Enhanced Care Management (ECM)
Enhanced Care Management (ECM) is a benefit offered through the statewide CalAIM initiative to eligible Medi-Cal members with complex needs. Members can choose whether or not they want these services, which help address complex care needs through person-centered and community-based support.
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.
Eligibility
An HPSM member is eligible for Enhanced Care Management services if they meet one or more of the following criteria. For detailed information and eligibility criteria for HPSM’s populations of focus, please see DHCS links APL 21-012, APL attachment and DHCS Enhanced Care Management Policy Guide.
Adults (21 or older)
- Experiencing homelessness and have at least one complex physical, behavioral or developmental need.
- Have serious mental health and/or substance use disorders (SUD) with additional specific criteria.
- Living in the community at risk of long term care (LTC) institutionalization.
- At risk for avoidable hospital or emergency department (ED) utilization with additional specific criteria.
- Nursing facility residents transitioning to the community.
- Pregnant or postpartum individuals who are subject to racial and ethnic disparities.
- Transitioning from incarceration.
Children and youth (20 or younger)
- Have serious mental health and/or SUD needs.
- At risk for avoidable hospital or emergency department (ED) utilization with additional specific criteria.
- Involved in child welfare who meet one or more specific conditions.
- Families or unaccompanied children/youth experiencing homelessness or sharing housing with other persons due to loss of housing, etc.
- Pregnant or postpartum individuals who are subject to racial and ethnic disparities.
- Transitioning from incarceration.
- CCS Whole Child Model with additional needs beyond the CCS condition
Refer a patient
To refer a patient for ECM services, an ECM Referral form must be completed accurately and completely. Providers should submit the referral form corresponding to the patient’s age.
The purpose of these referral forms is to collect key information about the member so that HPSM can confirm their eligibility for ECM. If member is eligible, they will be assigned to an ECM Provider who supports their specific Population(s) of Focus.
Submission Process
Completed ECM Referral forms may be submitted to HPSM Integrated Care Management via any of the following methods:
- Fax: 650-829-2047
- Secure email: CareCoordinationRequests@hpsm.org
Authorization decisions will be provided within five working days for routine submissions and within 72 hours for urgent submissions. For a more concise and user-friendly experience, we recommend downloading the form.
ECM Provider List
This ECM provider list should be used as a reference for referring patients. Before starting referrals, review capacity and eligibility.
NPI: 1609290030
Phone: 650-573-3900
Fax: 833-522-0986
801 Gateway Blvd.
Suite #400
South San Francisco, CA 94080
Populations of Focus
- Adults Living in the Community and At Risk for LTC Institutionalization
- Adults At Risk for Avoidable Hospital or ED Utilization (Formerly “High Utilizers”)
- CPT Code: G9012
- Capacity: Download the ECM Provider List for current capacity
NPI: 1871700716
Phone: 650-289-5417
Fax: 650-289-5452
450 Bryant St.
Palo Alto, CA 94301
Populations of Focus
- Adults Living in the Community and At Risk for LTC Institutionalization
- Adults At Risk for Avoidable Hospital or ED Utilization (Formerly “High Utilizers”)
- CPT Code: G9012
- Capacity: Download the ECM Provider List for current capacity
NPI: 1336809359
Phone: 650-573-4799
Fax: 833-218-8864
801 Gateway Blvd.
Suite #225
South San Francisco, CA 94080
Populations of Focus
- Adults without Dependent Children/Youth Living with Them Experiencing Homelessness
- Adults At Risk for Avoidable Hospital or ED Utilization (Formerly “High Utilizers”)
- Adults with Serious Mental Health and/or SUD Needs
- Adults Transitioning from Incarceration
- CPT Code: G9012
- Capacity: Download the ECM Provider List for current capacity
NPI: 1164105698
Phone: 650-616-2500 Fax:650-616-2598
801 Gateway Blvd.
Suite #400
South San Francisco, CA 94080
Populations of Focus
- Homeless Families or Unaccompanied Children/Youth Experiencing Homelessness
- Children and Youth At Risk for Avoidable Hospital or ED Utilization (Formerly “High Utilizers”)
- Children and Youth with Serious Mental Health and/or SUD Needs
- Children and Youth Enrolled in CCS or CCS WCM with Additional Needs Beyond the CCS Condition
