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Disease Management Programs

Disease management programs provide self-management tools for members diagnosed with diabetes, asthma or other chronic health conditions. The goal of these programs is to improve patients’ current health status, achieve optimal health outcomes and avoid future complications related to chronic disease.

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Asthma Education Benefit

Alliance members may access comprehensive asthma self-management education through Alliance-approved local education programs.

Approved education programs follow the National Institutes of Health (NIH) guidelines for asthma management. Instruction covers the disease process and daily management of the disease to avoid hospitalization and complications. Education is provided and/or supervised by an Alliance-approved respiratory therapist (RT) or an asthma educator (AE-C).

No RAF or TAR is required for the basic program as outlined below. Physicians should include relevant medical history when referring patients. Alliance members may also self-refer or be referred by Alliance staff. The education provider may contact the physician for additional information.

Review the information below for a list of asthma education benefits, support options and resources. You can also download a print-friendly copy of the Asthma Education Benefit Description.

Comprehensive Asthma Education Program

Individualized program	Individual assessment visit. Individual follow-up visits. Group classes. Periodic individual or group “refresher” training.
Individual assessments	Patient and family history. Asthma history. Medication history. Subjective symptom and trigger scoring. Severity assessment based on current classification criteria.
Education	Asthma action plan. Proper use of peak flow meter. Proper use of inhaler, and spacer if needed. Proper use of medications. How to avoid triggers. Self-management including when to contact physician, and when and how to access emergency care.

Authorization

The Alliance will cover up to six hours of training during the initial 12-month period, including up to four hours of individual training and the remainder group training. A TAR is required for additional individual training, if medically necessary.

The Alliance will also cover up to two hours of individual or group follow-up in each subsequent year.

Billing Code

Covered ICD-10 Diagnosis Codes	Individual Training*	Group Training*
J45.20-J45.52 Restricted to pre-approved providers.	Code: S9441 individual $45.74 per 30-minute unit	Code: S9441 group $13 per 30-minute unit
*State in claim form's remarks box whether individual or group visit. (Box #19 on CMS 1500 or box #84 of the UB-04.) Default reimbursement is for group visit.

Covered ICD-10 Diagnosis Codes

Individual Training*

Group Training*

J45.20-J45.52

Restricted to pre-approved providers.

Code: S9441 individual

$45.74 per 30-minute unit

Code: S9441 group

$13 per 30-minute unit

*State in claim form's remarks box whether individual or group visit. (Box #19 on CMS 1500 or box #84 of the UB-04.) Default reimbursement is for group visit.

Alliance-Approved Asthma Self-Management Education Providers

The following providers are approved to provide asthma education for Alliance members. If you are interested in becoming an Alliance-approved asthma education provider, call the Alliance Health Education Line at 800-700-3874, ext. 5580.

Education programs include:

Members can select from the following Alliance-approved asthma education providers. These approved education programs follow NIH guidelines for asthma management. You can also view the print-friendly list of Alliance-approved asthma education providers.

Santa Cruz and Monterey Counties
Breathe California Central Coast
Phone: 831-422-7306 or 831-809-9741
English or Spanish

www.lungsrus.org/

Merced, Turlock and Los Banos
Central Valley Allergy & Asthma
Phone: 209-383-6868
Fax: 209-383-0760
English or Spanish with an interpreter
Requires PCP referral

www.centralvalleyallergyasthma.com

Please note that professional services, rental, supplies and DME items cannot be billed to Medi-Cal for an amount greater than what is charged to the general public, per Title XXII.

If education is conducted as a home visit, bill only for education time. Travel time and expenses are not reimbursable.

Medicine and Supplies

The Alliance covers the following by prescription from the primary care provider or referring physician:

Asthma medication, as indicated.
Peak flow meter.
Aerochamber
Nebulizer (for children 4 or younger; for age 5 or older, submit TAR with medical necessity).
Nebulizer supplies.
Oxygen.
Continuous positive airway pressure (CPAP).

Authorization

Peak flow meters and aerochambers may be dispensed by a clinical health education benefits provider or a contracted pharmacy. Prescription is required.

Billing Code

Peak Flow Meter**	Aerochamber**	Asthma Kit Code
Code: S8096 Limit 1 per year, reimbursed at retail plus tax.	Code: 99070 Limit 2 per year, reimbursed at retail plus tax.	Code: S8097 Limit 1 per year, $25. Includes peak flow meter, aerochamber and other supplies. Kit is in lieu of separate peak flow meter and aerochamber billing.
**For peak flow meter or aerochamber/spacer, attach catalog page or invoice.

