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Enhanced Care Management (ECM)

ECM is a Medi-Cal only benefit through the CalAIM initiative offering comprehensive care management service for our highest-needs members. 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.

  1. Adults (21 or older) who are experiencing homelessness AND have at least one complex physical, behavioral or developmental need. 
  2. Families or unaccompanied children/youth who are experiencing homelessness OR are sharing housing with other persons due to loss of housing, etc. 
  3. Adults (21 or older) with serious mental health and/or substance use disorders (SUD) with additional specific criteria. 
  4. Children and youth with serious mental health and/or SUD needs. 
  5. Adults (21 or older) living in the community at risk of long term care (LTC) institutionalization. 
  6. Adults (21 or older) at risk for avoidable hospital or ED utilization with additional specific criteria. 
  7. Children and youth at risk for avoidable hospital or ED utilization with additional specific criteria. 
  8. Adults (21 or older) nursing facility residents transitioning to the community. 
  9. Children and youth enrolled in CCS Whole Child Model with additional needs beyond the CCS condition. 
  10. Children and youth involved in child welfare who meet one or more specific conditions. 
  11. Pregnant or postpartum individuals who qualify under any of the Enhanced Care Management populations of focus. 
  12. Adults and youth transitioning from incarceration. 

For detailed ECM information and eligibility criteria for HPSM’s populations of focus, refer to these DHCS resources: APL 21-012, APL attachment 1: Enhanced Care Management Population of Focus Eligibility Criteria and Enhanced Care Management Policy Guide.

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 at risk of institutionalization (LTC)
  • Adults with high utilization

NPI: 1871700716

Phone: 650-289-5417
Fax: 650-289-5452

450 Bryant St.
Palo Alto, CA 94301

Populations of Focus
  • Adult Individuals At Risk for Avoidable Hospital or ED Utilization (Formerly “High Utilizers”)
  • Adults Living in the Community and At Risk for LTC Institutionalization

NPI: 1336809359

Phone: 650-573-4799
Fax: 833-218-8864

801 Gateway Blvd.
Suite #225
South San Francisco, CA 94080

Populations of Focus
  • Adult individuals experiencing homelessness: Adults without dependent children/youth living with them experiencing homelessness
  • Adult individuals at risk for avoidable Hospital or ED Utilization (Formerly “High Utilizers”)
  • Adult Individuals with Serious Mental Health and/or SUD Needs
  • Adult Individuals Transitioning from Incarceration

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
  • 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

NPI: 1699041566

Phone: 669-444-5480
Fax: 408-579-6168

777 E Santa Clara St.
Suite 2004
San Jose, CA 95112

Populations of Focus
  • Individuals Experiencing Homelessness: Homeless Families or Unaccompanied Children/Youth Experiencing Homelessness
  • Children-youth-Individuals At Risk for Avoidable Hospital or ED Utilization (Formerly “High Utilizers”)
  • Children and youth Individuals with Serious Mental Health and/or SUD Needs
  • Children and Youth Involved in Child Welfare
  • Children and Youth Enrolled in California Children’s Services (CCS) or CCS Whole Child Model (WCM) with Additional Needs Beyond the CCS Condition
  • Birth Equity Population of Focus

NPI: 1881360758

Phone: 650-442-1569
Fax: 877-883-6503

275 Blomquist St.
Redwood City, CA 94063

Populations of Focus
  • Adult Individuals Experiencing Homelessness: Adults without Dependent Children/Youth Living with Them Experiencing Homelessness
  • Adult Individuals At Risk for Avoidable Hospital or ED Utilization (Formerly “High Utilizers”)
  • Adult Individuals with Serious Mental Health and/or SUD Needs
  • Adult Individuals Transitioning from Incarceration

NPI: 1255730222

Phone: 628-239-3565
Fax: 650-963-4699

3575 Geary Blvd.
San Francisco, CA 94118

Populations of Focus
  • Adults that are homeless with a medical issue.
  • Adults with high utilization.
  • Adults with serious mental health or substance use issues with case management needs.
  • Adults at risk for institutionalization.
  • Adult nursing facility residents transitioning to the community.

