Outreach and engagement of Enhanced Care Management (ECM)-eligible members is critical for the program’s success. ECM providers are responsible for conducting outreach to each newly assigned member listed on the member information file (MIF) file and engaging each assigned member to enroll into ECM.

The ECM provider must ensure outreach to assigned members prioritizes those assigned members with the highest level of risk and need for ECM. The ECM provider is expected to conduct outreach primarily through in-person interaction where members and/or their family member(s), guardian, caregiver, and/or authorized support person(s) live, seek care, or prefer to access services in their community, subject to public health protocols. The ECM provider may supplement in-person visits with secure teleconferencing and telehealth,^[1] where appropriate and with the member’s consent. The ECM provider must use the following modalities, as appropriate and as authorized by the member, if in-person modalities are unsuccessful or to reflect a member’s stated contact preferences: mail/letter, email, texts, phone calls and telehealth. The Plan requires the ECM provider to initiate outreach and complete at least five outreach attempts within 90 calendar days of the receipt of ECM MIF data file from the Plan. At least three different modalities will be used in attempt to reach members who are unable to be contacted in person and before a member is identified as an unsuccessful engagement. Providers are encouraged to complete the initial outreach as timely as possible upon receipt.

Members authorized for the Transitional Rent benefit are automatically referred to ECM. When an ECM provider receives a referral for such a member, they must conduct in-person outreach every week, as required by Department of Health Care Services (DHCS). Providers will be notified when a member assigned for outreach is authorized for Transitional Rent, and further details will be provided during the provider onboarding process.

All outreach attempts to enroll members identified on a providers monthly MIF must be tracked and reported to the Plan monthly through the outreach tracking file (OTF).

ECM providers must have the capacity and strong commitment to conduct in-person outreach. Should an ECM provider’s program or staffing change where in-person services can no longer be provided, the provider must notify the Plan immediately.

The ECM provider must comply with non-discrimination requirements set forth in state and federal law and the contract with the Plan.

Member engagement and response will vary based on the particular member’s circumstances. ECM providers’ ECM outreach activity protocols to assigned members must include active, meaningful, and progressive attempts to reach members each month between the initial 30-day and 90-day period, until each member is notified and engaged. The outreach and engagement expectations outlined in this section apply to assigned members not yet enrolled into ECM.

Providers must use all available information and resources to contact the member. This includes details from the MIF file, reaching out to the member’s primary care physician (PCP) and other healthcare providers for updated contact information, reviewing admission-discharge-transfer files, and using any other source to find current contact information.

Once the ECM provider determines that a member is not reachable within 90 days, declines to participate, continues to disengage, or meets an exclusion criterion, the ECM provider is expected to exclude the member from further outreach and report the information to the Plan in the Return Transmission File (RTF).

If the ECM provider cannot contact an enrolled member after five attempts using different modalities (in-person, mail/letter, email, texts, phone calls and telehealth), the ECM provider is expected to exclude the member from further outreach and report the member updated status to the Plan in the RTF submission. ECM providers are expected to provide a phone number for members to reach their ECM care team.

In an effort to mitigate adverse impacts to members transitioning to ECM and leverage the member’s existing relationship with the Whole Person Care (WPC) Lead Entity and/or Health Homes Program (HHP) Community-Based Care Management Entity (CB-CME), the WPC Lead Entity and/or HHP CB-CME shall be responsible for communicating to members about the transition to ECM. The Plan shall collaborate with and provide the WPC Lead Entity with guidance on communication with the member. The Plan will utilize DHCS’ HHP to ECM Transition Notice template to communicate transition expectations to the member.

^[1]The ECM provider is responsible to ensure secure teleconferencing and telehealth systems meet DHCS requirements. Find additional information from DHCS Medi-Cal and Telehealth.