Billable ECM Services
In order for a service to be billed under the Enhanced Care Management (ECM) program, it must:
- Be a meaningful and tangible service to the member.
- Support the goals and interventions outlined in the members assessment and care plan.
- Meet the rules for rounding to the nearest one-hour unit of service.
Covered ECM service activities include:
- Maintaining ongoing contact with members, caregivers, authorized supports, and the care team in the execution of care plan-based initiatives.
- Completing assessments to identify clinical and non-clinical needs, including gaps in care.
- Creating, updating and maintaining a person-centered care management plan.
- Coordinating care across providers, care settings and community resources.
- Making, and following up on, referrals to medical care, behavioral health, long-term services and supports, community-based services, and social drivers of health supports.
- Helping ensure members have and work with a primary care provider.
- Assisting with appointment scheduling, reminders, and access to covered services, including non-emergency medical transportation and interpretation services.
- Using care coordination strategies to help reduce avoidable hospital and emergency department use.
These examples are illustrative and not all-inclusive.