Peak Flow Meter**

Aerochamber**

Asthma Kit Code

Code: S8096

Limit 1 per year, reimbursed at retail plus tax.

Code: 99070

Limit 2 per year, reimbursed at retail plus tax.

Code: S8097

Limit 1 per year, $25. Includes peak flow meter, aerochamber and other supplies. Kit is in lieu of separate peak flow meter and aerochamber billing.

**For peak flow meter or aerochamber/spacer, attach catalog page or invoice.

Diabetes Prevention and Self-Management Education

Health Programs staff provide members with education and resources for diabetes management. Services include referrals to Alliance-approved clinical diabetes management education providers, who can help members access comprehensive diabetes prevention and self-management education. You can access more information on diabetes self-management below, or you can view a print-friendly Diabetes Self-Management Education Benefit Description.

Alliance-approved clinical diabetes management education providers work with members who have:

Higher than normal blood glucose levels.
A diagnosis of diabetes.
Impaired glucose tolerance.
Gestational diabetes.

Education enables the patient and their family to:

Understand the disease process and daily management of the disease.
Avoid hospitalization and complications.
Enjoy a healthy life with diabetes.

Live Better with Diabetes Program

The Live Better with Diabetes program teaches skills to help members understand:

What diabetes is.
The importance of healthy eating and physical activity.
How to manage symptoms.

The Alliance covers a minimum of up to 20.5 hours (4 hours of individual training and up to 16.5 hours of group training) of comprehensive Diabetes Self-Management Education during the initial 12-month period after diagnosis, with up to 2 hours of follow-up during each subsequent year. Education providers must be pre-approved by the Alliance to bill for these services. Education is provided on an individual or group basis and is delivered by a physician, certified diabetes educator or by a registered nurse or registered dietitian who meets specific criteria.

Eligibility and Requirements

Diabetes Self-Management Education (DSME)

Alliance-approved Diabetes Self-Management Education (DSME) providers must follow the recommendations of the American Diabetes Association (ADA) or the American Association of Diabetes Educators (AADE).

DSME providers can also provide prediabetes education, but they must follow an evidence-based program curriculum (this will be a non-CDC Diabetes Prevention Program education provider).

Gestational Diabetes and Comprehensive Perinatal Services Program

Medi-Cal members with gestational diabetes mellitus may be seen by a Comprehensive Perinatal Services Program (CPSP) provider in the Alliance service area. Medi-Cal members with gestational diabetes should be referred to a CPSP provider in the Alliance service area (CPSP providers bill with appropriate “Z” codes).

Age Requirements for Diabetes and Prediabetes Resources

Note that diabetes and prediabetes resources have age requirements, including:

DSME is only available to members ages 21 years or older.
Alliance members with diabetes under the age of 21 should be referred to California Children’s Services (CCS) approved Special Care Centers (SCC) for coordination of diabetes care by a CCS-paneled provider, as appropriate.
Prediabetes education is an Alliance-covered benefit for members of all ages, but some DSME providers may have age limitations. In addition, members ages 18 and older can be referred to the CDC Diabetes Prevention Program (DPP).

Members with Other Health Coverage

For members with other health insurance coverage, the Alliance is the secondary payer. All benefits available through the primary insurance provider must be utilized first.

Referrals

No RAF or TAR is required for the basic program as outlined below. Alliance members may self-refer or be referred by their PCP or Alliance staff. The education provider may contact the member’s physician for additional information.

Diabetes/Prediabetes Benefits, Billing and Reimbursement

Diabetes and prediabetes benefits include individual training, group training and a home blood glucose monitor. Up to two hours of individual or group follow-up will be covered in each subsequent year. If additional education is medically necessary, preauthorization is required.
Individualized programs will include the following services, as needed by the patient:

Individual assessment.
Individual nutrition counseling.
Glucometer and insulin training.
Group classes, if available.
Individual follow-up visits.

See the table below for billing and reimbursement details.

