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增强护理管理和社区支持 | Medi-Cal 转型
本页面介绍了有关增强护理管理 (ECM) 和社区支持计划的最新消息，以及加利福尼亚州为打破传统医疗保健壁垒和协调高需求成员的护理而采取的重要措施。
现已发布：新数据证实社区支持改善结果并降低成本
在6 月的3 、 2025新闻稿中，DHCS 引用了社区支持年度报告中的支持数据，以证明社区支持是成功且具有成本效益的。数据显示，社区支持正在履行其满足 Medi-Cal 成员需求的承诺——减少可避免的急诊就诊、住院和长期护理使用，同时显示出强劲的早期成本节约迹象。研究的 12 项社区支持措施均能降低成本，其中 9 项已在初步研究期间证明了其成本效益。其余三个项目预计将在更长的研究期内达到该阈值，这符合联邦政府评估成本效益的规定。请参阅这份社区支持情况说明书了解更多信息。
更新版《社区支持政策指南》--现分两卷发行
DHCS 很高兴与大家分享更新后的社区支持政策指南，该指南于 4 月30 、 2025发布。
To accommodate new policies related to Transitional Rent and other Community Supports for Members experiencing or at risk of homelessness, DHCS has reorganized the guide into two separate volumes:
- 第 1 卷包含针对会员健康相关社会需求的八项社区支持的服务定义，其中包括 DHCS 于 2025 年 2 月更新的四项社区支持：医学定制膳食/医学支持食品、哮喘治疗、辅助生活设施过渡和社区或家庭过渡服务。
- 第 2 卷包含其余七种社区支持的服务定义，包括过渡性租金，这些支持涉及住房或包含食宿部分，专门用于支持正在经历无家可归或面临无家可归风险的会员。
为了支持这些更新的实施，DHCS 将举办两场信息网络研讨会：
注册参加第 1 卷网络研讨会：5 月16 ，星期五， 2025 | 上午 11:00– 太平洋时间下午 12:30
注册参加第 2 卷（住房专题）网络研讨会：5 月14 、 2025星期三 | 太平洋时间下午 12:00 – 下午 1:30
We encourage you to review both volumes of the guide and join us at the upcoming webinars. DHCS also encourages the public to visit the Medi-Cal ECM and Community Supports webpage for regular updates and the new DHCS Housing for Health webpage for housing-related updates from various DHCS initiatives both within and outside Medi-Cal.
报告发布：增强护理管理和社区支持季度实施报告（截至 2024 年第二季度）
On December 20, 2024, DHCS released the latest Enhanced Care Management (ECM) and Community Supports quarterly report covering data from January 2022 through June 2024. ECM provides high-touch, team-based care management for Medi-Cal members with complex needs, while Community Supports offer cost-effective, medically appropriate alternatives to traditional services, addressing social determinants of health like housing and nutrition. Together, these initiatives are critical to ensuring holistic, person-centered care that improves health outcomes and quality of life for Medi-Cal members. The report demonstrates sustained, quarter-over-quarter growth in both ECM and Community Supports use, as additional populations of focus become eligible for ECM and more services are offered across the state.
该报告还提供了新推出的出生公平重点人群 (POF) 和监禁过渡个人 POF 中 ECM 成员的第一批数据，这两个 POF 均于 2024 年 1 月启动或扩展。
Key findings included 244,750 Medi-Cal members receiving ECM benefits, with 127,024 members served in Q2 2024. This represents a more than 50% increase in quarterly ECM members since Q2 2023. About 239,500 members used Community Supports services, and 89% of Medi-Cal members had access to at least 10 services. This represents a more than 120% increase in quarterly Community Supports members since Q2 2023. In Q2 2024, more than 59% of members using Community Supports accessed Medically Tailored Meals/Medically Supportive Foods, and approximately 35% accessed one or more services from the Housing Trio (Housing Transition Navigation Services, Housing Tenancy and Sustaining Services, and Housing Deposits).
