top of page

NYS FAM Research
Resource Guide

Medi-Cal Community Supports, or In Lieu of Services (ILOS), Policy Guide

This Community Supports Policy Guide Volume 1 is intended to serve as a resource for Medi-Cal Managed Care health plans, or Managed Care Plans (MCPs), in the implementation of Community Supports. A key feature of CalAIM was the statewide introduction, in January 2022, of the Enhanced Care Management (ECM) benefit and a menu of 14 Community Supports.

California Department of Health Care Services (DHCS). (Updated: 2025, April). Community Supports Policy Guide, Volume I. https://www.dhcs.ca.gov/Documents/MCQMD/DHCS-Community-Supports-Policy-Guide.pdf

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2025

Small Running Title

National Provider Identifier (NPI) Application A Step-by-Step Guide for Providers Participating in the ECM and Community Supports Programs 

This document provides step by step guidance to providers participating in the Enhanced Care Management (ECM) and Community Supports, or In Lieu of Services (ILOS), programs on how to obtain a National Provider Identifier (NPI). An NPI is a 10-digit numeric identifier assigned by the Centers for Medicare and Medicaid Services (CMS) to be used on electronic claim transactions for health care billing and reimbursement. As part of participation in the ECM or Community Supports programs, it is necessary for providers to apply for and obtain an NPI.

California Department of Health Care Services (DHCS). (n.d.). National Provider Identifier (NPI) Application. https://www.dhcs.ca.gov/Documents/MCQMD/NPI-Application-Guidance-for-MCPs-ECM-and-Community-Services-Providers.pdf

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

n.d.

Small Running Title

Enhanced Care Management and Community Supports (formerly “In Lieu of Services”) Provider Standard Terms and Conditions

This document is an outline for Enhanced Care Management (ECM) that contains pertinent definitions and provider requirements. It also provides an overview checklist, delivery and payment methods, data sharing to support Community Supports, and information on quality and oversight.

Baass, M., Newsom, G. (n.d.). Enhanced Care Management and Community Supports (formerly "In Lieu of Services") Provider Standard Terms and Conditions. State of California - Health and Human Services Agency, Department of Health Care Services. https://www.dhcs.ca.gov/services/Documents/MCQMD/ECM-and-Community-Supports-Standard-Provider-Terms-and-Conditions.pdf

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

n.d.

Small Running Title

Contract Template Provisions  

This document provides Enhanced Care Management (ECM) definitions, a breakdown of Scope of Services, Community Support definitions, and details of Community Supports.

Baass, M., Newsom, G. (n.d.). CalAIM Enhanced Care Management (ECM) and Community Supports (ILOS)
Contract Template Provisions. State of California - Health and Human Services Agency, Department of Health Care Services. https://www.dhcs.ca.gov/Documents/MCQMD/MCP-ECM-and-ILOS-Contract-Template-Provisions.pdf

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

n.d.

Small Running Title

Enhanced Care Management and Community Supports

This article explains what the Medi-Cal transformation means for Californians. ECM is available to eligible members with complex needs as well as Community Supports that will address health-related needs such as, housing transition and navigation services, medically tailored meals and medically supportive foods, and asthma remediation.

DHCS. (2025). Enhanced Care Management and Community Supports. State of California. https://www.dhcs.ca.gov/CalAIM/ECM/Pages/Home.aspx

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2025

Small Running Title

CalAIM Data Sharing Authorization Guidance

This document provides CalAIM background and overview, data sharing provisions in AB 133, supplemental guidance, and data sharing authorization use cases.

California Department of Health Care Services (DHCS). (2022, March). CalAIM Data Sharing Authorization Guidance. https://www.dhcs.ca.gov/Documents/MCQMD/CalAIM-Data-Sharing-Authorization-Guidance.pdf

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2022

Small Running Title

CalAIM Data Guidance: Community Supports Member Information Sharing Guidance

This document provides an overview, an MCP Community Supports authorization status file, and a Community Supports provider return transmission file, and an Appendix A and B containing Community Supports information.

California Department of Health Care Services (DHCS). (Updated: 2024, December). CalAIM Data Guidance: Community Supports Member Information Sharing Guidance. https://www.dhcs.ca.gov/Documents/MCQMD/CS-Member-Information-Sharing-Guidance.pdf

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2024

Small Running Title

Braiding Funding Streams to Deliver Integrated Care for Medi-Cal Members Under CalAIM - Center for Health Care Strategies (chcs.org) 

This webinar, made possible by the California Health Care Foundation (CHCF), featured two community-based organizations explaining how they braid funding streams within and outside Medi-Cal* to deliver integrated whole-person care and the strategies they use to mitigate the risks of braiding.

