家 CalAIM：變革加州醫療補助計劃加強護理管理和社區支持訊息​​ 

最新消息​​ 

加強護理管理 & 社區支持 | 醫療轉型​​ 

此頁面捕捉了有關增強護理管理（ECM）和社區支持計劃的最新消息，以及加利福尼亞正在打破傳統醫療保健的牆壁並協調為高需要成員的照護所採取的重要步驟。​​ 

現已上載：新數據確認社區支持改善成果並降低成本​​ 

在6 月的3 、 2025新聞稿中，DHCS 引用了社區支持年度報告中的支持數據，以證明社區支持是成功且具有成本效益的。數據顯示，社區支持正在履行其滿足 Medi-Cal 成員需求的承諾——減少可避免的急診就診、住院和長期護理使用，同時顯示出節省成本的早期強勁跡象。研究的 12 項社區支持措施均能降低成本，其中 9 項已在初步研究期間證明了其成本效益。其餘三個項目預計將在更長的研究期內達到該閾值，這符合聯邦政府評估成本效益的規定。請參閱這份社區支援情況說明書以了解更多資訊。​​ 

社區支援政策指南的更新版本 - 現已發行兩冊​​  

DHCS 很高興分享更新的社區支持政策指南，該指南於 4 月 30，2025 發布。​​  

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:​​  

  • 第一卷包含了八個社區支持的服務定義，以滿足成員與健康相關的社會需求，包括 DHCS 先前在 2025 年 2 月更新的社區支持：醫療量身定制的膳食/醫療支持食物、哮喘補救、輔助生活設施轉換以及社區或家庭轉換服務。​​   
  • 第 2 卷包含其餘七個社區支援服務定義，包括過渡性租金，這些服務定義，這些服務有關住房或具有房間和膳食組件，並專門設計用於支持遇到或有無家可歸風險的會員。​​   

為了支持這些更新的實施，DHCS 正在舉辦兩個資訊網路研討會：​​  

報名參加第一卷網絡研討會：5 月，星期五 16，2025 | 上午 11 點— 太平洋標準時間下午 12 時 30 分​​  

報名參加第二卷（房屋特定）網絡研討會：5 月 14 星期三 2025 | 台灣時間中午 12 時至下午 1 時 30 分​​  

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.​​  

報告發布：到 2024 年第二季度的增強照護管理和社區支持季度實施報告​​ 

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.​​ 

該報告還提供了有關新推出的聚焦生育平等人口（POF）中的 ECM 成員的第一個數據，兩者都在 2024 年 1 月推出或擴展。​​ 

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).​​ 

簡化存取 ECM 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，在 10 月 9 日，PDT 上午 11 點至下午 12 點，DHCS 將舉辦「All Comer 網絡研討會」，以分享有關全州 ECM 推薦標準和 ECM 假設授權政策的詳細信息。需要進階註冊。部落合作夥伴和利益相關者也可以通過 CalAIMECMILOS@dhcs.ca.gov 向 DHCS 提出有關新指引的問題。​​ 

CalAIM 過渡性租金概念文件徵求公眾意見​​ 

8 月 30 日，DHCS 發布過渡性租金概念文件，供公眾意見。 該概念文件總結了過渡租金的設計，這是一項根據加州進和創新的 Medi-Cal（CalAIM）第 1115 條豁免示範下的一項新計劃，旨在為經歷或有無家可歸風險並符合某些額外資格標準的 Medi-Cal 成員提供租金/臨時住房的保障。 由 1 月 1, 2025 開始，Medi-Cal 管理護理計劃將是選擇性的保障，將作為社區支持服務的過渡性租金保障，並且將是所有計劃在 1 月 1、2026 提供的強制保障。 DHCS 將在概念文件中尋求廣泛利益相關者的意見。​​ 

為改善 Medi-Cal 會員在重大過渡期期間或符合某些高風險標準的人士的福祉和健康狀況，加州希望為無家可歸或無家可歸風險轉移的合資格會員提供長達六個月的過渡租服務服務，集體住宿，懲教設施，兒童福利系統，康復服務設施，短期住院後住房，過渡住房，無家可歸者避難所或臨時住房。作為成員符合無家可歸無家可歸或全方位服務合作夥伴計劃的標準。 只有在根據臨床及其他與健康相關的社會需求標準確定醫療合適的情況下，才會提供過渡性租金服務。​​ 

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 為無家可歸的個人和家庭提供服務​​ 

太平洋時間 5 月 31 日星期五下午 1:30 至 3:00 Department of Health Care Services (DHCS) ) 為無家可歸的個人和家庭舉辦了一場關於加強護理管理(ECM) 和社區支持的全民網絡研討會。​​  

在這次網絡研討會中，DHCS 領導人與來自提供者和託管護理計劃的小組成員加入，提供 ECM 和關鍵房屋相關的社區支持。 他們提供：​​   

  • Overviews of how ECM and Community Supports aim to address Members’ clinical and non-clinical needs;​​  
  • 提供者對將成員與主要社區支持聯繫，例如住房存款和房屋過渡導航服務，以及針對無家可歸的個人和家庭編織 ECM 和社區支持服務的觀點；​​ 
  • 向社區合作夥伴和提供者有關推薦個人和家庭參加 ECM 和社區支持，以及在 ECM 和社區支持中參與無家可歸的會員參與。​​ 

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.​​ 

報告發佈：截至 2023 年第二季度的增強護理管理和社區支持季度實施報告​​ 

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.​​  

報告連結：​​  ECM 和社區支持季度實施報告（arcgis.com）​​ 

更新的政策指南版本：社區支持​​ 

  • 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 致力於為加州不斷成長的 ECM 提供者網路提供技術協助和支援，並發佈一系列 ECM 聚焦，以提供更多提供者如何調整 ECM 以滿足不同重點人群 (POF) 需求的詳細資訊。這些 Spotlights 旨在協助已簽約和潛在的 ECM 提供者發展和強化其 ECM 模型。​​ 

ECM 出生公平焦點人口常見問題​​ 

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.​​ 

概觀文件​​ 

下載供應商和其他利益相關者的 ECM 和社區支持政策更新概述。 它總結了關鍵政策以及國家標準化政策之間的區別，以及 MCP 可以靈活地定義自己的政策和程序之間的區別。​​