Enhanced Care Management and In Lieu of Services
Enhanced Care Management (ECM) and In Lieu of Services (ILOS) are foundational components of CalAIM. ECM will be a whole-person, interdisciplinary approach to comprehensive care management that addresses the clinical and non-clinical needs of high-cost, high-need managed care members 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 covered under the State Plan. ILOS are optional services for Medi-Cal managed care plans (MCPs) to provide and are optional for managed care members.
ECM and ILOS are ambitious reforms with implementation beginning in January 2022. This landing page will serve as the centralized repository for the most up-to-date information about ECM and ILOS. Please submit questions about ECM and ILOS to: CalAIMECMILOS@dhcs.ca.gov
IMPORTANT UPDATE: The California Department of Health Care Services (DHCS) is accepting written feedback on the Incentive Payment Draft Program Design and Measure Set, please submit feedback to CalAIMECMILOS@dhcs.ca.gov by Wednesday, July 14.
DHCS has released finalized requirements documents and additional supporting resources for the Enhanced Care Management (ECM) benefit and In Lieu of Services (ILOS), available below.
Please note that DHCS will incorporate the provisions in the DHCS-MCP ECM and ILOS Contract Template below as an attachment to existing MCP Contracts. These provisions will also be included as part of the 2024 Request for Proposal (RFP)/Main Contract.