Enhanced Care Management (ECM) Referral Form - CHILD & YOUTH
Governs submission and content requirements for ECM referrals for Medi-Cal children, youth, and homeless families so the managed care plan (MCP) can determine ECM eligibility and assignment. Affects referring organizations, ECM providers, community partners, and MCP staff in North Carolina (NC).
No material clinical or coverage changes in this revision.
Children & Youth ECM Eligibility Criteria
Children/Youth ECM eligibility checklist
Eligibility criteria for Children/Youth Populations of Focus (check all that apply):
AVOIDABLE HOSPITAL OR EMERGENCY DEPARTMENT UTILIZATION (last 12 months)
- Three or more emergency room visits that could have been avoided with appropriate care within the last 12 months
- Two or more unplanned hospital and/or short-term skilled nursing facility stays that could have been avoided with appropriate care within the last 12 months
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