Staffing, Provider Capacity and Training
ECM Provider Care Team Staffing
Highly qualified and skilled staff are essential to the success of the Enhanced Care Management (ECM) benefit. ECM providers are required to develop and maintain a care team, including all required care team roles and/or functions, to deliver ECM services to members. The ECM provider is responsible to maintain adequate staff and ensure the ECM provider’s ability to carry out responsibilities for each member consistent with the DHCS provider standard terms and conditions, the Department of Health Care Services (DHCS)-Managed Care Plan (MCP) ECM Contract, and any other related DHCS guidance. The Plan will work with the ECM provider to ensure the ECM provider’s staffing model emphasizes and optimizes the roles of different team members while meeting the ECM requirements, including required ECM staffing ratios.
DHCS specifies that each enrolled ECM member must have a Lead Care Manager. An ECM Lead Care Manager is a member’s designated care manager for ECM who works for the ECM provider organization. The Lead Care Manager operates as part of the member’s multi-disciplinary care team and is responsible for coordinating all aspects of ECM and coordination with a Community Supports provider, as applicable. To the extent a member has other care managers, the Lead Care Manager is considered to be the primary care manager, and single point of contact, for the member and will be responsible for coordinating with those individuals and/or entities to ensure a seamless experience for the member and non-duplication of services. Each Lead Care Manager must be able to provide both in-person and telephonic services to the member, depending on the member’s needs and preferences. ECM providers must have protocols in place outlining how clinical supervision is provided to non-licensed (i.e., paraprofessional) staff members by the clinical consultant (see below) to ensure continued guidance, training, and clinical support to appropriately oversee the non-licensed (i.e., paraprofessional) staff members activities aligning to the ECM member’s care plan and care coordination needs.
The ECM provider is responsible for maintaining the following roles/positions on the care team:
- Lead Care Manager(s).
- ECM director.
- ECM clinical consultant(s).
If at any time, a provider’s program does not contain these required team members, they must immediately notify the Plan to discuss next steps to ensure members are continuously supported by a full and compliant ECM team.
The table below describes the DHCS ECM care team requirements. As DHCS may provide additional guidance regarding staffing, this section of the guide may be updated in the future.
ECM Team Member | Qualifications | Role |
|---|---|---|
Lead Care Manager | Professional (i.e., licensed mental health or behavioral health professional/clinician, social worker, or nurse) or Paraprofessional (with appropriate training, lived experience, and oversight) |
|
ECM director | Ability to manage multi- disciplinary care teams |
|
ECM clinical consultant | Clinician consultant(s), independently licensed clinician who may be a primary care physician, specialist physician, psychiatrist, psychologist, pharmacist, registered nurse, advanced practice nurse, licensed clinical social worker, or other licensed behavioral health care professional |
|
Staffing Ratios
We expect ECM providers to staff appropriately for the Population of Focus that they serve for whom they are providing ECM services. Though maximum caseloads are defined below, providers are encouraged to reduce those based on the level of needs of the member and Populations of Focus that they serve to best support the members at the intensity that is expected in the ECM program.
Provider Caseloads
The Lead Care Manager caseload ratio recommendation is less than 50:1 but not to exceed 60:1. Providers are encouraged to reduce caseloads based on the acuity of members to ensure Lead Care Managers have the appropriate bandwidth to provide all seven core ECM services consistently, as required by DHCS.
Staffing and Capacity Report
To understand the staffing capacity, measure network adequacy, demonstrate growth over time, and identify staff who will need to complete required training, ECM providers are required to submit an initial, prospective staffing and capacity report before providing ECM services (as part of the ECM provider certification process). ECM providers are required to submit staffing and capacity reports at minimum on a quarterly basis. The required report will include the following, subject to change:
- Tax identification number (TIN)/National Provider Identifier (NPI).
- Team members’ names.
- Team members’ ECM role.
- Team members’ ECM caseload capacity for ECM enrolled members (quarterly).
- Member caseload for the Plan within the context of service provision to all MCPs with whom the ECM provider is contracted.
Capacity reports are due quarterly, submitted through secure file transfer protocol (SFTP), by the following dates:
- January 31
- April 30
- July 31
- October 31
The Plan will utilize the data provided in the staffing and capacity reports to ensure the ECM provider’s caseloads do not surpass the thresholds outlined by the Plan. The individual Lead Care Manager’s caseload count is defined as the cumulative count of members supported by the Lead Care Manager regardless of the member’s health plan assignment. Lead Care Managers can serve members from different MCPs, but the individual Lead Care Manager’s caseload capacity count cannot exceed the threshold number for each individual care manager as a whole.
Training
ECM providers are expected to participate in all mandatory, provider-focused ECM training and technical assistance provided by the Plan, including in-person sessions, webinars and/or calls, as necessary.
There are two trainings that are required annually for provider teams to support the CalAIM program.
- Person Centered Care Planning: Must be completed by all Lead Care Managers and clinical consultants.
- Cultural Humility and Competency: Must be completed by all staff who work directly with members.
Additionally, providers serving Justice-Involved members must ensure staff are trained and operationally prepared to coordinate reentry-related ECM activities, including member engagement before or after release when information is available, linkage to primary care and behavioral health providers, coordination with correctional and reentry partners, medication and treatment continuity support, transportation and interpretation access, and referrals to community-based and social drivers of health supports.
Providers who fail to consistently meet these training requirements may not be allowed to continue to support members in this program.