The ECM Benefit provides comprehensive care management services to 4 different Populations of Focus with the goal to improve the health and social outcomes of the ECM-enrolled member.
Medi-Cal members are eligible for the ECM Benefit if they meet the ECM Populations of Focus eligibility criteria as defined in this checklist and are not enrolled in duplicative services (as defined in the Exclusionary Checklist).
ECM Population of Focus
Has ONE of the following:
*Unplanned hospital stays exclude voluntary surgeries and deliveries
**Use the score in Extended Patient Data; the pharmaceutical cost exclusion has been calculated and incorporated for you
LTCELI Exclusion: Has NONE of the following:
AND Has ALL the following:
AND Has ONE the following:
NFRT Exclusion: Has NONE of the following:
AND Has ALL the following:
*“postpartum” period is defined as the 12 months following the last day of the pregnancy (regardless of pregnancy outcome)
AND
Has ONE of the following:
