Enhanced Care Management Clause Samples
Enhanced Care Management. 1. Delivery of the ECM benefit for individuals who meet ECM Population of Focus definitions (including, but not limited to, the Individuals with Severe Mental Illness and Children Populations of Focus) must be consistent with DHCS guidance regarding ECM, including:
a. That MCP prioritize assigning a Member to a DMC- ODS Provider as the ECM Provider if the Member receives DMC-ODS services from that Provider and that Provider is a contracted ECM Provider, unless the Member has expressed a different preference or MCP identifies a more appropriate ECM Provider given the Member’s individual needs and health conditions; and
b. That the Parties implement a process for DMC-ODS Providers to refer their patients to MCP for ECM if the patients meet Population of Focus criteria.
2. The Parties must implement a process for avoiding duplication of services for individuals receiving ECM with DMC-ODS care coordination. Members receiving DMC-ODS care coordination can also be eligible for and receive ECM. 4 CalAIM Population Health Management Policy Guide available at ▇▇▇▇▇://▇▇▇.▇▇▇▇.▇▇.▇▇▇/CalAIM/Documents/2023-PHM-Policy-Guide.pdf.
3. MCP must have written processes for ensuring the non- duplication of services for Members receiving ECM and DMC-ODS care coordination.
Enhanced Care Management. Delivery of the ECM benefit for individuals who meet ECM Population of Focus definitions (including, but not limited to, the Individuals with Severe Mental Illness and Children Populations of Focus) must be consistent with DHCS guidance regarding ECM, including:
Enhanced Care Management. 1. Delivery of the ECM benefit for individuals who meet ECM Population of Focus definitions (including, but not limited to, the Individuals with Severe Mental Illness and Children Populations of Focus) must be consistent with DHCS guidance regarding ECM, including:
a. That MCP prioritize assigning a Member to an SMHS Provider as the ECM Provider if the Member receives SMHS from that Provider and that Provider is a contracted ECM Provider, unless the Member has expressed a different preference or MCP identifies a more appropriate ECM Provider given the Member’s individual needs and health conditions;
b. That the Parties implement a process for SMHS Providers to refer their patients to MCP for ECM if the patients meet Population of Focus criteria; and
c. That the Parties implement a process for avoiding duplication of services for individuals receiving ECM with SMHS Targeted Case Management (“TCM”), Intensive Care Coordination (“ICC”), and/or Full-Service Partnership (“FSP”) services as set forth in the CalAIM ECM Policy Guide, as revised or superseded from time to time, and coordination activities.
Enhanced Care Management. 1. Delivery of the ECM benefit for individuals who meet ECM Population of Focus definitions (including, but not limited to, the Individuals with Severe Mental Illness and Children Populations of Focus) must be consistent with DHCS guidance regarding ECM, including:
a. That MCPs prioritize assigning a Member to a DMC Provider as the ECM Provider if the Member receives DMC State Plan services from that Provider and that Provider is a contracted ECM Provider, unless the Member has expressed a different preference or MCPs identify a more appropriate ECM Provider given the Member’s individual needs and health conditions, and;
b. That the Parties implement a process for DMC Providers to refer their patients to MCPs for ECM if the patients meet Population of Focus criteria.
2. The Parties must implement a process for avoiding duplication of services for individuals receiving ECM with DMC State Plan care coordination. Members receiving DMC State Plan care coordination can also be eligible for and receive ECM.
3. MCPs must have written processes for ensuring the non- duplication of services for Members receiving ECM and DMC State Plan care coordination.
Enhanced Care Management. 1. Delivery of the ECM benefit for individuals who meet ECM Population of Focus definitions (including, but not limited to, the Individuals with Severe Mental Illness and Children Populations of Focus) must be consistent with DHCS guidance regarding ECM, including:
a. That MCP prioritize assigning a Member to an SMHS Provider as the ECM Provider if the Member receives SMHS from that Provider and that Provider is a contracted ECM Provider, unless the Member has expressed a different preference or MCP identifies a more appropriate ECM Provider given the Member’s individual needs and health conditions;
Enhanced Care Management. 1. Delivery of the ECM benefit for individuals who meet ECM Population of Focus definitions (including, but not limited to, the Individuals with Severe Mental Illness and Children Populations of Focus) must be consistent with DHCS guidance regarding ECM, including:
a. That MCP prioritize assigning a Member to an SMHS Provider as the ECM Provider if the Member receives SMHS from that Provider and that Provider is a contracted ECM Provider, unless the Member has expressed a different preference or MCP identifies a more appropriate ECM Provider given the Member’s individual needs and health conditions;
b. That the Parties implement a process for SMHS Providers to refer their patients to MCP for ECM if the patients meet Population of Focus criteria; and
c. That the Parties implement a process for avoiding duplication of services for individuals receiving ECM with SMHS Targeted Case Management (“TCM”), Intensive Care Coordination (“ICC”), and/or Full-Service DocuSign Envelope ID: C977AC65-61FC-46C9-BACA-08CFF903E6C6 Partnership (“FSP”) services as set forth in the CalAIM ECM Policy Guide, as revised or superseded from time to time, and coordination activities.
Enhanced Care Management i. Delivery of the ECM benefit for individuals who meet ECM Population of Focus definitions (including, but not limited to, the Individuals with Severe Mental Illness and Children Populations of Focus) must be consistent with DHCS guidance regarding ECM, including:
1. That MCP prioritize assigning a Member to an SMHS or DMC- ODS Provider as the ECM Provider if the Member receives SMHS or DMC-ODS services from that Provider and that Provider is a contracted ECM Provider, unless the Member has expressed a different preference or MCP identifies a more appropriate ECM Provider given the Member’s individual needs and health conditions;
2. That the Parties implement a process for SMHS and DMC- ODS Providers to refer their patients to MCP for ECM if the patients meet Population of Focus criteria; and
3. That the Parties implement a process for avoiding duplication of services for individuals receiving ECM with SMHS Targeted Case Management (“TCM”), Intensive Care Coordination (“ICC”), and/or Full-Service Partnership (“FSP”) services as set forth in the CalAIM ECM Policy Guide, as revised or superseded from time to time, and coordination activities.
ii. Delivery of the ECM benefit for individuals who meet ECM Population of Focus definitions (including, but not limited to, the Individuals with Severe Mental Illness and Children Populations of Focus) must be consistent with DHCS guidance regarding ECM, including:
1. That MCP prioritize assigning a Member to an SMHS Provider or a DMC-ODS Provider as the ECM Provider if the Member receives SMHS or DMC-ODS services from that Provider and that Provider is a contracted ECM Provider, unless the Member has expressed a different preference or MCP identifies a more appropriate ECM Provider given the Member’s individual needs and health conditions;
2. That the Parties implement a process for SMHS and DMC- ODS Providers to refer their patients to MCP for ECM if the patients meet Population of Focus criteria; and
iii. That the Parties implement a process for avoiding duplication of services for individuals receiving ECM with SMHS Targeted Case Management (“TCM”), Intensive Care Coordination (“ICC”), and/or Full-Service Partnership (“FSP”) services as set forth in the CalAIM ECM Policy Guide, as revised or superseded from time to time, and coordination activities.
iv. The Parties must implement a process for avoiding duplication of services for individuals receiving ECM with DMC-ODS care coordination. Members receiving DMC-ODS c...