Benefit	Allowable	Billing Code*	Reimbursement
Individual training	4 hours (per 12-month period)	HCPCS: G0108	$45.74 per 30-minute unit
Group training	16.5 hours (per 12-month period)	HCPCS: G0109	$13 per 30-minute unit
Home blood glucose monitor	Formulary model only, limit 1	HCPCS: E0607 with modifier NU**	$100 maximum
Providers
Medical Doctor (MD), Certified Diabetes Educator (CDE), Registered Nurse (RN), Registered Dietician (RD) who meets specific criteria outlined in the Alliance Diabetes Education Benefit Policy.
Covered ICD-10 Diagnoses
Prediabetes Dx Categories: R73.01, R73.02, R73.03 and R73.09 Diabetes Dx Categories: E08-E13, O24; and O99.810, O99.814, O99.815 Note: Prediabetes education is covered for all ages. Some DSME providers can provide prediabetes individual and group education training.

*Billing codes are restricted to pre-approved diabetes education providers only. Do not use these codes for CPSP billing (use appropriate “Z” codes).

**Note: excluding continuous glucose monitors (CGM). They are billed as medical supplies and requires a prior authorization to be submitted to the Alliance.

Alliance-Approved DSME Providers

Refer Alliance Medi-Cal members with gestational diabetes (diabetes during pregnancy) to a CPSP provider in the Alliance service area or to a provider listed below with an “x” in the gestational diabetes column.

County	City	Provider	Gestational Diabetes	Notes/Restrictions
Merced	Merced	Golden Valley Health Centers* Phone: 209-383-7441 Fax: 209-383-1643	x	Diabetes self-management and prediabetes education available. Linked patients only. A Sweet Success and CPSP Provider. Staff speaks English and Spanish.
Monterey	Salinas	Natividad Medical Center Diabetes Education Center Phone: 831-755-6292 Fax: 831-796-2833	x	Diabetes Self-Management Education. Staff speaks English and Spanish.
Monterey	Salinas	Salinas Valley Medical Clinic Diabetes & Endocrine Center Phone: 831-422-3636 Fax: 831-422-1255	x	Diabetes Self-Management Education. Staff speaks English and Spanish.
Monterey	Monterey	Community Hospital of the Monterey Peninsula Diabetes Program Phone: 831-649-7220 Fax: 831-649-7221	x	Diabetes self-management and prediabetes education available. A Sweet Success and CPSP Provider. Staff speaks English and Spanish.
Monterey	Soledad	Soledad Medical Clinic Phone: 831-678-2665 Fax: 831-678-2020	x	Diabetes self-management and prediabetes education available. A Sweet Success and CPSP provider. Staff speaks English and Spanish.
Santa Cruz	Watsonville	Diabetes Health Center Centro de Diabetes Phone: 831-763-6445 Fax: 831-722-2462	x	Diabetes self-management and prediabetes education available. Staff speaks English and Spanish.
Santa Cruz	Santa Cruz	Dominican Hospital Lifestyle Management Phone: 831-457-7077 Fax: 831-457-7149		Diabetes self-management and prediabetes education available. Staff speaks English and Spanish. PCP referral required.
Santa Cruz	Santa Cruz and Watsonville	Palo Alto Medical Foundation Phone: 831-460-7333 Fax: 831-458-6999	x	Diabetes self-management and prediabetes education available. Linked patients only. A Sweet Success Provider.

Please note that professional services, rental, supplies and DME items cannot be billed to Medi-Cal for an amount greater than what is charged to the general public, per Title XXII.
If education is conducted as a home visit, bill only for education time. Travel time and expenses are not reimbursable.

If you are interested in becoming an Alliance-approved DSME provider, please call the Alliance Health Education line at 800-700-3874, ext. 5580 for details on the application and approval process.

Diabetes and Eye Exam Services

You can refer members with diabetes to receive eye exam services within the Alliance network. Use our Eye Exam Services Resource List below, available in English, Spanish and Hmong.

For more information on these programs, please view Section 13 of the Provider Manual.

Diabetes Prevention Program

The Diabetes Prevention Program (DPP) is available for members ages 18 and older. DPP is an evidence-based lifestyle change program. The CDC established DPP and oversees delivery of the program through a set of national standards and guidelines known as the CDC Diabetes Prevention Recognition Program (DPRP).

DPP focuses on encouraging and supporting participants to adopt and maintain healthy lifestyle behaviors, including healthier eating, increased physical activity and modest weight loss (goal of 5-7% weight loss).

More details about referrals, reimbursements and providers are included below. Visit the DHCS DPP webpage for more information, including required Medi-Cal program components. You can also view a print-friendly Diabetes Prevention Program (DPP) Benefit Description.

