Frequently Asked Questions (FAQs) Additional Resources Below!
- Is there flexibility in how the MCPs can interpret the ECM Populations of Focus definitions?
No. ECM is a statewide, standardized benefit that is designed to be available to all
who meet the Populations of Focus definitions. MCPs may not narrow the
Populations of Focus Definitions. The Adult High Utilizer Population of Focus
the definition allows MCPs to authorize ECM services for individual high-utilizers who
would benefit from ECM but may not meet the numerical thresholds, but this
flexibility does not displace the numerical thresholds and MCPs must use the
numerical thresholds to identify members in this Population of Focus.
- Must individuals consent to ECM before they can receive it?
There are no formal requirements for the ECM Provider or MCP to document the individual’s consent before beginning to provide services. DHCS removed documentation requirements to streamline and simplify the implementation of the benefit. However, an individual may decline to engage in or continue ECM at any time.
- What counts as an outreach attempt for ECM?
Outreach attempts are defined as individualized communication with a prospective ECM enrollee who is provided with the opportunity to respond directly. Individualized communication can occur through in-person, email, text, phone call, or other electronic method. An outreach attempt counts regardless of whether or not successful contact was made with the enrollee, and whether or not the outreach directly results in ECM enrollment. Below are some common examples, and not an exhaustive list, of outreach scenarios.
For more FAQs, please see the DHCS FAQ Document (click here)!
Anthem Provider Directories and Referral Forms
California Advancing and Innovating Med-Cal (CalAIM)
Enhanced Care Management
Enhanced Care Management – Populations of Focus