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Community Supports/LOS referral form(For Medical/Partnership recipients only.) Fax this form and patient\'s recent progress note with problem list (complete with ICD10 codes) and medication list to:7078871440
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ECM and Community Supports Standard Provider Terms refer to the guidelines and expectations set forth for service providers within the ECM (Enhanced Care Management) and community support frameworks. These terms outline the responsibilities, qualifications, and operational standards that providers must adhere to in order to deliver services effectively.
Service providers that participate in ECM and Community Supports programs are required to file the ECM and Community Supports Standard Provider Terms to ensure compliance with state regulations and program requirements.
To fill out the ECM and Community Supports Standard Provider Terms, providers must carefully review the guidelines, fill in required information such as provider details, services offered, and compliance measures, and submit the completed form according to the specified filing instructions.
The purpose of the ECM and Community Supports Standard Provider Terms is to establish a clear framework for service delivery, ensure quality of care, and outline the rights and responsibilities of providers to improve overall health outcomes in the community.
The information that must be reported includes provider name, contact information, type of services offered, operational practices, compliance with health regulations, and any specific conditions related to the delivery of ECM and Community Supports.
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