CalAIM Enhanced Care Management and Community Supports Launching in 2022
After significant timeline disruptions due to the pandemic, several of the California Advancing and Innovating Medi-Cal (CalAIM) proposals are set to launch next year. CalAIM is a multiyear, layered approach to transform California’s Medi-Cal program, with a special attention to social services and supports for the millions of Californians with the most complex needs. CalAIM marks an incredible opportunity to align systems, integrate wholistic care and focus more intentionally on prevention, early intervention, and wrap around supports.
Under CalAIM, DHCS would create and standardize several new Medi-Cal programs and benefits. Of particular interest and importance to health centers, Enhanced Care Management (ECM) and Community Supports (formerly in-lieu-of-services) go live in January 2022. These programs build on lessons learned and successes of the Whole Person Care Pilots and Health Homes Programs, which end this year.
Managed Care Plans (MCPs) have a broad implementation flexibility, within limits.
The state has a vision of how ECM and Community Supports will look, but they’re leaving it up to local MCPs to implement. MCPs have until December 2021 to submit their gap analysis and gap filling plan to the Department of Health Care Services (DHCS). These plans will outline which services and providers are needed in each county and how the plans intend to build provider capacity within a county. As health centers embark on deciding whether to participate as contracted ECM/Community Supports providers, financing and service reimbursement will be critical components of the decision-making process. Health centers should carefully review the policy guidance developed by the state and begin negotiating contracts with their MCPs.
MCPs are not meant to be ECM or ILOS care managers.
MCPs are meant to contract with existing health care providers and community-based organizations to build their provider networks. One benefit of the new pool of providers is the potential to forge partnerships with Community Based Organizations having expertise in the populations of focus, particularly racial and ethnic groups with unmet health and social needs. An infusion of Medi-Cal funding into these non-traditional providers may go a long way to address disparities.
The state is requiring data, transparency, and accountability.
CalAIM (and the upcoming MCP procurement) are directly focused on improving the quality and care coordination of the Medi-Cal delivery system. Improving quality scores and coordination requires much more extensive and robust data capture and reporting for both providers to plans and plans to the state. Unfortunately, there are few minimum standards for data capture, claims/invoice processing, and reporting guidance from the state, meaning there is potential for providers in multi-plan counties to experience disparate business processes and data reporting.
Keep an eye on the PATH funding.
DHCS is seeking an unprecedented $2.7 billion (pending approval by CMS) through the state’s 1115 waiver that is intended to support the transition and implementation of ECM/Community Supports and special programs for justice-involved populations. MCP’s are ineligible to apply for these funds but the expectation is that they will be closely involved in the deliverables. MCP’s will need to coordinate with grantees in their county/region to demonstrate how these activities close any gaps identified in their ECM/Community Supports gap assessments.
As if ECM and Community Supports weren’t enough, DHCS plans to move forward with several reforms to the specialty behavioral health system, Denti-Cal, and population health. We will closely monitor these developments and share updates with respective committees, task forces, workgroups, and peer networks.
CPCA will continue to track ECM and Community Supports implementation and provide updates, principally through the Managed Care Task Force. Questions, concerns, or comments can be directed to Allie Budenz at abudenz@cpca.org.