D-SNP FAQs for Providers

No. Alliance providers are not automatically enrolled as D-SNP providers. However, they do have the option to participate in the Alliance D-SNP network. If a provider chooses not to join the Alliance D-SNP network, they will be considered out of network for Alliance D-SNP members.

No, providers who have opted out of Medicare cannot participate. To join the Alliance D-SNP network, providers must be enrolled in Medicare and accept assignment. Providers do not need to be enrolled in Medicare if they do not see Medicare beneficiaries, including Alliance D-SNP members.

If a provider has opted out of enrolling in Medicare and decides they’d like to be in the Alliance D-SNP network, they will need to opt in to Medicare and accept Medicare assignment prior to contracting with the Alliance for the D-SNP program.

The Alliance is required to credential our D-SNP providers. The Alliance will follow the required credentialing process for Medicare Advantage providers. If you are already credentialed by the Alliance for Medi-Cal, you may be asked to provide additional information to be credentialed for Medicare.

The Alliance is actively collaborating with local and regional SNF partners to expand access to SNF services. D-SNP members will receive intensive care coordination before, during and after SNF stays. This comprehensive approach aims to enhance access and streamline the experience for members requiring facility-based services.

The Alliance’s care management team will support members across all care settings, ensuring continuity and quality of care. For short-stay residents, the care management team will assist with transitions, such as discharging to home or other settings, while also helping to place on hold and reactivate community services as needed. For long-term residents in skilled nursing facilities, care managers will collaborate closely with the facility staff to ensure member preferences are clearly communicated and that the appropriate plan services are effectively implemented.

Yes. Medicare covers mental health and substance use disorder services. Services include individual and group therapy, family counseling, psychotherapy for crisis, diagnostic tests, inpatient hospitalization, partial hospitalization, intensive outpatient services, substance use disorder treatment, medication-assisted treatments through opioid treatment programs or office-based settings, and more. Depression screenings are offered to patients at no cost through annual wellness visits.

See the DHCS fact sheet for more information.

MFTs must enroll in Medicare to be able to serve Medicare recipients and accept reimbursement. Learn more from the DHCS fact sheet on coverage for behavioral health services.

• Alliance D-SNP members will have access to both Medicare and Medi-Cal benefits. The Alliance will coordinate all of a member’s benefits between the Medicare and Medi-Cal programs, as we do today.
• In addition, the Alliance D-SNP will offer supplemental or extra benefits not provided through either Medi-Cal or traditional Medicare.

Beginning Jan. 1, 2026, the Alliance D-SNP will provide the equivalent of Medi-Cal Enhanced Care Management (ECM) services called California Integrated Care Management (CICM). Members enrolling into the D-SNP will receive CICM services in place of the ECM services received under Medi-Cal.

Providers will be reimbursed in accordance with the Medicare Physician Fee Schedule.

There is no difference, as Part A and Part B services are standard regardless of age.

Yes. Providers can be both Medicare FFS and D-SNP providers.

Medicare Advantage plans, including D-SNPs, generally do not cover non-emergent or non-urgent care outside their service areas. However, the Alliance is exploring the possibility of offering a travel benefit. More details will be shared in the coming months as plans develop.

Yes. As a member of our D-SNP network, all providers must participate in the Model of Care (MOC) training that is deployed each year. All providers and staff that care for members enrolled in special needs plans (SNPs) must complete and attest to such training.