All Plan Letters
The latest legislative updates are available from the Department of Health Care Services (DHCS). For more information, please contact your Provider Relations representative.
APL
Relevant Provider Takeaways
Related Policies
All
- All
- 2024
- 2023
- 2022
- 2020
APL: APL 24-022
Date: Mar 25, 2025
Date: Mar 25, 2025
DMHC APL 24-022: Children and Youth Behavioral Health Initiative, Certified Wellness Coaches
- AB 133 established the Children and Youth Behavioral Health Initiative (CYBHI), part of the Master Plan for Kids’ Mental Health. The CYBHI introduced a new category of behavioral health providers, the Certified Wellness Coach, in its directive to HCAI to assist in expanding the supply of behavioral health providers.
- The scope of services provided by Certified Wellness Coaches is limited to prevention and early intervention behavioral health services to children and youth through age 25 and their families.
- For more information, please refer to DMHC APL 24-022.
- Please watch out for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL.
APL: APL 24-023
Date: Mar 25, 2025
Date: Mar 25, 2025
DMHC APL 24-023: Newly Enacted Statutes Impacting Health Plans
- This APL outlines the newly enacted statutory requirements for health care service plans regulated by the Department of Managed Health Care. This APL identifies and discusses the 23 total bills enacted this session.
- For more information, please refer to DMHC APL 24-023.
- Please watch out for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL.
APL: APL 22-013
Date: Mar 25, 2025
Date: Mar 25, 2025
APL 22-013: Provider Credentialing/Re-Credentialing
- Please review the APL for updated screening and enrollment requirements for providers.
- For more information, please refer to DHCS APL 22-013.
- Please watch out for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL.
APL: APL 24-019
Date: Mar 25, 2025
Date: Mar 25, 2025
APL 24-019: Minor Consent to Outpatient Mental Health Treatment or Counseling
- Assembly Bill (AB) 665 amends certain statutory sections allowing minors aged 12 and older to consent to outpatient mental health treatment or counseling without parental consent, provided they are deemed mature enough by a professional.
- Minors aged 12 or older can independently consent to non-specialty outpatient Medi-Cal mental health treatment or counseling if, in the professional’s opinion, they are mature enough.
- The law applies to non-specialty outpatient mental health services. Specialty mental health services are governed by county Mental Health Plans (MHPs).
- Minors cannot consent to convulsive therapy, psychosurgery, or psychotropic drugs without parental consent.
- For more information, please refer to DHCS APL 24-019.
- Please watch out for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL.
APL: APL 24-015
Date: Mar 25, 2025
Date: Mar 25, 2025
DHCS APL 24-015: CCS WCM Program
- The Whole Child Model (WCM) Program integrates CCS-covered services into Medi-Cal managed care for comprehensive care coordination encompassing primary, specialty and behavioral health services for CCS-eligible children and youth.
- MCPs are responsible for authorizing, case managing and paying for services that correct or ameliorate CCS-eligible conditions, adhering to CCS Program standards.
- Care must be provided by CCS-paneled providers, CCS-approved Special Care Centers, or CCS-approved pediatric acute care hospitals.
- This APL supersedes APL 23-034 and aims to ensure that MCPs and County CCS Programs effectively collaborate to provide comprehensive and coordinated care for CCS-eligible children and youth within the WCM framework.
- For more information, please refer to DHCS APL 24-015.
- Please watch out for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL.
APL: APL 24-017
Date: Mar 25, 2025
Date: Mar 25, 2025
DHCS APL 24-017: Transgender, Gender Diverse or Intersex Cultural Competency Training Program and Provider Directory Requirements
- This APL provides Medi-Cal managed care plans (MCPs) with guidance regarding the transgender, gender diverse, intersex (TGI) cultural competency training program and Provider Directory changes that Senate Bill (SB) 923 requires to provide trans-inclusive health care to MCP Members.