简化企业内容管理访问的新政策
DHCS is releasing new policies that will streamline and improve access to ECM by standardizing referrals and expediting the authorization process. DHCS worked extensively with stakeholders to develop statewide ECM Referral Standards and an updated ECM presumptive authorization policy. Both policies take effect on January 1, 2025, and MCPs are currently operationalizing the new guidance. This adds to a series of reforms DHCS has made to streamline access to ECM and Community Supports outlined in the 2023 ECM/Community Supports Action Plan.
The ECM Referral Standards define the information all MCPs will collect via ECM referrals. Entities making referrals to ECM will submit the same information in their ECM referrals across counties and MCPs rather than navigating different information requirements across referral forms or batch templates. Additionally, MCPs may not require additional documentation (e.g., ICD-10 codes, supplemental checklists, or Treatment Authorization Request (TAR) forms) from referring partners or ECM providers beyond the information provided in the ECM referral to authorize ECM. The goal is to reduce barriers and burdens for referring entities and support DHCS’ goal that the majority of ECM referrals come from the community, which is also associated with increased ECM uptake.
DHCS is also releasing updated requirements for MCPs to expand the use of ECM presumptive authorization. Select ECM providers already contracted in an MCP’s ECM provider network will be able to directly authorize ECM for members and be paid for ECM services during a 30-day timeframe without waiting for an MCP’s authorization decision. ECM providers under presumptive authorization will still need to submit a referral to the MCP for full authorization within the 30-day timeframe. The goal is to ensure that select ECM providers can begin providing the ECM benefit immediately when they reach a member without waiting for authorization, which may delay services. For full details on the policy and eligible ECM Providers, please see the updated ECM Policy Guide.
此外，10 月 9 日，太平洋夏令时间上午 11 点至中午 12 点，DHCS 将举办 All Comer 网络研讨会，分享全州 ECM 转诊标准和 ECM 推定授权政策的详细信息。需要提前注册。部落合作伙伴和利益相关者也可以直接向 DHCS 咨询有关新指南的问题，邮箱地址为CalAIMECMILOS@dhcs.ca.gov 。
CalAIM 过渡性租金概念文件征求公众意见
8 月 30 日，DHCS 发布了过渡租金概念文件，征求公众意见。 概念文件总结了过渡性租金的设计，这是加州推进和创新 Medi-Cal (CalAIM) 第 1115 条豁免示范下的一项新举措，旨在为正在经历无家可归或面临无家可归风险并符合某些额外资格标准的 Medi-Cal 成员提供租金/临时住房保障。 自 年1月2025日起，过渡性租金作为一项社区支持服务对于 Medi-Cal 管理式医疗计划而言将是可选的，并且自 年2026月1日起，它将成为所有计划提供的强制性福利。 DHCS 将就概念文件征求广泛利益相关者的意见。
为了改善处于关键过渡期或符合某些高风险标准的 Medi-Cal 成员的福祉和健康状况，加利福尼亚州寻求为无家可归或面临无家可归风险并正在从机构护理级别、集体居住环境、惩教设施、儿童福利系统、康复护理设施、短期住院后住房、过渡住房、无家可归者收容所或临时住房过渡的合格成员，以及符合无庇护所无家可归者标准或全方位服务合作伙伴 (FSP) 计划的成员提供长达六个月的过渡租金服务。 仅当根据临床和其他健康相关的社会需求标准确定其在医学上合适时，才会提供过渡租金服务。
DHCS invites the public to comment on this concept paper. Comments are due by 5 p.m. PT, September 20, 2024. Comments may be submitted to CalAIMECMILOS@dhcs.ca.gov with the subject line “Comments on Transitional Rent.”
