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Home > For Providers > Provider Resources > All Plan Letters

Resources

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.

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APL: APL 23-004
Date: Mar 14, 2023
DHCS APL 23-004: Skilled Nursing Facilities -- Long Term Care Benefit Standardization And Transition Of Members To Managed Care
  • Provides requirements on the Skilled Nursing Facility (SNF) Long Term Care (LTC) benefit standardization provisions of the California Advancing and Innovating Medi-Cal (CalAIM) initiative, including the mandatory transition of beneficiaries to managed care plans such as the Alliance.
APL: APL 23-004
Date: Mar 14, 2023
DHCS APL 23-004 - Skilled Nursing Facilities - Long-Term Care Benefit Standardization and Transition of Members to Managed Care
  • The California Advancing and Innovating Medi-Cal (CalAIM) Initiative seeks to move Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility through benefit standardization.
  • Please refer to this APL for detailed requirements for all Medi-Cal managed care health plans (MCPs) regarding Skilled Nursing Facility (SNF) Long Term Care (LTC) benefit standardization provisions of the CalAIM initiative, including the mandatory transition of beneficiaries to managed care.
  • 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 a managed care plan such as the Alliance.
  • The Alliance is conducting outreach to regional and statewide subacute and ICF/DD providers to ensure network adequacy.
  • 404-1524 – Long-Term Care for Medi-Cal Members
  • 404-1525 – Skilled Nursing Program Policy for Medi-Cal
  • 404-1525 – Attachment A – Skilled Nursing Facility Levels of Care Matrix
APL: APL 23-003
Date: Mar 8, 2023
DHCS APL 23-003 - California Advancing And Innovating Medi-Cal Incentive Payment Program

​California Advancing and Innovating Medi-Cal Incentive Payment Program (Supersedes APL 21-016)

APL: APL 23-002​
Date: Jan 17, 2023
DHCS APL 23-002​: 2023-2024 Medi-Cal Managed Care Health Plan Meds/834 Cutoff And Processing Schedule

2023-2024 Medi-Cal Managed Care Health Plan MEDS/834 Cutoff and Processing Schedule​

APL: APL 23-001
Date: Jan 6, 2023
DHCS APL 23-001​: Network Certification Requirements

​Network Certification Requirements (Supersedes APL 21-006)

  • Attachment A: Network Adequacy Standards (PDF)
  • Attachment B: Annual Network Certification Instruction Manual (PDF)
  • Attachment C: Alternative Access Standard (AAS) Request Template (.xls)
APL: ​APL 22-032​
Date: Dec 27, 2022
DHCS ​APL 22-032​: Continuity of care for Medi-Cal Beneficiaries who newly enroll in Medi-Cal Managed Care from Medi-Cal Fee-for-Service, and for Medi-Cal members who transition into a new Medi-Cal Managed Care Health Plan on or after January 1, 2023​
  • Beneficiaries who mandatorily transition from Medi-Cal FFS to enroll as members in the Alliance or transition from the Alliance with contracts expiring or terminating to a new health plan on or after January 1, 2023, have the right to request Continuity of Care with Providers in accordance with federal and state law and the health plan contract, with some exceptions.

404-1114 Continuity of Care

APL: ​APL 22-031​​
Date: Dec 27, 2022
DHCS ​APL 22-031​​: ​Doula Services
  • Effective January 1, 2023, the Alliance covers doula services for prenatal, perinatal, and postpartum members.
  • Doula services can be provided virtually or in-person with locations in any setting including, but not limited to, homes, office visits, hospitals, or alternative birth centers.
  • The Alliance covers doula services to include personal support to pregnant individuals and families throughout pregnancy, labor, and the postpartum period.
  • To be eligible for doula services, and be covered under Medi-Cal managed care, a beneficiary must be eligible for Medi-Cal, enrolled with the Alliance, and have a recommendation for doula services from a physician or other licensed practitioner.
  • Doula Providers must meet the requirements and qualifications (i.e., training/experience pathway, continuing education, etc.), as outlined in APL 22-031 linked below.

300-4045 – Doula Requirements

APL: ​APL 22-030​
Date: Dec 27, 2022
DHCS ​APL 22-030​: Initial Health Appointment

Initial Health Appointment (Supersedes APL 13-017 and Policy Letters 13-001 and 08-003)

APL: ​APL 22-029​
Date: Dec 27, 2022
DHCS ​APL 22-029​: ​Dyadic Services and Family Therapy Benefit​
  • The Alliance covers dyadic care services for members and their caregivers that are medically necessary.
  • A dyad refers to a child and their parent(s) or caregiver(s). Dyadic care refers to serving both parent(s) or caregiver(s) and child together as a dyad and is a form of treatment that targets family well-being as a mechanism to support healthy child development and mental health. It is provided within pediatric primary care settings whenever possible and can help identify behavioral health interventions and other behavioral health issues, provide referrals to services, and help guide the parent-child or caregiver-child relationship. Dyadic care fosters team-based approaches to meeting family needs, including addressing mental health and social support concerns, and it broadens and improves the delivery of pediatric preventive care.
  • The Alliance covers family therapy for at least two family members when medically necessary. .
  • Family therapy is a type of psychotherapy covered under Medi-Cal’s Non-Specialty Mental Health Services (NSMHS) benefit since 2020 Family therapy sessions, which must have at least two family members, address family dynamics as they relate to mental status and behavior(s). It is focused on improving relationships and behaviors in the family and between family members, such as between a child and parent(s) or caregiver(s).
  • Examples of family therapy include but not limited to:
    • Child-parent psychotherapy (ages 0 through 5)
    • Parent child interactive therapy (ages 2 through 12)
    • Cognitive-behavioral couple therapy (adults)
APL: APL 22-028
Date: Dec 27, 2022
DHCS APL 22-028: ​Adult and Youth Screening and Transition of Care Tools for Medi-Cal Mental Health Services​

The Department of Health Care Services (DHCS) California Advancing and Innovating Medi-Cal (CalAIM) initiative for “Screening and Transition of Care Tools for Medi-Cal Mental Health Services” aims to ensure all Medi-Cal members receive timely, coordinated services across Medi-Cal mental health delivery systems and improve member health outcomes. The goal is to ensure member access to the right care, in the right place, at the right time.