- SB 923, the TGI Inclusive Care Act, established requirements to improve trans-inclusive health care in California. A TGI Working Group was created to develop training standards and gather community input. Trans-inclusive care emphasizes respecting bodily autonomy, avoiding gender assumptions and treating all individuals with compassion and respect.
- For more information, please refer to DHCS APL 24-017.
- Please watch out for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL.
APL: APL 24-016
Date: Mar 25, 2025
Date: Mar 25, 2025
DHCS APL 24-016 Diversity, Equity and Inclusion (DEI) Training Program Requirements
- Managed Care Plans (MCP) must develop and implement DEI training programs encompassing sensitivity, diversity, cultural competency, cultural humility and health equity for all MCP staff and network providers. The MCP’s Chief Health Equity Officer is responsible for overseeing the DEI training program, ensuring that training materials are current, evidence-based and region-specific. MCPs must also establish mechanisms to monitor training completion and address deficiencies. The DEI training programs must align with the National Committee for Quality Assurance (NCQA) Health Equity Accreditation Standards, aiming to improve communication between providers and members from diverse backgrounds, thereby enhancing access to care and health outcomes.
- Supersedes APL 99-005 & APL 22-013.
- For more information, please refer to DHCS APL 24-016.
- Please watch out for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL.
APL: APL 24-018
Date: Oct 16, 2024
Date: Oct 16, 2024
DMHC APL 24-018 Compliance with Senate Bill 923
- This APL provides guidance regarding the implementation of Senate Bill 923-Gender-Affirming Care, including filing and compliance with requirements for all full-service and certain specialized health care services plan(s).
- This APL formally adopts the Transgender, Gender Divers, or Intersex (TGI) Working Group recommendations regarding the topics in the training curriculum for health care service plan staff.
- This APL requires a plan to ensure all health care service staff complete evidence-based cultural competency training when providing trans-inclusive health care for individuals who identify as TGI. For more information, refer to pages 7-10 of the APL.
- The Alliance is required to include which in-network providers offer gender-affirming services in provider directories and call centers no later than Feb.14, 2025.
- Please fill out this form to let us know if you offer gender-affirming services.
- For more information, please refer to DMHC APL 24-018.
- Please watch out for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL.
APL: APL 24-013
Date: Sep 18, 2024
Date: Sep 18, 2024
DHCS APL 24-013 - Managed Care Plan Child Welfare Liaison
- This APL clarifies the intent and objectives of the Medi-Cal Managed Care Plan (MCP) Child Welfare Liaison, formerly referred to as the Foster Care Liaison. This is to improve care coordination and outcomes for children and youth involved in child welfare by ensuring effective collaboration between MCPs and other involved entities.
- The primary responsibilities of the designated MCP Child Welfare Liaison include but are not limited to:
- Serving as a key point of contact for escalated issues related to child welfare.
- Providing guidance and resources to MCP staff involved in care coordination for members and building partnerships with specified entities.
- Supporting MCP staff and providers with trauma informed approaches when interacting with children, youth or others involved.
- Foster Youth Bill of Rights: The California Department of Social Services provides resources regarding the rights of foster youth, including documents and guidelines often distributed to foster youth and their caregivers. Resources are available on their official website.
- Trauma-Informed Care: The National Child Traumatic Stress Network (NCTSN) is a key federal resource offering extensive training, materials and information on trauma-informed care. The Substance Abuse and Mental Health Services Administration (SAMHSA) provides national resources and guidelines for trauma-informed approaches, including the Trauma-Informed Care in Behavioral Health Services publication.
- CBI Provider Incentives: The Alliance offers a $200 incentive per provider for completing the ACEs Aware Core Training and Attestation on the ACEs Aware website. For more details on this incentive, please refer to our CBI webpage. You may contact Dr. Dianna Myers, Medical Director, Alliance Child Welfare Liaison with questions at (800) 700-3874 ext. 5513 or via email at ListCMIntakeCoordinators@ccahstage.wpengine.com.