- Children and Youth Involved in Child Welfare
- CPT Code: G9012
- Capacity: Download the ECM Provider List for current capacity
NPI: 1699041566
Phone: 669-444-5480
Fax: 408-579-6168
777 E Santa Clara St.
Suite 2004
San Jose, CA 95112
Populations of Focus
- Homeless Families or Unaccompanied Children/Youth Experiencing Homelessness
- Children and Youth At Risk for Avoidable Hospital or ED Utilization (Formerly “High Utilizers”)
- Adults/Children and Youth with Serious Mental Health and/or SUD Needs
- Children and Youth Involved in Child Welfare
- Children and Youth Enrolled in CCS or CCS WCM with Additional Needs Beyond the CCS Condition
- Birth Equity Population of Focus
- Adults Living in the Community and At Risk for LTC Institutionalization
- CPT Code: G9012
- Capacity: Download the ECM Provider List for current capacity
NPI: 1881360758
Phone: 650-442-1569
Fax: 877-883-6503
275 Blomquist St.
Redwood City, CA 94063
Populations of Focus
- Adults without Dependent Children/Youth Living with Them Experiencing Homelessness
- Adults At Risk for Avoidable Hospital or ED Utilization (Formerly “High Utilizers”)
- Adults with Serious Mental Health and/or SUD Needs
- Adults Transitioning from Incarceration
- CPT Code: G9012
- Capacity: Download the ECM Provider List for current capacity
NPI: 1255730222
Phone: 628-239-3565
Fax: 650-963-4699
3575 Geary Blvd.
San Francisco, CA 94118
Populations of Focus
- Adults without Dependent Children/Youth Living with Them Experiencing Homelessness
- Adults At Risk for Avoidable Hospital or ED Utilization (Formerly “High Utilizers”)
- Adults with Serious Mental Health and/or SUD Needs
- Adults Living in the Community and At Risk for LTC Institutionalization
- Adult Nursing Facility Residents Transitioning to the Community
- CPT Code: G9012
- Capacity: Download the ECM Provider List for current capacity
NPI: 1699052266
Phone: 650-550-3923
Fax: 415-202-6498
211 Eastmoor Ave.
Daly City, CA 94015
Populations of Focus
- Adults/Children and Youth At Risk for Avoidable Hospital or ED Utilization (Formerly “High Utilizers”)
- Adults/Children and Youth with Serious Mental Health and/or SUD Needs
- Adults Living in the Community and At Risk for LTC Institutionalization
- Homeless Families or Unaccompanied Children/Youth Experiencing Homelessness
- Children and Youth Enrolled in CCS or CCS WCM with Additional Needs Beyond the CCS Condition
- Children and Youth Involved in Child Welfare
- Birth Equity Population of Focus
- CPT Code: G9012
- Capacity: Download the ECM Provider List for current capacity
NPI: 1821170044
Phone: 650-330-7400
Fax: 1-650-965-1020
1885 Bay Rd.
East Palo Alto, CA 94303
Populations of Focus
- Adults without Dependent Children/Youth Living with Them Experiencing Homelessness
- Adults At Risk for Avoidable Hospital or ED Utilization (Formerly “High Utilizers”)
- CPT Code: G9012
- Capacity: Download the ECM Provider List for current capacity
NPI: 1821376641
Phone: 650-366-8436
Fax: 650-412-2337
420 Brewster Ave.
Redwood City, CA 94063
Populations of Focus
- Homeless Families or Unaccompanied Children/Youth Experiencing Homelessness
- Children and Youth with Serious Mental Health and/or SUD Needs
- Children and Youth Transitioning from Incarceration
- Children and Youth Enrolled in CCS or CCS WCM with Additional Needs Beyond the CCS Condition
- Children and Youth Involved in Child Welfare
- CPT Code: G9012
- Capacity: Download the ECM Provider List for current capacity
NPI: 1407518780
Phone: 650-955-7915
Fax: 650-955-7397
400 Concar Dr.
San Mateo, CA 94402
Populations of Focus
- Adults without Dependent Children/Youth Living with Them Experiencing Homelessness
- Homeless Families or Unaccompanied Children/Youth Experiencing Homelessness
- Adults At Risk for Avoidable Hospital or ED Utilization (Formerly “High Utilizers”)
- Adults with Serious Mental Health and/or SUD Needs
- Adults Living in the Community and At Risk for LTC Institutionalization
- Adult Nursing Facility Residents Transitioning to the Community
- Birth Equity Population of Focus
- CPT Code: G9012
- Capacity: Download the ECM Provider List for current capacity