Services Covered

The Medi-Cal benefit covers a minimum of:

22 hours of group sessions in the first year per the full CDC curriculum.
8 hours of group sessions in the second year to promote maintenance. Second year sessions are reserved for individuals who have successfully completed the first year and have achieved and maintained their weight loss goal.

Members with Other Health Coverage

For members with other health insurance coverage, the Alliance is the secondary payer. All benefits available through the primary insurance provider must be utilized first.

Referrals

No RAF or TAR is required for the basic program as outlined in the table.

Alliance members may self-refer or be referred by their PCP or Alliance staff. For more information about this benefit, call the Alliance Health Education Line at 800-700-3874, ext. 5580.

DPP Education Providers

The program can be delivered by non-medical personnel such as lifestyle coaches, community outreach workers or promotoras. See the table below for a list of Alliance-approved Diabetes Prevention Program education providers.

Alliance-approved DPP education providers must meet the following requirements:

Completion of the CDC Diabetes Prevention Recognition Program. This includes obtaining CDC recognition status of preliminary, pending and full.
Current enrollment in the Medi-Cal Program with the Department of Health Care Services.
Contracted as an Alliance provider prior to rendering services to Alliance members.

Please contact your Provider Services Representative at 831-430-5504 for details on the approval process.

Alliance-Approved DPP Education Providers Reimbursement

Providers must go through the Alliance onboarding process and be contracted with the Alliance prior to receiving DPP reimbursement.

Alliance-approved DPP education providers will be reimbursed as follows:

At the Alliance rate of $26 for each one-hour session, including up to 22 hours of group sessions in the first year (not to exceed $572).
Add the Medi-Cal milestone-based payment in the first and second year (not to exceed $536).

Members must have a prediabetes diagnosis or have a high-risk score using the ADA or CDC Prediabetes Screening Test.

Diagnoses

Covered ICD-10 Diagnoses

Prediabetes Dx Categories: R73.01, R73.02, R73.03 and R73.09

Coding and Billing

The codes and associated payments under the per session Alliance Attendance Model Rate are as follows:

Description	Code*	Payment
Completion of each session	HCPCS: G0109 (per 30-minute unit)	$26 per one hour

The codes and associated payments under Medi-Cal Milestone-Based Rates are as follows:

Description	HCPCS Code*	Payment
Completion of 1 session in months 1-6	G9873	$20
Completion of 4 sessions in months 1-6	G9874	$40
Completion of 9 sessions in months 1-6	G9875	$72
Completion of 2 sessions in months 7-9, weight loss goal not met	G9876	$12
Completion of 2 sessions in months 7-9, weight loss goal met	G9878	$48
Completion of 2 sessions in months 10-12, weight loss goal not met	G9877	$12
Completion of 2 sessions in months 10-12, weight loss goal met	G9879	$48
Completion of 5% weight loss goal	G9880	$128
Completion of 9% weight loss goal	G9881	$20
Completion of 2 sessions in months 13-15, weight loss goal met	G9882	$40
Completion of 2 sessions in months 16-18, weight loss goal met	G9883	$40
Completion of 2 sessions in months 19-21, weight loss goal met	G9884	$40
Completion of 2 sessions in months 22-24, weight loss goal met	G9885	$40

Other Codes:

Description	Payment
Bridge payment (G9890 HCPCS)	$20
Telehealth modifiers (95 modifier)	$0

Alliance-Approved DPP Education Providers

County	City	Provider	Notes/Restrictions
Merced	Livingston	Livingston Community Health Phone: 209-394-7913 Fax: 209-394-9093	Diabetes Prevention Program (CDC curriculum). Linked members only. Also a CPSP provider. Staff speaks English and Spanish.
Merced	Merced	Merced County Public Health Phone: 209-381-1223 Fax: 209-724-4008	Diabetes Prevention Program (CDC curriculum). For people 18 years of age and older. Staff speaks English and Spanish.
Santa Cruz and Monterey	Monterey, Salinas, Watsonville and Soledad	Central Coast YMCA Phone: 831-757-4633 Fax: 831-757-1241	Diabetes Prevention Program (CDC curriculum). Hosts sites throughout Monterey and Santa Cruz counties. Staff speaks English and Spanish.

County

City

Provider

Notes/Restrictions

Merced

Livingston

Livingston Community Health

Phone:
209-394-7913

Fax:
209-394-9093

Diabetes Prevention Program (CDC curriculum). Linked members only. Also a CPSP provider. Staff speaks English and Spanish.

