Program Completion
Department of Health Care Services (DHCS) has identified Enhanced Care Management (ECM) as the most intensive level of care management services to be offered. Each member must be assessed for an ongoing need specifically for the ECM benefit or readiness to graduate from ECM. To support this requirement, the ECM Program Completion Questionnaire (PCQ) serves as a standardized tool that ensures all contracted ECM providers are using the same set of criteria to assess a member’s readiness for an ongoing need for ECM services or ECM completion.
Generally, members will be considered ready to graduate from the ECM benefit when they have completed their care plan goals and demonstrated improvement in self-management of physical and behavioral health, social determinants of health (SDOH), and activities of daily living. Most health plans encourage ECM Lead Care Managers to use a questionnaire (based on the program completion/step-down criteria) with the member to help determine readiness for program completion of ECM and/or transition out of ECM.
When an ECM provider identifies a member who is ready to graduate from the ECM benefit, the ECM provider will conduct an ECM case conference with the multidisciplinary team to review the recommendation to step down from ECM and transition to another setting and ensure any resources and/or care coordination needs are in place. This can include community-based services and other case/care management programs.