TotalCare (HMO D-SNP) FAQs for Providers

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

No, providers who have opted out of Medicare cannot participate. To join the TotalCare 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 TotalCare members.

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

If you would like to be a TotalCare (HMO D-SNP) provider, you will need to be enrolled as both a Medi-Cal and Medicare provider. If you are already credentialed by the Alliance for Medi-Cal, you may be asked to provide additional information to be credentialed for Medicare.

You can find more information on becoming a Medicare provider on the CMS website.

The Alliance is actively collaborating with local and regional SNF partners to expand access to SNF services. TotalCare 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.

TotalCare 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, TotalCare will offer supplemental or extra benefits not provided through Medi-Cal or traditional Medicare. These benefits are listed on the member-facing Welcome to TotalCare page.

For a full list of benefits, we recommend viewing the Summary of Benefits. Full details on the TotalCare plan are outlined in the Evidence of Coverage (Member Handbook).

For a full list of benefits, we recommend viewing the Summary of Benefits. Full details on the TotalCare plan are outlined in the Evidence of Coverage (Member Handbook).

Beginning Jan. 1, 2026, TotalCare will provide the equivalent of Medi-Cal Enhanced Care Management (ECM) services called California Integrated Care Management (CICM). Members enrolling in TotalCare 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, TotalCare provides a supplemental benefit of worldwide emergency medical care coverage outside of the U.S. ($50,000 maximum).

Yes. As a member of our TotalCare 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.