- Please watch out for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL.
APL: APL 24-012
Date: Sep 17, 2024
Date: Sep 17, 2024
DHCS APL 24-012 - Non-Specialty Mental Health Services (NSMHS): Member Outreach, Education, and Experience Requirements
- Health plans are required to conduct regular outreach to members who may benefit from mental health services by conducting screenings and assessments during routine interactions.
- The outreach and education plan must include information about the mental health benefits that are covered by the Managed Care Plan (MCP). Please see APL 18-016, or any superseding APL, for additional guidance and requirements regarding outreach, education and member information.
- Health plans must update outreach and education plans in subsequent years, as needed, based on learnings from the Diversity, Equity and Inclusion training programs, as outlined in APL 23-025, or any superseding APL.
- For more information, please refer to DHCS APL 24-012.
- Please watch out for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL.
APL: APL 24-011
Date: Sep 16, 2024
Date: Sep 16, 2024
DHCS APL 24-011 - Intermediate Care Facilities for Individuals with Developmental Disabilities – Long Term Care Benefit Standardization and Transition of Members to Managed Care (Supersedes APL 23-023)
- CalAIM seeks to move Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility through benefit standardization. To further these goals, the Department of Health Care Services (DHCS) is implementing benefit standardization – also termed a “carve-in” – of the ICF/DD Home benefit statewide.
- Effective January 1, 2024, DHCS will require Non-Dual and Dual LTC Members (including those with Medi-Cal Share of Cost coverage) to enroll in an MCP and receive their LTC ICF/DD Home benefit through their MCP. Enrollment into an MCP does not change a Member’s relationship with their Regional Center. Access to Regional Center services and to the current IPP process will remain the same.
- ICF/DD Homes that collect SOC payments or obligated payments are responsible for certifying SOC in the Medi-Cal eligibility verification system to show the Member has paid or obligated payment for the monthly SOC amount owed. Instructions for Providers to perform SOC clearance transactions in the Medi-Cal eligibility verification system are provided in Part 1 of the Medi-Cal Provider Manual.
- For more information, please refer to DHCS APL 24-011.
- Please watch out for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL.
APL: APL 24-010
Date: Sep 16, 2024
Date: Sep 16, 2024
DHCS APL 24-010 - Subacute Care Facilities – Long Term Care Benefit Standardization and Transition of Members to Managed Care (Supersedes APL 23-027)
- Subacute Care Facility services include those provided to both adult and pediatric populations, that are provided by a licensed general acute care hospital with distinct part skilled nursing beds, or by a freestanding certified nursing facility. 2 In each case, the facility must have the necessary contract with the Department of Health Care Services (DHCS)
- Effective January 1, 2024, DHCS will require non-dual and dual LTC Members (including those with a Share of Cost) receiving institutional LTC services in a Subacute Care Facility or Intermediate Care Facility for the Developmentally Disabled (ICF/DD) to be enrolled in an MCP. This APL focuses on subacute care services as part of institutional LTC services
- The physician’s prescriptions for SOC expenditures must be maintained in the Member’s medical record. If a Member spends part of their SOC on necessary, noncovered, medical or remedial care services or items, the Subacute Care Facility will subtract those amounts from a Member’s SOC and collect the remaining SOC amount owned. The Subacute Care Facility will adjust the amount on the claim and submit the claim to the MCP to pay the balance. Further DHCS guidance regarding Johnson v. Rank requirements are available in the Medi-Cal LTC Provider Manual. Subacute Care Facilities that collect SOC payments or obligated payments are responsible for certifying SOC in the Medi-Cal eligibility verification system to show the Member has paid or obligated payment for the monthly SOC amount owed. Instructions for Providers to perform SOC clearance transactions in the Medi-Cal eligibility verification system are provided in Part 1 of the Medi-Cal Provider Manual.
- For more information, please refer to DHCS APL 24-010.