CalAIM 为无家可归的个人和家庭提供帮助
卫生保健服务部 (DHCS) 于太平洋时间 5 月 31 日星期五下午 1:30–3:00 举办了一场关于为无家可归的个人和家庭提供增强护理管理 (ECM) 和社区支持的网络研讨会。
在本次网络研讨会上，DHCS 领导与来自提供 ECM 和关键住房相关社区支持的供应商和管理式医疗计划的小组成员一起参加了会议。 他们提供了：
- Overviews of how ECM and Community Supports aim to address Members’ clinical and non-clinical needs;
- 服务提供商关于将会员与关键社区支持（如住房押金和住房过渡导航服务）联系起来的观点，以及为无家可归的个人和家庭结合 ECM 和社区支持服务；
- 为社区合作伙伴和服务提供商提供指导，帮助个人和家庭获得 ECM 和社区支持，并让无家可归的会员参与 ECM 和社区支持。
A recording, transcript and slides are available under the “Webinar & Meetings” tab. These materials will be of special interest to MCPs, providers, and organizations working with individuals and families experiencing homelessness, including counties and CBOs.
报告发布：增强护理管理和社区支持季度实施报告（截至 2023 年第二季度）
On January 29th, 2024, DHCS released its ECM and Community Supports Quarterly Implementation Report for Q2 2023. This report summarizes ECM and Community Supports implementation trends and data for the first 18 months of the programs, spanning January 2022 through June 2023. Similar to the 2022 Year One Implementation Report released last August, this report provides insight into state-, county-, and managed care plan-level data.
In the first 18 months, 140,886Medi-Cal MCP members across the state received the ECM benefit and 75,834 members received 167,960 Community Supports services. As California continues advancing its Medi-Cal transformation, ECM and Community Supports play a critical role in supporting whole-person care for Medi-Cal members with complex medical and health-related social needs. DHCS expects to see more enrollment growth across both programs in the coming months and years, including as additional Populations of Focus become eligible for ECM and additional Community Supports services are offered in counties across the state. DHCS remains committed to supporting and sustaining this growth through program monitoring, design improvements, and standardization.
报告链接： ECM 和社区支持季度实施报告 (arcgis.com)
更新后的政策指南发布：社区支持
- In July 2023, DHCS released its updated Community Supports Policy Guide. These updates reflect the policy refinements discussed at the June 9th, 2023 Summit and cover key areas including eligibility, referrals and authorizations, provider networks, payment, market awareness, and data exchange.
ECM 聚焦
DHCS 致力于为加州不断壮大的 ECM 提供商网络提供技术援助和支持，并发布了一系列 ECM 专题报道，以更详细地介绍提供商如何调整 ECM 以满足不同重点人群 (POF) 的需求。这些专题报道旨在帮助已签约和潜在的企业内容管理 (ECM) 提供商开发和改进其 ECM 模型。
- 2025 年 12 月，DHCS 发布了ECM 加利福尼亚儿童服务 (CCS) 技术援助资源聚焦及配套幻灯片：ECM CCS 资源幻灯片。 这些资源提供了一些策略，以识别正在接受儿童保育服务的儿童，他们可能会从幼儿保育中受益，加强儿童保育服务和幼儿保育团队之间的合作，并提高幼儿保育服务提供者的能力，以满足儿童保育服务中儿童的独特需求。
- 2024 年 2 月，DHCS 发布了针对无家可归者的 ECM POF 聚焦。 聚焦》介绍了将 ECM 与与住房相关的社区支持联系起来，以减少会员住房不安全的战略。
- 2023 年 11 月，DHCS 发布了《儿童和青少年 ECM POF 聚焦》，旨在为正在考虑是否适合为儿童和青少年提供 ECM 的医疗机构提供支持。
ECM 出生公平重点人群常见问题
The ECM Birth Equity POF that launched on January 1, 2024 is one component of DHCS’ overall approach to improving prenatal and postpartum care and is aimed at addressing specific disparities in access to prenatal care and pregnancy-related mortality. In February 2024, DHCS released answers to frequently asked questions on Member eligibility and dual enrollment in additional Medi-Cal services for the ECM Birth Equity POF. Additional information can be found in DHCS ECM Policy Guide. DHCS welcomes additional questions via email at CalAIMECMILOS@dhcs.ca.gov.
概述文件
下载针对供应商和其他利益相关者的 ECM 和社区支持政策更新概述。 它总结了关键政策以及国家标准化政策之间的区别以及 MCP 定义自己的政策和程序的灵活性。