Los Angeles County Managed Care Plans - Enhanced Care Management (ECM) Provider Reference Guide - Version 3.0 - Revised 3/24/2026

Sep 24, 2026

Uploaded by noah

Los Angeles County Enhanced Care Management (ECM) Provider Reference Guide (Version 3.0, revised 3/24/2026) outlines requirements and operational expectations for ECM providers. It covers regulatory authorities, steps to become an ECM provider, provider certification needs, NPI use, Medi-Cal enrollment, and the structure of the ECM care team, staffing, capacity, and staff training. It also details member eligibility and continuity rules, referral and assignment processes, member identification and data sharing, ECM core services, and procedures for discontinuing and reauthorizing ECM.

LanguageEnglish

CategoryGeneral

FormatPDF

Pages42

Reading Time15 min

AccessFree to download

1 About this Guide

2 Introduction

3 Regulatory Authorities

4 How to Become an ECM Provider

4.1 ECM Provider Experience and Qualifications

4.2 Provider Certification

4.3 National Provider Identifier (NPI)

4.4 Medi-Cal Enrollment

4.5 ECM Provider Care Team

4.6 Staffing and Capacity

4.7 ECM Staff Training

5 ECM Member Eligibility

5.1 Adult and Youth Definitions

5.2 Continuity of ECM Services for Members Who Change Managed Care Plans

5.3 ECM Program Overlaps and Exclusions

6 Member Identification

6.1 Community-Based Referrals

6.2 ECM Provider-Initiated Referrals

6.3 Member Self-Referral

6.4 ECM Member Information File (MIF)

7 ECM Provider Referrals: Submission Processes and Eligibility Determination

7.1 LA County Enhanced Care Management (ECM) Benefit Referral Form

7.2 ECM Eligibility Determination

7.3 Electronic Presumptive Authorization Tool

7.4 Member Assignment to ECM Providers

7.5 Assign Lead Care Manager

7.6 Member Ability to Change Provider

8 ECM Core Services

8.1 Outreach and Engagement

8.2 Comprehensive Assessment and Care Plan

8.3 Enhanced Coordination of Care

8.4 Health Promotion

8.5 Transitional Care Services (TCS)

8.6 Member and Family Supports

8.7 Coordination of and Referral to Community and Social Support Services

9 Discontinuing and Reauthorizing ECM

Los Angeles County Managed Care Plans Enhanced Care Management (ECM) Provider Reference Guide Version 3.0 Revised 3/24/2026 Version 3.0 | Page 1 of 42 PL2709 0426 1 About this Guide ............................................................................................................................... 4 2 Introduction...................................................................................................................................... 4 3 Regulatory Authorities ...................................................................................................................... 5 4 How to Become an ECM Provider ...................................................................................................... 5 4.1 ECM Provider Experience and Qualifications ...................................................................................... 6 4.1.1 ECM JI ECM Providers...................................................................................................... 6 4.2 Provider Certification ........................................................................................................................... 6 4.3 National Provider Identifier (NPI) ........................................................................................................ 8 4.4 Medi-Cal Enrollment ............................................................................................................................ 8 4.5 ECM Provider Care Team ..................................................................................................................... 8 4.6 Staffing and Capacity ......................................................................................................................... 11 4.7 ECM Staff Training .............................................................................................................................. 12 5 ECM Member Eligibility................................................................................................................... 12 5.1 Adult and Youth Definitions ............................................................................................................... 13 5.2 Continuity of ECM Services for Members Who Change Managed Care Plans .................................. 20 5.3 ECM Program Overlaps and Exclusions.............................................................................................. 20 5.3.1 Non Duplication of Services ........................................................................................... 22 6 Member Identification .................................................................................................................... 23 6.1 Community-Based Referrals: ............................................................................................................. 23 6.2 ECM Provider-Initiated Referrals: ...................................................................................................... 23 6.3 Member Self-Referral: ....................................................................................................................... 23 6.4 ECM Member Information File (MIF): ............................................................................................... 23 7 ECM Provider Referrals: Submission Processes and Eligibility Determination................................... 23 7.1 LA County Enhanced Care Management (ECM) Benefit Referral Form ............................................. 23 7.2 ECM Eligibility Determination ............................................................................................................ 23 7.3 Electronic Presumptive Authorization Tool ....................................................................................... 24 7.4 Member Assignment to ECM Providers....................................................................................

FAQs

What does the ECM provider guide cover for providers and care teams?

It covers how to become an ECM provider, provider certification, NPI and Medi-Cal enrollment, and expectations for the ECM care team, including staffing, capacity, and staff training requirements.

How are ECM member eligibility and eligibility changes handled?

The guide explains adult and youth eligibility definitions and the continuity rules for members who change managed care plans, including how ECM service overlaps and exclusions are managed.

What referral and member assignment processes are included?

It outlines referral submission processes, the LA County ECM benefit referral form, eligibility determination, an electronic presumptive authorization tool, member assignment to ECM providers, and procedures for lead care manager assignment and provider change ability.

Sep 24, 2026

Uploaded by noah