MedicaidAdministrativeMedium impact
25-160m Support Members Enrolled in ECM Prior to Release from Correctional Facilities
Health Net·CA · Psychiatry, Family Medicine, Internal Medicine·Prior Authorization
Effective date
Oct 1, 2024
We identified it
Jun 20, 2026
Summary
New policy establishes requirements for Enhanced Care Management (ECM) providers supporting members transitioning from correctional facilities, including pre-release care planning, warm handoffs, and post-release follow-up within 1-2 business days. ECM providers must bill pre-release services to DHCS fee-for-service and only bill Health Net starting from the member's release date.
Action Required
Immediately: ECM providers must establish protocols to monitor sFTP folders daily for member assignments and schedule warm handoff meetings for justice-involved members. Billing team must ensure pre-release services are billed directly to DHCS fee-for-service per DHCS billing guidelines, and Health Net billing only begins on the member's release date. Contact Plan Justice Involved Liaison team at 800-526-1898 for assistance with reentry care plans.