Merced

Merced County Public Health

Phone:
209-381-1223

Fax:
209-724-4008

Diabetes Prevention Program (CDC curriculum). For people 18 years of age and older. Staff speaks English and Spanish.

Santa Cruz and Monterey

Monterey, Salinas, Watsonville and Soledad

Central Coast YMCA

Phone:
831-757-4633

Fax:
831-757-1241

Diabetes Prevention Program (CDC curriculum). Hosts sites throughout Monterey and Santa Cruz counties. Staff speaks English and Spanish.

Note: the education provider may contact the member’s physician for additional information.

If you are interested in becoming an Alliance-approved DPP education provider, please contact your Provider Services Representative at 831-430-5504 for details on the application and approval process.

Healthy Breathing for Life Program

In the Healthy Breathing for Life program, Alliance Health Programs staff work with high-risk members 5-64 years of age to assess their asthma management skills and help them create an Asthma action plan (AAP). Members who are moderate and low risk do not receive direct contact from the Alliance, but all participating members receive health education materials via mail. These materials emphasize the importance of asthma management and provide an overview of asthma health education. Members can also be referred to an Alliance-approved asthma self-management education provider.

Learn more about the program below. You can also view our print-friendly description of the Healthy Breathing for Life program.

Alliance-approved asthma self-management education providers and Alliance Health Programs staff work with eligible Alliance members to ensure that members:

Develop self-management skills.
Have regular routine visits with their PCPs.
Are provided with appropriate treatment.

The Alliance covers up to six (6) hours of comprehensive asthma self-management education, including up to four (4) hours of individual training and the remaining hours as group training during the initial 12-month period after an asthma diagnosis. The Alliance covers up to two hours of follow-up during each subsequent year.

Asthma education providers must be pre-approved by the Alliance to bill for these services. Education is provided on an individual or group basis and is delivered and/or supervised by a respiratory therapist (RT) or a nationally certified asthma educator (AE-C). PCPs should include relevant medical history when referring patients, and the asthma education provider will contact the member’s PCP when indicated.

Learn more about program best practices, criteria and outcome measures below.

Purpose

Lack of appropriate treatment to control asthma symptoms is often a significant problem for low-income individuals. Therefore, the Alliance has adopted the following National Asthma Education and Prevention Program (NAEPP) goals for asthma control for all members:

Reduce impairment: prevent chronic symptoms, require infrequent use of short-acting beta2agonist (SABA) and maintain (near) normal lung function and normal activity levels.
Reduce risk: prevent exacerbations, minimize need for emergency care or hospitalization, prevent loss of lung function; or for children, prevent reduced lung growth, and have minimal or no adverse effects of therapy.

These goals are based on the Asthma Care Quick Reference guide, developed by the NAEPP Coordinating Committee and coordinated by the National Heart, Lung and Blood Institute (NHLBI) (EPR-3). The Alliance has adopted these guidelines as our standard of care for all members diagnosed with asthma.

Clinical Guidelines and Best Practices

Complete an asthma action plan (AAP). Following the National Guidelines for the Diagnosis and Management of Asthma (EPR-3), the Alliance recommends that an asthma action plan be completed for all members with a diagnosis of persistent asthma. An AAP provides members with information about self-management and how to recognize and handle worsening asthma. The AAP is regularly reviewed with the patient to achieve asthma control.
Treat member with daily controller medication. Per guidelines, all members with any type of persistent asthma should be treated with a daily controller medication in following the stepwise approach (EPR-3) to prevent flare-ups.
Discourage exposure to environmental allergens/pollutants. Advise patients on ways to reduce exposure to environmental allergens, pollutants or irritants to which the patient is sensitive. Multifaceted approaches are beneficial; single steps alone are generally ineffective. Advise all patients and pregnant women to avoid exposure to tobacco or wildfire smoke.
Consider inactivated influenza vaccination for patients who have asthma. This vaccine is safe for administration to patients over 6 months of age. The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC) recommends vaccination for persons who have asthma because they are considered to be at risk for complications from influenza. However, the vaccine should not be given with the expectation that it will reduce either the frequency or severity of asthma exacerbations during the influenza season.

Criteria for Identification and Risk Stratification

Alliance members ages 5-64 who have had any one of the following (within the last 12 months):

Four or more outpatient claims with asthma as the primary diagnosis and two asthma medications.
One or more acute inpatient admissions with asthma as the primary diagnosis.
One or more emergency department visits with asthma as the primary diagnosis.
Four or more prescriptions for asthma medications (leukotriene must be supported by claims with diagnoses of asthma).