APL: APL 22-031
Date: Dec 22, 2022
DMHC APL 22-031 – Newly Enacted Statutes Impacting Health Plans (2022 Legislative Session)
  • Please review this APL from the Department of Managed Health Care (DMHC) that lists multiple statutes that impact health plans and our partners.
APL: APL 22-027
Date: Dec 6, 2022
DHCS APL 22-027: Cost Avoidance And Post-Payment Recovery For Other Health Coverage

Cost Avoidance and Post-Payment Recovery for Other Health Coverage (Supersedes APL 21-002)​

  • Appendix A​
  • Appendix B
  • FAQs

Prior to delivering services to members, Providers must review the Medi-Cal Eligibility Record for the presence of OHC. If the requested service is covered by the OHC, Managed care health plans must ensure Providers instruct the member to seek the service from the OHC carrier. Regardless of the presence of OHC, Providers must not refuse a covered Medi-Cal service to a Medi-Cal member.

702-1780 Other Health Coverage Confirmation

702-2100 Other Health Coverage Premium Payment Program

702-1750 Coordination of Benefits Guidelines for Providers

APL: ​APL 22-026
Date: Nov 29, 2022
DHCS ​APL 22-026: ​Interoperability and Patient Access Final Rule

​Interoperability and Patient Access Final Rule

APL: ​​APL 22-025​
Date: Nov 28, 2022
​DHCS ​​APL 22-025​: Responsibilities for Annual Cognitive Health Assessment for Eligible Members 65 Years of Age or Older​
  • Provider Training and Payment for Annual Cognitive Health Assessments
  • Managed care health plans must cover an annual cognitive health assessment for their members who are 65 years of age or older and who do not have Medicare coverage. The annual cognitive health assessment is intended to identify whether the patient has signs of Alzheimer’s disease or related dementias, consistent with the standards for detecting cognitive impairment under the Medicare Annual Wellness Visit and the recommendations by the American Academy of Neurology (AAN).
  • In order to be reimbursed for this assessment, providers must have previously completed the DHCS Dementia Care Aware cognitive Health Assessment training. More details are available within the APL.

300-4195 Provider Training and Payment for Annual Cognitive Health Assessments

401-1502 Adult Preventive Care

APL: ​APL 22-024​
Date: Nov 28, 2022
DHCS ​APL 22-024​: ​Population Health Management Program Guide

​Population Health Management Program Guide (Supersedes APLs 17-012 and 17-013)

APL: APL 22-023​
Date: Nov 8, 2022
​DHCS APL 22-023​: Street Medicine Provider: Definitions and Participation in Managed Care
  • Street medicine refers to a set of health and social services developed specifically to address the unique needs and circumstances of individuals experiencing unsheltered homelessness, delivered directly to them in their own environment. The fundamental approach of street medicine is to engage people experiencing unsheltered homelessness exactly where they are and on their own terms to maximally reduce or eliminate barriers to care access and follow through.
  • The Alliance will operate a street medicine program, and associated criteria. There are certain training, systems and data sharing requirements. Members may select a street medicine provider as their PCP if appropriate requirements are met.

300-4046 Street Medicine Providers

APL: APL 22-022​
Date: Oct 28, 2022
​DHCS APL 22-022​: Abortion Services
  • Abortion services are a covered benefit. There is no medical justification or utilization management required for outpatient abortion services. However, non-emergency inpatient hospitalization may require prior authorization.
  • Member confidentiality should be safeguarded in accessing abortion services, including for minors.
  • No physician, provider or person is required to participate in an abortion and no person refusing to participate is subject to penalty for such choice. The Alliance will assist members in accessing timely access to abortion services if a provider refuses to perform them.

404-1309 Member Access to Self-Referred Services

404-1702 Provision of Family Planning Services to Members

APL: ​​APL 22-021​
Date: Oct 26, 2022
DHCS ​​APL 22-021​: ​Proposition 56 Behavioral Health Integration Incentive Program​

​Proposition 56 Behavioral Health Integration Incentive Program​

APL: APL 22-020
Date: Oct 21, 2022
DHCS APL 22-020: Community-Based Adult Services (CBAS) Emergency Remote Services
  • Qualified CBAS providers are required to provide Emergency Remote Services (ERS) as a mode of service delivery when members experience emergencies for up to three consecutive months. Emergencies may be public (state/local disasters) or personal (serious illness/injury, crisis, care transition)
  • Contracted CBAS providers must obtain ERS approval and provide each participant’s discharge plan to the Alliance within 30 days of discharge. Additional reporting & documentation requirements are within the APL.
  • ERS for an emergency occurrence may not exceed three consecutive months, either within or crossing over an authorized period, without assessment and review for possible continued need for remote/telehealth delivery of services and supports as part of the reauthorization of the individual’s care plan.

This is in the Alliance Provider Manual: Section 6, pages 45-48

405-1111 Community Based Adult Services

APL: ​​APL 22-019
Date: Oct 10, 2022
DHCS ​​APL 22-019: Proposition 56 Value-Based Payment Program Directed Payments

​Proposition 56 Value-Based Payment Program Directed Payments (Supersedes APL 20-014)​

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