NPI: 1699052266

Phone: 650-550-3923
Fax: 415-202-6498

211 Eastmoor Ave.
Daly City, CA 94015

Populations of Focus
  • Adult Individuals At Risk for Avoidable Hospital or ED Utilization (Formerly “High Utilizers”)
  • Adult Individuals with Serious Mental Health and/or SUD Needs
  • Adults Living in the Community and At Risk for LTC Institutionalization
  • Homeless families or unaccompanied children and 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 CCS WCM with additional needs beyond the CCS condition.
  • Children and youth involved in child welfare.
  • Birth equity/youth pregnant and postpartum.

NPI: 1821170044

Phone: 650-330-7400
Fax: 650-321-2002

1885 Bay Rd.
East Palo Alto, CA 94303

Populations of Focus
  • Adult Individuals Experiencing Homelessness: Adults without Dependent Children/Youth Living with Them Experiencing Homelessness
  • Adult Individuals At Risk for Avoidable Hospital or ED Utilization (Formerly “High Utilizers”)

NPI: 1821376641

Phone: 650-366-8436
Fax: 650-412-2337

420 Brewster Ave.
Redwood City, CA 94063

Populations of Focus
  • Individuals Experiencing Homelessness: Homeless Families or Unaccompanied Children/Youth Experiencing Homelessness
  • Children and Youth Individuals with Serious Mental Health and/or SUD Needs
  • Children and Youth Individuals 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

Upward Health

NPI: 1407518780

Phone: 650-955-7915
Fax: 650-955-7397

400 Concar Dr.
San Mateo, CA 94402

Populations of Focus
  • Adult Individuals Experiencing Homelessness: Adults without Dependent Children/Youth Living with Them Experiencing Homelessness
  • Adult Individuals Experiencing Homelessness: Homeless Families or Unaccompanied Children/Youth Experiencing Homelessness
  • Adult Individuals At Risk for Avoidable Hospital or ED Utilization (Formerly “High Utilizers”)
  • Adult Individuals 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

Refer a patient

To refer a patient for ECM services, a prior Authorization Request form must be completed accurately and completely. Fax the completed form to 650-829-2079.

To ensure a smooth process please read the instructions before completing the Authorization Request Form.

  1. Include the available ECM provider information for “Requesting Provider Name,” “Street Address,” “City,” “State,” “Zip,” “NPI,” “Phone Number,” and “Fax.” Use the provider list to complete this request accurately.
  2. If you are not the provider who will be rendering the service, please include your name/facility/practice and NPI in the “Servicing Provider” section. To receive a notification of outcome HPSM must have your NPI number and adjoining fax number on record. If you are unsure if this is on record, state your fax number or email clearly in attached documents or in the optional comments box at the bottom of the form.
  3. Use correct CPT Codes listed in the provider list. HPSM adopted a simplified G9012 code for authorization purposes.
  4. Diagnosis Codes: include primary diagnosis that indicates population of focus or service option qualification (example: Z codes for housing).
  5. Attach any information, including recent appointment notes, care plan, summary of needs, or forms that demonstrate members qualifying criteria. Not including information demonstrating qualifying criteria may result in your patient NOT being approved for services.
    For ECM requests, please specify which Population of Focus the member qualifies for in the comments on the PA form.
  6. Make sure “Requested Service Dates From” and “To” do not overlap any existing Authorization of the same type of services. Authorizations cannot exceed one year.
  7. For “Units of service” please enter numbers only. Do not write any words in the box.
    ECM Authorizations only need to request one unit

ECM & CS Resources

CalAIM Provider FAQs

CS Information for HPSM Members

ECM Information for HPSM Members

HPSM Care Coordination / Integrated Care Management

DHCS CS Policy Guide

Videos and Webinars

 
CS Housing Services
(54:22)

 
CS Medically Tailored Meals
(35:52)

 
CS Provider Onboarding
(46:48)