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California Integrated Care Management (CICM) Program

Some TotalCare (HMO D-SNP) members may be eligible for and benefit from extra support in addition to the plan’s care management program. The California Integrated Care Management (CICM) program is a comprehensive care management model that supports TotalCare members with complex medical, behavioral health, functional or social needs. The program aligns with statewide CalAIM objectives and offers enhanced integration with community services to improve clinical outcomes, stability and overall quality of life.

There are a few different ways that members can connect to CICM services:

Members may be automatically enrolled.
Providers can refer members.
Caregivers or members may request evaluation for CICM services.

Program goals

The goals of CICM are to:

Promote integrated coordination across medical, behavioral health and social supports.
Support member engagement in care and self-management.
Reduce preventable emergency department (ED) visits and hospitalizations.
Improve communication and shared care planning among providers.
Address social determinants of health.
Ensure continuity and safety during transitions of care.

Face-to-face (F2F) engagement requirements

For members experiencing homelessness or significant housing instability, care managers may meet members in a variety of community-based settings. A face-to-face (F2F) encounter may occur in person at:

A member’s temporary or permanent residence.
A shelter, navigation center, supportive housing site or motel placement.
A clinic, community health center or behavioral health provider’s office.
Locations where outreach services are provided.
Public spaces where the member is safely reachable.

Telehealth or telephonic contact may be used when in-person contact is clinically inappropriate, not feasible or when member preference indicates. Documentation should reflect the reason for alternative contact and member engagement status.

Eligible population

Eligibility is determined based on CalAIM’s populations of focus criteria. Members may be evaluated for CICM at any time. Some members may be automatically enrolled and notified of their enrollment. However, participation is voluntary and members may choose to discontinue care management support at any time without impact to their coverage or benefits.

Eligible members include those experiencing:

Multiple or advanced chronic medical conditions.
Co-occurring behavioral health needs impacting daily functioning.
Frequent emergency department utilization or recent inpatient admissions.
Housing instability or homelessness.
Gaps in coordination across treating providers or service systems.
Difficulty accessing or engaging in ongoing medical or behavioral health care.

Role of providers

Referral process

Providers may refer members to CICM when integrated care coordination is indicated. The following referral methods are accepted:

Online referral form in the Alliance Provider Portal.
Direct referral from provider to care manager.
Internal Alliance Care Management referral workflows.
Fax using the Care Management Referral Form.

The TotalCare Care Management team will review referrals within 5–7 business days. Referring providers will be notified of outcomes or follow-up steps.