California Medicaid Enhanced Care Management & In Lieu of Services Provider Standard Terms & Conditions

The document was released on May 28, 2021, by the California Department of Health Care Services. It presents the terms and conditions required of provider organizations delivering Medicaid Enhanced Care Management (ECM) and In Lieu of Services (ILOS). ECM is a whole-person, interdisciplinary approach to comprehensive care management, which addresses the clinical and non-clinical needs of high-cost, high-need managed care members. This is done through systematic coordination of services that is community-based, interdisciplinary, high-touch, and person-centered. ILOS are medically appropriate and cost-effective alternatives to services such as hospital care, nursing facility care . . .