Section 5: Care Coordination

Table of Contents - Medi-Cal

Policy/Procedure Title	Policy Number
Care Coordination Program Description	MPCD2013
Advice Nurse Program	MCCP2018
CalAIM Enhanced Care Management (ECM)	MCCP2032
Individualized Care Plan Example	MCCP2032-A
Enhanced Care Management (ECM) Release of Information Form (ROI)	MCCP2032-B
Community Health Worker Archived June 11, 2025 See Enhanced Health Services MPAP7004	MCCP2033
Complex Case Management	MCCP2007
Continuity of Care	MPCP2014
Continuity of Care Data Sharing Information	MPCP2014-A
Continuity of Care (CoC) Data Template - 1) Elements for All Members	MPCP2014-B
Continuity of Care (CoC) Data Template - 2a) Special Populations Specifications	MPCP2014-C
Continuity of Care (CoC) Data Template – 2b) Special Population Member File	MPCP2014-D
Continuity of Care (CoC) Data Template – 2c) Special Populations Accompanying Data	MPCP2014-E
Coordination of Services for Members with Special Health Care Needs (MSHCNs) and Persons with Developmental Disabilities (previously -Identification of Children with Special Health Care needs (CSHCN) through programmatic linkages)	MPCP2006
Diabetes Prevention Program	MPCP2026
Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services	MCCP2022
Emergency Medical Transportation	MCCP2029
Identification and Care Coordination for Seniors and Persons with Disabilities	MCCP2019
Health Risk Assessment	MCCP2019-A
PHRA (Pediatric)	MCCP2019-B
HRA Stratification Matrix (Adult)	MCCP2019-C
PHRA Stratification Matrix (Pediatric)	MCCP2019-D
Lactation Policy and Guidelines Archived - See Population Health Management MPNP9007
Local Health Department (LHD) Coordination	MCCP2035
Local Health Department Memorandum of Understanding template (DHCS)	MCCP2035-A
New Member Needs Assessment	MCCP2023
Health Information Form (HIF)/Member Evaluation Tool (MET)	MCCP2023-A
Health Risk Assessment (HRA) Form	MCCP2023-B
PHRA Form	MCCP2023-C
Memorandum of Understanding (MOU) Requirements for Medi-Cal Managed Care Plans and Third-Party Entities	MCCP2036
Base MOU Template	MCCP2036-A
In Home Supportive Services MOU Template	MCCP2036-B
Regional Center MOU Template	MCCP2036-C
Specialty Mental Health Services MOU Template	MCCP2036-D
Substance Use Disorder Treatment Services MOU Template	MCCP2036-E
Local Health Department MOU Template	MCCP2036-F
County Social Services Programs and Child Welfare MOU Template	MCCP2036-G
Women, Infant & Children MOU Template	MCCP2036-H
County-Based Targeted Case Management MOU Template	MCCP2036-I
Drug Medi-Cal State Plan MOU Template	MCCP2036-J
First 5 MOU Template	MCCP2036-K
California Children's Services (CCS) Whole Child Model Program MOU Template	MCCP2036-L
Pediatric Quality Committee Policy	MCCP2025
Private Duty Nursing	MCCP2031
Scope of Primary Care - Behavioral Health & Indications for Referral Guidelines	MPCP2017
Carelon/ Partnership Behavioral Health Care Management Referral Form (including Authorization for Carelon Behavioral Health, Inc. to Release Confidential Information	MPCP2017-A
Carelon/ Partnership Primary Care Provider (PCP) Referral Form (including Authorization for Carelon Behavioral Health, Inc. to Release Confidential Information)	MPCP2017-B
Transportation Policy for Non-Emergency Medical (NEMT) and Non-Medical Transportation (NMT)	MCCP2016
Provider Certification Statement	MCCP2016-A
Transitional Care Services	MPCP2034
Whole Child Model For California Children's Services (CCS)	MCCP2024
Pediatric Risk Stratification Process	MCCP2024-A
Partnership HealthPlan of California’s Whole Child Model Family Advisory Committee (FAC) Charter	MCCP2024-B
Women, Infants and Children (WIC) Supplemental Food Program Archived 08/13/25 - See Population Health MPNP9008

Please Direct Questions To:

Partnership HealthPlan of California
4665 Business Center Drive
Fairfield, CA 94534
Phone: (707) 863-4100

Section 5: Care Coordination

​Table of Contents - Medi-Cal

Table of Contents - Medi-Cal