Alliance health navigators, nurses, and social workers can provide short-term assistance if your patients need:

• Help finding community resources.
• Help finding providers in the Alliance network.
• Help with illness self-management.
• Support coordinating among multiple health care providers.

Referrals

• Work with your patient to see if they qualify for this program. You can refer your patients by completing the Alliance Case Management Referral Form.
• The Alliance may contact the member to see if they would like to enroll.
• Members may also self-refer.
  You can advise your patient to call:
  Alliance Case and Disease Management Department
  Monday – Friday, 8 am – 5 pm
  Phone Number: 1.510.747.4512
  Toll-Free: 1.877.251.9612
  People with hearing and speaking impairments (CRS/TTY): 711/1.800.735.2929

Community-Based Adult Services (CBAS) is an outpatient, facility-based service program that delivers skilled nursing care, social services, therapies, personal care, family/caregiver training and support, meals and transportation to Alliance members. The Alliance authorizes CBAS based on a referral from the member’s PCP and an eligibility assessment completed by a CBAS provider.

CBAS Criteria

Alliance members who reside in an intermediate care facility/developmentally disabled-habilitative (ICF/DD-H) facility that provides 24-hour personal care, habilitation, developmental and supportive health services are qualified for CBAS services.

All other Alliance members must meet all of the following medical necessity criteria to qualify for CBAS:

• 18 years of age and older.
• A high potential for the member’s medical, cognitive, or mental health condition(s) to deteriorate or result in an emergency department (ED) visit, hospitalization, or other institutionalization if CBAS services are not provided.
• The member has one (1) or more chronic or post-acute medical, cognitive or mental health condition(s) that requires monitoring, treatment or intervention to prevent deterioration, ED visits, hospitalizations, or other institutionalization.
• The member’s medical condition(s) require all core CBAS services performed on each day of attendance to allow the member to remain in the community and avoid ED visits, hospitalizations, or other institutionalization.

Core Services Include:

• Meal service
• Personal care services/social services
• Professional nursing services (which includes observation, assessment, and monitoring of member’s health status and medications; communication with member’s healthcare providers regarding changes in health status; supervision of personal care services; and/or skilled nursing care and intervention)
• Therapeutic activities

The member’s non-CBAS center support network insufficient to maintain the individual in the community, as demonstrated by at least one (1) of the following:

• The member has family or caregivers available, but those individuals require respite in order to continue providing sufficient and necessary care or supervision to the member.
• The member lives alone and has no family or caregivers available to provide sufficient and necessary care or supervision.
• The member resides with one (1) or more related or unrelated individuals, but they are unwilling or unable to provide sufficient and necessary care or supervision to the member.

Referrals

Work with your patient to see if they qualify for CBAS. To refer your member, please complete the Alliance CBAS Referral Form.

After we receive your referral, a nurse will interview the Alliance member to see if they are eligible for CBAS.

Alliance members can receive Community Supports (CS) Services.  The Alliance currently offers the following Services:

• Housing Transitions Navigation Services
  • Assists members with obtaining housing.
• Housing Deposits
  • Assists members with identifying, coordinating, securing, or funding one-time services and modifications necessary to enable a member to establish a basic household (that do not constitute room and board).
• Housing Tenancy and Sustaining Services
  • Assist members with providing tenancy and sustaining services, with a goal of maintaining safe and stable tenancy once housing is secured
• Recuperative Care (Medical Respite)
  • Short-term residential care for individuals who no longer require hospitalization, but still need to heal from an injury or illness (including behavioral health conditions) and whose condition would be exacerbated by an unstable environment.
• Medically Tailored Meals/Medically-Supportive Food
  • Meals provided/delivered to the home that meet the unique dietary needs of those with chronic conditions, immediately following discharge from a hospital or nursing home.
• Asthma Remediation
  • Physical modifications to a home environment that are necessary to ensure the health, welfare, and safety of the individual, or enable to individual to function in the home and without which acute asthma episodes could result in the need for emergency services and hospitalization.

• Nursing Facility Transition/Diversion to Assisted Living Facilities, such as Residential Care Facilities for Elderly and Adult Residential Facilities
  • Assist individuals to live in the community and/or avoid institutionalization when possible.
• Community Transition Services/Nursing Facility Transition to a Home
  • Helps individuals to live in the community and avoid further institutionalization.

• (Caregiver) Respite Services
  • Assist members (and their caregivers) by providing relief support to caregivers, while continuing to serve members who live in the community and are compromised in their activities of daily living (ADLs).
• Personal Care & Homemaker Services
  • Assist individuals who are approved (or in process) for In-Home Supportive Services
• Environmental Accessibility Adaptations (Home Modifications)
  • Assist members who require physical adaptations to a home that are necessary to ensure health, welfare and safety of the individual, without which the member would require institutionalization.

Starting January 1, 2025, the Alliance will be offering the following Community Supports service:

• Sobering Centers
  • Alternative destinations for members who are found to be publicly intoxicated (due to alcohol and/or other drugs) and would otherwise be transported to the emergency room or jail.

For more information, to see if you are eligible, or would like to refer to any of the above programs please call:

Alliance Case and Disease Management Department
Monday – Friday, 8 am – 5 pm
Phone Number: 1.510.747.4512
Toll-Free: 1.877.251.9612
People with hearing and speaking impairments (CRS/TTY): 711/1.800.735.2929

The Alliance Complex Case Management (CCM) Program works collaboratively with our network of providers and members to optimize member benefits and health. This program is designed for members who have complex health needs and at risk for frequent use of emergency department services. If an Alliance member qualifies for this program, a nurse will reach out to the member to complete a comprehensive assessment.

