Referrals
• Hospitals and Facilities

• ECM Providers or Community Support Providers* follow the process outlined during training. For any questions, please call Health Plan Customer Service at 888.936.7526.
• Primary Care Providers or Community Based Organizations*- please complete the CSS Referral Form and fax it to Health Plan Case Management Department at 209.762.4720.
• Member, Family, or Caregiver* may call Health Plan Customer Service at 888.936.7526.
• Hospitals and Facilities* may request a Community Support Service through the standard communications with their Health Plan Concurrent Review nurse or Transition of Care staff.