- Please watch out for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL.
APL: APL 24-009
Date: Sep 16, 2024
Date: Sep 16, 2024
DHCS APL 24-009 - Skilled Nursing Facilities – Long Term Care Benefit Standardization and Transition of Members to Managed Care (Supersedes APL 23-004)
- CalAIM seeks to move Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility through benefit standardization. The Medi-Cal program provides benefits through both a Fee-For-Service (FFS) and managed care delivery system. While Medi-Cal managed care is available statewide, the benefits vary among counties depending on the managed care plan model. Variations in benefits include coverage of SNF services. Prior to January 1, 2023, MCPs operating in 27 counties covered SNF services under the institutional LTC services benefit. Conversely, managed care Members in 31 counties were disenrolled from managed care to Medi-Cal FFS if they required institutional LTC services.
- Effective January 1, 2024, institutional LTC Members receiving institutional LTC services in a Subacute Care Facility or Intermediate Care Facility for the Developmentally Disabled (ICF/DD) must be enrolled in an MCP. APLs specific to subacute care services (provided in both freestanding and hospital-based, as well as pediatric and adult subacute care facilities) and ICF/DD services will be released separately.
- Because of the Johnson v. Rank lawsuit, Medi-Cal Members, not their Providers, can elect to use the SOC funds to pay for necessary, non-covered, medical or remedial care services, supplies, equipment, and drugs (medical services) that are prescribed by a physician and part of the plan of care authorized by the Member’s attending physician. The physician’s prescriptions for SOC expenditures must be maintained in the Member’s medical record. Instructions for Providers to perform SOC clearance transactions in the Medi-Cal eligibility verification system are provided in Part 1 of the Medi-Cal Provider Manual.
- For more information, please refer to DHCS APL 24-009.
- Please watch out for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL.
APL: APL 24-008
Date: Aug 16, 2024
Date: Aug 16, 2024
DHCS APL 24-008 Immunization Requirements
- The changes to this APL supersede APL 18-004 and APL 16-009. This APL clarifies requirements related to providing immunization services.
- Effective Aug. 1, 2024, retroactive to Jan. 1, 2023, Vaccines for Children (VFC) program providers who administer VFC-funded vaccines to VFC-eligible Medi-Cal members and bill VFC-funded vaccines as a pharmacy benefit to Medi-Cal Rx can now be reimbursed. Providers will be reimbursed for pharmacy administration of the vaccines and the professional dispensing fee in accordance with recommendations by the Advisory Committee on Immunization Practices (ACIP).
- Providers are required to document each member’s need for ACIP-recommended immunizations as part of all regular health visits, including but not limited to the following types:
- Illness, care management or follow-up appointments.
- Initial Health Appointments (IHAs).
- Pharmacy services.
- Prenatal and postpartum care.
- Pre-travel visits.
- Sports, school or work physicals.
- Visits to an LHD (local health department).
- Well patient checkups.
- The Alliance will provide the specified pharmacist services as a reimbursable Medi-Cal benefit when rendered to a member in the outpatient pharmacy setting. Pharmacist services may be billed on a medical claim for Alliance members. The Alliance will reimburse pharmacy providers for rendering the specified pharmacist services in accordance with the requirements of Business and Professions Code (B&P) and California Code of Regulations (CCR).
- For more information, please refer to DHCS APL 24-008.
Please watch out for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL.
- Alliance policies related to this APL.
APL: APL 24-006
Date: Aug 16, 2024
Date: Aug 16, 2024
DHCS APL 24-006: Community Health Worker Services Benefit
- The changes of this APL supersede DHCS APL 22-016. This APL provides guidance on the qualifications to become a Community Health Worker (CHW), the definitions of populations eligible for CHW services and descriptions of applicable conditions for the CHW benefit.
- Please review the changes made to the “Provider Enrollment” section of the APL.
- Please watch for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL.
