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
On September 9, 2021, DHCS released its ECM Policy Guide and ILOS Policy Guide, providing a comprehensive overview of ECM and ILOS as well as additional operational guidance for MCPs as they prepare to offer ECM and ILOS beginning in 2022. The Policy Guides are intended to serve as a resource for MCPs preparing to offer ECM and ILOS, as well as for other key stakeholders involved in ECM and ILOS, such as providers, counties, and community-based organizations. Updates will be published as needed.
On September 1, 2021, DHCS released its ECM and ILOS Incentive Payment Program draft documents for review and comment. The draft documents, which can be found below in the "Resources" section, include the All Plan Letter and the Medi-Cal managed care plan (MCP) Reporting Templates. The Reporting Templates detail the required measures that MCPs would need to complete should they choose to participate in the incentive payment program.
On August 27, 2021, DHCS released the Non-Binding ILOS Pricing Guidance, offering information on potential rates for each of the fourteen (14) pre-approved ILOS, including midpoint benchmarks, a range around the benchmarks, and a discussion of key cost drivers for MCPs and ILOS Providers to consider as they establish their own contracting and payment arrangements. Also released was the California ILOS Evidence Base Executive Summary, which summarizes select highlights and key findings of DHCS’ research on the measurable impacts ILOS may have on health care costs, utilization, and health outcomes.
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.