Our team of nurses, social workers, and health navigators can help Alliance members:

• Connect to community and social services.
• Coordinate home-based services and durable medical equipment (DME), supplies, and devices.
• Coordinate multiple physical and mental health care appointments.
• Provide disease management and self-management support.
• Reach health-related goals that the provider and member identify.
• Understand medication adherence and safety.

This program also offers individualized care plans. Our care management team works collaboratively with the provider and member to complete comprehensive care plans. The assigned Alliance case manager will contact the provider’s office for input.

The final care plans are shared with the provider’s office. Please let us know how you would like to receive the care plans.

Referrals

• Please work with your patient to find out if they qualify for this program. You can refer your patients by completing the Alliance Case Management Referral Form.
• The Alliance may contact the member to see if members would like to enroll.
• Members may also self-refer.

You can advise your patient to call:

Alliance Case and Disease Management Department
Monday – Friday, 8 am – 5 pm
Phone Number: 1.510.747.4512
Toll-Free: 1.877.251-9612
People with hearing and speaking impairments (CRS/TTY): 711/1.800.735.2929

The Alliance Disease Management Program offers support for our members who have a diagnosis of asthma, diabetes, high blood pressure, or depression. This program offers support for services and resources to help you carry out your doctor’s advice and treatment.

 Who is Eligible?

Alliance members with asthma, diabetes, high blood pressure and depression during pregnancy.  Eligibility for some programs may depend on the severity of your current health condition and risk factors.

For more information, to see if you are eligible, or would like to refer to this program please call:

Alliance Case and Disease Management Department
Monday – Friday, 8 am – 5 pm
Phone Number: 1.510.747.4512
Toll-Free: 1.877.251-9612 People with hearing and speaking impairments (CRS/TTY): 711/1.800.735.2929

Enhanced Care Management (ECM) is a Medi-Cal benefit that provides extra care coordination to members with highly complex needs. Getting ECM services will not change the Medi-Cal benefits you already have. There is no cost to you.

What are ECM services?

In ECM, you will have your own care team with a care coordinator. This person will talk to you, your doctors, and others involved in your health care to get you the care you need.

Your ECM care coordinator can help you:

• Find doctors and get appointments for health care services you may need.
• Better understand and keep track of your medications.
• Set up a ride to get to your doctor visits.
• Find and apply for community services based on your needs, like housing supports or healthy food.
• Get follow-up care after you leave the hospital.

How do I find out if I can get ECM services?

ECM will be offered to members who meet at least one of the ECM Populations of Focus definitions described below. The Alliance may contact you about ECM if you qualify. You can call the Alliance or your health care provider to find out whether and when you can receive ECM.

Populations of Focus:

• Individuals Experiencing Homelessness:
  • Adults without depend children/youth living with them experiencing homelessness.
  • Homeless families or unaccompanied children/youth experiencing homelessness.
• Individuals at risk for avoidable hospital or emergency department (ED) utilization (formerly known as ‘High Utilizers’)
• Individuals with serious mental health and/or substance use disorder (SUD) needs
• Adults living in the community and at risk for long-term care institutionalization.
• Adult nursing facility residents transitioning to the community.
• Children and youth enrolled in California’s Children Services (CCS) or CCS Whole Child Model (WCM) with additional needs beyond the CCS condition.
• Children and youth involved in child welfare.
• Birth equity population of focus

Questions?

For questions about ECM, please call:

Alliance Case and Disease Management Department
Monday – Friday, 8 am – 5 pm
Phone Number: 1.510.747.4512
Toll-Free: 1.877.251.9612
People with hearing and speaking impairments (CRS/TTY): 711/1.800.735.2929

The Health Information Form/Member Evaluation Tool (HIF-MET) is a survey that Alliance members fill out.

Why is it important?

• This tool helps members share their health concerns with their doctor. It also helps us learn what other services they may need to stay healthy.
• The California Department of Health Care Services (DHCS) requires the Alliance to send a HIF-MET to all new Alliance members. The tool helps identify Alliance members who may need expedited services. HIF/MET aims to identify serious health concerns that should be quickly addressed.
• Completed HIF/METs are faxed to assigned provider offices. Please review the forms as it may include helpful information that can direct their care and be incorporated into your new patient’s Initial Health Assessment (IHA).

The Health Risk Assessment (HRA) is a survey that seniors or persons with disabilities (SPDs) fill out each year.

Why is it important?

This tool helps our members share their health concerns with their doctor. It also helps us learn what other services they may need to stay healthy.

The California Department of Health Care Services (DHCS) requires the Alliance to annually send HRAs to all of our members who qualify as an SPD. The HRA helps identify Alliance members who may need expedited services. The HRA aims to identify serious health concerns that should be quickly addressed. The assessment is also a guide for the Alliance to create care plans for members.

HRA questionnaires can be filled out by members, or with an Alliance Case Management staff if help is requested. After review, the Alliance creates an individualized care plan. When a member does not complete their questionnaire, a standardized care plan is created, which includes tips on health and wellness.

Care plans are faxed or mailed in batches to provider offices. Please review the care plans prior to seeing your patients as they may include information that can help direct their care.

We welcome any feedback that you may have on how to incorporate the HRA into your plan of care.

The Alliance provides Transitional Care Services (TCS) to members who are transferring from one setting or level of care to another. A single point of contact will help members during their transition.

Who is Eligible

Transitional Care Services will be offered to members who meet criteria.  The Alliance may contact you about TCS if you qualify. You can also call the Alliance or your health care provider to find out when you can receive TCS.

How to Enroll

• The Alliance may contact you to find out if you would like to enroll.
• You may also self-refer by calling:

Alliance Case and Disease Management Department
Monday – Friday, 8 am – 5 pm
Phone Number: 1.510.747.4512
Toll-Free: 1.877.251-9612
People with hearing and speaking impairments (CRS/TTY): 711/1.800.735.2929