Frequently Asked Questions
Below are FAQs developed by the L.A. County Managed Care Plans (MCPs) to support Enhanced Care Managment (ECM) providers.
ECM is a state-wide CalAIM benefit that replaces the now-ended Health Homes Program (HHP) and Whole Person Care (WPC) pilots as of January 1, 2022.
This new five-year benefit provides comprehensive care management services to members with highly complex needs. ECM addresses both the clinical and social determinants of health needs of high-cost and high-need members.
ECM services are interdisciplinary, team-based, high-touch and person-centered.
Members enrolled in HHP and WPC were automatically grandfathered into ECM on January 1, 2022. They do not need to sign-up or enroll into ECM.
The goal is to provide a seamless transition for the member with some services also provided under Community Supports (CS).
The ECM model of care provides the highest level of care management to the clinically and socially complex member.
It is very similar to HHP, with a majority of HHP Care Teams transitioning over as ECM providers.
The Core Services provided in ECM and HHP are essentially the same, with the exception of Outreach and Engagement added as a Core Service to ECM (which HHP prioritized in practice).
Other differences between the services include the removal of Housing Transition/ Tenancy Sustaining Services in ECM; these services are transferring to the Community Supports (CS) Program. Members receiving these services in HHP will receive them through CS.
ECM also expands eligibility to additional populations with criteria attached to each.
Several Populations of Focus and services have gone live since January 1, 2022.
Individuals experiencing homelessness, adults with SMI/SUD, Individuals who are high utilizers of services, and persons transitioning from incarceration are eligible for the ECM Benefit as of January 1, 2022, in Los Angeles County.
As ECM is a benefit for MediCal members enrolled in a Health Plan, non-Medi-Cal members are not be eligible. The recommendation to the ECM provider is to support the HHP member in re-accessing Medi-Cal benefit in order to be eligible for ECM.
Children and youth who have been enrolled in HHP are automatically grandfathered into ECM, regardless of eligibility criteria for ECM.
There are currently two ECM Populations of Focus in which children/youth may be eligible: Individuals and families experiencing homelessness and individuals transitioning from incarceration.
Individuals receiving both Medi-Cal and Medicare coverage can receive ECM if they meet Population of Focus criteria. The Exclusionary Checklist tool lists the specific plans that dually eligible individuals can be enrolled in while also participating in ECM:
- Dual Eligible Special Needs Plans (D-SNPs)
- D-SNP Look-alike Plans
- Other Medicare Advantage Plans
- Medicare FFS
Duals with managed care Medi-Cal and Medicare FFS are ECM eligible, but duals enrolled in other Medicare Advantage plans are not.
With regards to the Populations of Focus checklist, specifically Adults with Serious Mental Illness or Substance Use Disorder, you can determine if an individual is eligible for obtaining services through the County Specialty Mental Health (SMH) system or the Drug Medi-Cal Organized Delivery System (ODS) by checking eligibility requirements for these programs on the following sites:
There are portals in place to receive this information regarding existing patients, including ADT (admission, discharge, transfer) data for existing clinic patients. You can also receive this information from the member's Health Plan.
If unable to verify when referring the member, note on the form how you received the information (e.g. patient self-report, hospital referral).
If you suspect that an individual may be in a program that may be exclusionary or duplicative, but are unable to verify, note this on the Referral form when submitting to the Health Plan.
All ECM referrals are reviewed to confirm eligibility. Health Plans may not have access to all duplicative program information.
As providers continue to work with members, it may be discovered that a member is in a program that is considered duplicative or exclusionary of ECM. If the program is duplicative, the member must make a choice of either the ECM benefit or the other program. If the program is exclusionary, the member must be disenrolled from the ECM benefit.
Below are slide decks from our webinars on various aspects of the ECM program.
Enhanced Care Management 101: Overview for New Providers and Teams
The ECM Referral Form and Submission Process
Member Information File (MIF)
Outreach and Engagement in ECM - Practical Strategies
The Assessment and Care Plan in ECM - Practical Strategies
ECM Claims Guidance
Supporting Continuity of Care in ECM - Practical Strategies