25-521 Help Ensure Medi-Cal Members Get the ECM and CS Services They Need
Date: 06/06/25
Comply with closed-loop referral requirements, effective July 1, 2025
The Plan, physicians and other providers each play a critical role in supporting referrals that resolve system barriers and result in successful service delivery. To assist in fulfilling that responsibility, the Department of Health Care Services (DHCS) has released guidance and closed-loop referral requirements through an addendum to the CalAIM Population Health Management (PHM) Policy Guide.
What this means for you
Closed-loop referral measures will start being monitored by the Plan and the DHCS as of July 1, 2025. Physicians and other providers must comply with program requirements, support related plan goals and help ensure referral closure through data submission, data quality, timely outreach and enrollment, and by using the Findhelp platform to make Community Supports (CS) referrals.1
Primary components of the requirements center around tracking, supporting and monitoring member referrals.
The Plan is required to use electronic methods to communicate certain information to referring entities unless another non-electronic method is mutually agreed upon by both parties. Note, faxes do not qualify as an electronic method and should only be used if mutually agreed upon between the Plan and referring entities.
Starting July 1, 2025, the following notifications will be distributed for Enhanced Care Management (ECM) and CS services:
- Member notification of referral and assignment to the ECM or CS provider, which includes the name and contact information of the assigned provider.
- Referring provider notification of member assignment to ECM or CS provider.
The Plan is not permitted to build alternative tools or pathways for ECM and CS providers to submit the required minimum data elements outside of return transmission files.1
- Data supplied by ECM and CS providers to the Plan on a monthly basis is the key source of data that measures the closed-loop referral process and will be reported to DHCS.
- All ECM and CS Providers must ensure that they successfully submit their Return Transmission Files through SFTP to the Plan each month by the 5th calendar day.
- All members assigned to an ECM or CS provider via the ECM Member Information File (MIF) and/or Community Supports Authorization Status File (CSASF) must be included in your data submission to the Plan each month with updated information.
- The Plan will be sharing data on a regular basis with its CalAIM providers on any members with an aging referral status per the data received by the Plan, asking the provider to address the applicable member referral status as timely as possible.
What is a closed-loop referral?
The DHCS defines a closed-loop referral as a referral initiated on behalf of a Medi-Cal managed care member that is tracked, supported and monitored, and results in a known closure. A known closure occurs when a member’s initial referral loop is completed with a known-closure reason, such as the member receiving services.1
The goal of closed-loop referrals
The goal of closed-loop referrals is to increase the share of Medi-Cal members successfully connected to the services they need by identifying and addressing gaps in referral practices and service availability. The closed-loop referral requirements aim to improve the Plan’s information collection, supportive actions on individual referrals and system-level improvements that will result in members being connected more quickly to priority services for their health and well-being. 1
Although the DHCS has not specified the amount of time required to close the loop on member referrals, the Plan has set the following internal goals for timely loop closure:
- Members should have a resolution on their ECM or CS status within 90 days of being assigned to a provider for outreach.
- For ECM, the loop is considered closed when a member is reported to the Plan as Enrolled, Declined or Excluded through the monthly Return Transmission File.
- For CS, the loop is considered closed when a member is reported to the Plan as “Currently Delivering Services” or “Services Discontinued” as the member’s engagement status, and the referral status is marked “Referral Loop Closed.”
Referral resources
You can make referrals to ECM and CS services using the following resources.
Provider portal
Contracted providers can make referrals on the provider portal. Follow these steps:
A Provider Portal > Select Authorization from the top toolbar.
B Complete sections 1-3 on the right panel:
1 Provider Request
2 Service Line
3 Finish Up (auto-populates the member’s information)
C Select Submit. You will receive a confirmation code.
Findhelp
Using Findhelp (formerly known as Aunt Bertha) is recommended for submitting CS referrals. The Findhelp platform connects you with a network of social needs programs. It is the largest online platform used to find local programs. Findhelp also supports physicians, other providers and community partners with searching for local services. With Findhelp, you can connect members to find social service programs in their ZIP Code.
Findhelp supports members with social determinants of health (SDOH) needs by helping physicians, other providers and community partners search for no-cost or reduced-cost social services. Next, it helps make referrals and promotes community programs and services. Community Connect provides culturally and competent social needs support. The support available addresses the SDOH needs of members and closes the loop on referrals.
Physicians, other providers and community partners can use Findhelp by going to Findhelp at the link shown below. On the public site, physicians, other providers and community partners can find no-cost and reduced-cost services. You can also complete the social needs self-assessment for members and complete referrals to social service programs.
Note, ECM referrals should only be submitted through Findhelp for members who are self-referring. Physicians and other providers submitting ECM referrals on behalf of members should use the provider portal or fax options.
To identify local resources, use Findhelp:
A Log in or create an account.
B Select the ECM referral button on the homepage.
C Complete the referral and screener form.
Provider Directory (anyone can make a referral)
Find an ECM provider for members via the Community Health Plan of Imperial Valley (CHPIV) directory.
Member Services (Call Center) (anyone can make a referral)
Contact CHPIV at 833-236-4141. Behavioral health providers can call 844-966-0298.
Fax ECM referrals (anyone can make a referral)
Submit a referral by faxing in the member’s information that supports their ECM eligibility. The ECM referral template can be used, but it is not a requirement. Download the form at Health Net > CalAIM Resources > Forms & Tools. Fax the form to 800-743-1655.
View the PHM Policy Guide and Addendum online
Access the Policy Guide and Addendum at the links below.
Resource Links |
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Addendum to the PHM Policy Guide: Closed-Loop Referral Implementation Guidance (PDF) |
1Information for this provider update was taken or derived from the Department of Health Care Services Addendum to the PHM Policy Guide: Closed-loop Referral Implementation Guidance.
This information applies to Community Supports (CS) Providers andEnhanced Care Management (ECM) Providers.
This information applies to Medi-Cal in Imperial county.