- Alliance policies related to this APL:
APL: APL 24-016
Date: Aug 16, 2024
Date: Aug 16, 2024
DHCS APL 24-016: Blood Lead Screening of Young Children
- The “Blood Lead Testing & Anticipatory Guidance” document has been retired and removed from APL 20-016. Please review this update to APL 20-016, which includes minor and technical edits.
- For more information, please refer to DHCS APL 20-016.
- Please watch out for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL.
APL: APL 24-002
Date: Feb 8, 2024
Date: Feb 8, 2024
DHCS APL 24-002: Medi-Cal Managed Care Plan Responsibilities for Indian Health Care Providers and American Indian Members
- The purpose of this All Plan Letter (APL) is to summarize and clarify existing federal and state protections and alternative health coverage options for American Indian members enrolled in Medi-Cal managed care plans (MCPs).
- This APL supersedes APL 09-009.
- This APL also consolidates various MCP requirements relating to protections for Indian Health Care Providers.
- The MCP contract defines “American Indian” as a member who meets the criteria for an “Indian” as defined in federal law. For consistency with the MCP contract, this APL uses the term “American Indian.”
- Tribal Liaison: Effective Jan. 1, 2024, MCPs are required to have an identified tribal liaison dedicated to working with each contracted and non-contracted IHCP in its service area. The tribal liaison is responsible for coordinating referrals and payment for services provided to American Indian MCP members who are qualified to receive services from an IHCP.
- You can contact Cynthia Balli, Provider Relations Supervisor for Merced County, with questions regarding the Alliance’s tribal liaison, at (209) 381 –7394.
APL: APL 23-025
Date: Feb 7, 2024
Date: Feb 7, 2024
DMHC APL 23-025 – Newly Enacted Statutes Impacting Health Plans
- Please review this APL from the Department of Managed Health Care (DMHC) that outlines multiple new statutory requirements for health care plans.
APL: APL 24-001
Date: Jan 12, 2024
Date: Jan 12, 2024
DHCS APL 24-001: Street Medicine Provider: definitions and participation in managed care
- This APL provides guidance to Medi-Cal managed care plans (MCPs) on how to use street medicine providers to address clinical and non-clinical needs of Medi-Cal members experiencing homelessness. This APL supersedes DHCS APL 22-023.
- Under this APL, street medicine providers should bill Place of Service (POS) code 27 (outreach site/street) to Medi-Cal Fee-For-Service (FFS) or MCPs when rendering services for street medicine as of Oct. 1, 2023.
- Please note that DHCS is currently making updates in the California Medicaid Management Information System (CA-MMIS) to accommodate POS code 27. Any FFS claims that are denied for using POS code 27 during CA-MMIS updates do not need to be resubmitted and will be processed automatically once the system changes are complete.
- Continue to use POS codes 04 (Homeless Shelter), 15 (Mobile Unit) and 16 (Temporary Lodging) for services provided in those respective settings. Both street medicine and mobile medicine are reimbursable services in accordance with billing protocols and a provider’s scope of practice.
- Please read the Alliance Policy related to this APL: 300-4046-Street Medicine Providers.
You can find related Alliance policies and procedures in the Alliance Provider Manual.
APL: APL 23-034
Date: Dec 27, 2023
Date: Dec 27, 2023
DHCS APL 23-034 – California Children's Services (CCS) Whole Child Model (WCM) Program
- This initiative seeks to provide direction and guidance to providers participating in the California Children’s Services (CCS) Whole Child Model (WCM) Program.
- The Alliance is responsible for the CCS program in Merced, Monterey and Santa Cruz counties.
- Starting January 2025, the Alliance will be responsible for CCS in Mariposa and San Benito counties. For now, the county CCS programs will coordinate CCS services to CCS-eligible members in Mariposa and San Benito Counties.
- This APL conforms with CCS Numbered Letter (N.L.) 12-1223, which provides direction and guidance to county CCS programs on requirements related to the WCM program.