ECM Service Provision Expectations
Enhanced Care Management (ECM) providers are expected to ensure ECM is a whole-person, interdisciplinary approach to care that addresses the clinical and non-clinical needs of high-need and/or high-cost Medi-Cal members enrolled in managed care. The ECM provider must ensure the approach is person-centered, goal-oriented, and culturally appropriate. If the ECM provider subcontracts with other entities to administer ECM functions, the ECM provider will ensure agreements with each entity bind the entities to the terms and conditions set forth here and that its subcontractors comply with all requirements in these Standardized Terms and Conditions and the Department of Health Care Services (DHCS)-Managed Care Plan (MCP) ECM Contract. The utilization of any ECM provider subcontractors must be vetted and approved by the Plan and are subject to the requirements outlined in Required Area 12 of the ECM Provider Certification Application.
Reminder, as stated in Section 3.5.1 of this guide, the ECM provider must ensure each member receiving ECM has a Lead Care Manager.
As stated in Section 4.2 of this guide, if a member is receiving care management from multiple sources, ECM providers are expected to coordinate across all sources of care management. If a member is receiving care management or duplication of services from multiple sources, ECM providers are expected to alert the Plan to ensure non-duplication of services. ECM providers are also expected to follow the Plan instruction and participate in efforts to ensure ECM and other care management services are not duplicative.
The ECM provider must also collaborate with area hospitals, primary care physicians (PCPs) (when not serving as the ECM provider), behavioral health providers, specialists, dental providers, providers of services for LTSS and other associated entities, such as Community Supports providers, as appropriate, to coordinate member care.