MedicaidAdministrativeMedium impact
25-162m Support Members Enrolled in ECM Prior to Release from Correctional Facilities
Health Net·CA·Prior Authorization
Effective date
Oct 1, 2024
We identified it
Jun 20, 2026
Summary
New requirements established for Enhanced Care Management (ECM) providers supporting justice-involved members transitioning from correctional facilities. ECM providers must create comprehensive reentry care plans, conduct warm handoffs, and meet specific timelines for pre-release and post-release care coordination. This affects billing workflows as pre-release services must be billed to DHCS fee-for-service, while post-release services are billed to the Plan starting from the release date.
Action Required
Immediately: ECM providers in Imperial County must implement new billing workflows - bill pre-release correctional facility services directly to DHCS fee-for-service per DHCS billing guidelines, and bill post-release services to the Plan beginning with the member's release date. Monitor sFTP folders daily for member assignments and establish processes for warm handoffs within required timelines (meet members within 1-2 business days of release, conduct second follow-up within one week). Contact Plan Justice Involved Liaison at 800-526-1898 for assistance with reentry care plans.