For risk stratification only, members with an asthma medication ratio of less than 0.50 will be included in the point calculation.

Members with the following conditions are excluded from the stratification logic:

Emphysema.
Chronic obstructive pulmonary disease (COPD).
Cystic fibrosis.
Acute respiratory failure.

Stratification Logic and Risk Levels

The following tables provide the event and weighting that defines the risk and program intervention levels.

Stratification Logic
Area/Measure	Criteria (Last 12 Months)	Risk Weighting
Inpatient admissions	Each visit with asthma as primary diagnosis.	5
Emergency department visit	Each visit with asthma as primary diagnosis.	2
Outpatient visits	Absence of outpatient visits.	1
Asthma medications	Four or more rescue medications without controller.	2

Member Outreach by Risk Level

The stratification risk group drives the level of interventions indicated below.

High Risk (≥ 6 points): members are contacted by phone.

Alliance staff assesses member’s asthma-specific health risks during the outreach call.
Members are referred to external resources as needed, such as:
- Alliance-approved asthma self-management education providers.
- 2-1-1 resource and information line (Monterey and Santa Cruz counties).
- Community-based organizations.
- California Smokers’ Helpline.
Members receive age-appropriate health education materials on topics like:
- Asthma self-management.
- Rescue and controller medications.
- Triggers.
- Smoking cessation (if applicable).

Medium Risk (3-5 points) and Low Risk (0-2 points): Members receive mailed materials only.

Members receive age-appropriate health education materials on topics like:
- Asthma self-management.
- Rescue and controller medications.
- Triggers.
- Smoking cessation (if applicable).

Members also receive information about the Alliance’s Asthma Education Benefit and a list of Alliance-approved asthma self-management education providers.

PCP Notification and Involvement

Through the Provider Portal, PCPs receive a quarterly report of all linked members identified with asthma (as defined above). The report also includes members’ previous and current risk levels.

Outcome Measures

The Alliance evaluates program effectiveness based on the following outcome measures:

Rate of inpatient admissions for asthma per 1,000 total members.
Rate of emergency department visits for asthma per 1,000 total members.
Medication management agreement (MMA) for people with asthma.
- Measures the percent of members with persistent asthma that were dispensed appropriate medications (both a controller and a rescue medication) that stayed on their treatment for at least 50% of the treatment period.
- Our Care-Based Incentive program uses asthma medication ratio (AMR). AMR is the percentage of identified members 5-64 years of age with persistent asthma and a ratio of controller medication to total asthma medication of 0.50 or more during the measurement year.

For more information, review NAEPP guidelines on the diagnosis and treatment of asthma.

Healthier Living Program

The Alliance’s Healthier Living Program (HLP) is an evidence-based program originally developed at Stanford University. It’s a series of self-management workshops designed to help Alliance members diagnosed with chronic conditions.

During these workshops, participants build self-confidence in their ability to manage their symptoms and understand how their health problems affect their lives. The program focuses on problems that are common to individuals suffering from any chronic condition, such as pain management, goal setting, nutrition, exercise, medication usage, emotions and communicating with doctors and family members.

The HLP is a six-week program led by two trained Alliance staff facilitators. Each session is 2.5 hours. Members who participate in a six-week workshop will receive a Target gift card for up to $50.

To refer an Alliance member to the HLP, submit the Health Education and Disease Management Programs referral form. Members can also self-refer by calling the Alliance Health Education Line at 800-700-3874, ext. 5580.

Wellness that Works Program

The Wellness that Works (formerly Weight Watchers) (WW) program provides scholarships for members to participate in the Wellness that Works adult weight management program. This program is not a Medi-Cal benefit, but an Alliance-covered service.

Members can join the WW program if they:

Are referred by a PCP who completes a WW program application.
Have a BMI of 30 or above.
Are 18 years of age or older.

Only members with the Alliance as their primary insurance are eligible for the scholarship. Members can only be enrolled in the WWS program once due to a limited number of scholarships available.

Please note that the Alliance offers the Healthy Weight for Life program for members ages 2-18.

Please complete all sections of the Health Education and Disease Management Programs referral form prior to submission, including height and weight for the member. Do not send additional medical documents. The referral form is the only document needed.

If you have questions, please call the Alliance Health Education Line at 800-700-3874, ext. 5580.