Center for Health Care Strategies. (2024, August 21). Braiding Funding Streams o Deliver Integrated Care for Medi-Cal Members Under CalAIM. [Video]. Webinar. https://www.chcs.org/resource/braiding-funding-streams-to-deliver-integrated-care-for-medi-cal-members-under-calaim/

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2024

Small Running Title

Non-Binding ILOS Pricing Guidance

This document offers guidance on non-binding in lieu of services (ILOS) pricing. The DHCS has pre-approved a list of 14 ILOS that managed care plans (MCPs) are strongly encouraged to offer. ILOS are medically appropriate and cost-effective alternatives to services covered under the State Plan. The approved ILOS are designed to be highly valuable to Members with complex health issues including conditions that are exacerbated by external drivers such as lack of food, housing or other social drivers of health.

Lightbourne, W., Newsome, G. (n.d.). Non-Binding ILOS Pricing Guidance. State of California - Health and Human Services Agency, DHCS. https://www.dhcs.ca.gov/Documents/MCQMD/ILOS-Pricing-Guidance-Updated-8-5-2021.pdf

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

n.d.

Small Running Title

CalAIM Data Guidance: Billing and Invoicing between ECM/Community Supports Providers and MCPs 

This document provides updated guidance for providers on invoicing standards to mitigate provider burden and promote data quality. This guidance is offered based on stakeholder input. In Q3 2022, DHCS launched a survey, and over 200 MCPs and ECM and Community Supports Providers responded with feedback about which updates should be considered.

California Department of Health Care Services (DHCS). (Updated: 2023, April). CalAIM Data Guidance: Billing and Invoicing between ECM/Community Supports Providers and MCPs. https://www.dhcs.ca.gov/Documents/MCQMD/ECM-and-Community-Supports-Billing-and-Invoicing-Guidance.pdf

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2021

Small Running Title

Enhanced Care Management and Community Supports  Coding Options 

This document contains the DHCS-established Healthcare Common Procedure Coding System (HCPCS) codes that must be used for documenting the rendering of ECM & Community Supports services in MCPs encounters. DHCS has continued to consider stakeholder feedback in updates to coding guidance in which plan and provider administration must adhere to.

California Department of Health Care Services (DHCS). (Updated: 2024, June). ECM and Community Supports HCPCS Coding Guidance. https://www.dhcs.ca.gov/Documents/MCQMD/Coding-Options-for-ECM-and-Community-Supports.pdf

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2021

Small Running Title

Coding4Food — California Medically Supportive Food & Nutrition

This article highlights the need for new codes to be created to reflect new pathways of care. The Coding4Food project aims to address the lack of adequate codes to document and bill for Food is Medicine interventions. The Healthcare Common Procedure Coding System, or HCPCS, codes integrate a spectrum of Food is Medicine interventions into the healthcare system.

California Medically Supportive Food & Nutrition. (2023). Coding4Food. https://www.msfnca.org/coding4food

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2023

Small Running Title

The Role of Community-Based Organization Networks in CalAIM: Seven Key Considerations

This issue brief offers insights into the collaborations between community-based organizations (CBOs) and Medi-Cal managed care plans. It highlights roles, opportunities, and challenges that CBO networks present in the context of CalAIM. It also identifies the resources and supports needed to foster the development of effective CBO networks and the vital role they play in addressing the nonclinical needs of Foundational Components of CalAIM community members, including providing job training, housing and tenancy support, behavioral health services, violence prevention, and food and nutrition services.

Spencer, A. & Clemente, I. (2022, August). The Role of Community-Based Organization Networks in CalAIM: Seven Key Considerations. CHCF. https://www.chcf.org/wp-content/uploads/2022/08/RoleCBONetworksCalAIMSevenKeyConsiderations.pdf

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2022

Small Running Title

Providing Access and Transforming Health (PATH) Initiative 

This site page welcomes visitors to explore the On-Demand Resource Library available to assist California communities in locating the resources they require. Providing Access and Transforming Health (PATH) enables California community-based organizations (CBOs), hospitals, county agencies, Tribes and Indian Health Care Providers, among others to successfully participate in the Medi-Cal delivery system as California widely implements Enhanced Care Management (ECM) and Community Supports and Justice Involved services under CalAIM.

California Department of Health Care Services (DHCS). (2025). Providing Access and Transforming Health. PATH. https://www.ca-path.com/

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2025

Small Running Title

Capacity and Infrastructure Transition, Expansion and Development (CITED)

This site page highlights the Providing Access and Transforming Health (PATH) CITED initiative and encourages applicants to coordinate applications with local organizations they contract with or intend to contract with to provide ECM and/or Community Supports services. Information is provided on who is eligible to apply and allowable uses for funds.

California Department of Health Care Services (DHCS). (2025). Capacity and Infrastructure Transition, Expansion and Development (CITED). PATH. https://www.ca-path.com/cited

Link

Addressing Health-Related Social Needs: Information, Guidance, and Lessons Learned

2025

Small Running Title

bottom of page