Whole Person Care/Health Homes Program Transition
The Enhanced Care Management (ECM) benefit replaces the Health Homes Program (HHP) and elements of the Whole Person Care (WPC) pilots, building on positive outcomes from those programs over the past several years. DHCS requires that beneficiaries receiving HHP or WPC services are transitioned to continue receiving care coordination services by way of the new ECM benefit to eligible members.
To ensure continuity between WPC and ECM, the following steps will be taken:
- The Plan automatically authorized all members enrolled in a WPC Pilot on December 31, 2021, who are identified by the WPC Lead Entity as belonging to an ECM population of focus; and
- For those members transitioned to ECM and who continue to see their current WPC provider, the ECM provider will assess to determine the most appropriate level of services for the member. The assessment is done within six months of enrollment in ECM or other timeframes provided by Department of Health Care Services (DHCS) in guidance for specific transitioning subpopulations. This is to confirm whether ECM or a lower level of care coordination best meets the member’s needs.
- For those members transitioned to ECM and who are seen by a new ECM provider (not their current WPC provider), the ECM provider will assess the member upon engagement.
To ensure continuity between HHP and ECM, the Plan will:
- Automatically authorize ECM for all members of ECM Populations of Focus who are enrolled in or are in the process of being enrolled in HHP on benefit effective date.
- Ensure each member who is automatically authorized for ECM under this provision (also referred to as the grandfathered ECM member population) is assessed by the ECM provider within six months of enrollment in ECM, to determine the most appropriate level of services for the member, and to confirm whether ECM or a lower level of care coordination best meets the member’s needs.
ECM providers need to reassess grandfathered WPC and/or HHP members assigned to them by the Plan within six months or other timeframes provided by DHCS in guidance for specific transitioning subpopulations, to determine the most appropriate level of services for the member, to confirm whether ECM or a lower level of care coordination best meets the member’s needs. ECM providers will be required to conduct a member reassessment by or before six months of enrollment in ECM based on the ECM program completion/step-down criteria. The Plan will provide additional information on the ECM program completion/step criteria.
Members enrolled in WPC and HHP received notices from the Plan or WPC Lead Entity in late 2021 about the upcoming transition of WPC and HHP to ECM. Additionally, WPC Lead Entities have reached out to WPC enrollees transitioning to ECM, per DHCS requirements. The Plan informed the grandfathered ECM member population of their provider assignments.