Home > For Providers > Manage Care > Quality of Care > Provider Incentives > Behavioral Health Incentive Program

Behavioral Health Incentive Program

Effective date: Jan. 1–Dec. 31, 2026

Introduction

This page sets forth terms of the Behavioral Health Incentive Program (“BHI Program”) offered by the Alliance, as described herein. The BHI Program compensates BHI Eligible Providers for providing access to Behavioral Health services for Alliance Eligible Members and encourages Behavioral Health provider participation in the Alliance Medi-Cal program.

Expand All

Definitions

The following terms shall have the definitions contained in the section below. Capitalized terms used in this document and not otherwise defined herein shall have the meanings assigned to them in the Agreement.

BHI Eligible Provider

A BHI Eligible Provider is an Alliance Participating Provider who has entered into a Behavioral Health Agreement (“Agreement”) with the Alliance, that is in effect at the end of the BHI Term.

BHI Term

The term of the BHI Program shall begin the first of the following quarter after the Commencement Date of the Agreement

BHI Eligible Member

BHI eligibility is only extended to Medi-Cal eligible members.

BHI Provider Type

Participating Provider(s) are behavioral health providers that have entered into written contracts directly or indirectly with the Alliance to provide covered services to members pursuant to the behavioral health program.

General Terms

Policies regarding actual and proposed budget and cost allocations are subject to the approval of the Alliance. The Alliance shall have the sole discretion to establish binding policies regarding determination of incentive payments. The Alliance, in its sole and absolute discretion, may implement Behavioral Health Incentive Programs for periods after completion of the BHI Term. Any such programs shall be on terms determined by the Alliance. The BHI Program does not contain any financial incentive or make any payment that acts directly or indirectly as an inducement to reduce or limit medically necessary covered services provided to a member.

Effect of Termination

In the event of the termination of the BHI Eligible Provider’s Agreement for any reason prior to the expiration of the BHI Term, the BHI Eligible Provider will only be eligible for payment of measures that are payable via claims for any services provided prior to the termination date.

BHI Program Measure Overview

The following table includes the names of the seven measures included in the 2026 BHI Program and a description of each measure's goal.

	Measure	Goal
1	Coordination with Primary Care Provider (PCP)	Increase data sharing and collaboration between BH providers and PCPs.
2	Provider Completion of Satisfaction Survey	Improve Provider Satisfaction Survey responsiveness.
3	Provider Completion of Diversity, Equity, Inclusion, Belonging (DEIB) Training	Provider training on Health Equity to meet health equity accreditation and NCQA/DHCS requirements.
4	Increase in Volume of Member Seen	Expand provider acceptance of members and increase number of members seen with timely access to care.
5	Provider Completion of Adverse Childhood Experiences (ACEs) Training and Attestation	Increase ACEs (adverse childhood experience) screenings.
6	Increase Access to Community Settings	Reduce access barriers and increase member access to care outside clinic settings/community setting.
7	Emergency Department Follow-Up Visit	Reduce emergency department (ED) utilization and inpatient admissions through FUA/FUM.

BHI Measure Specifications

This section includes specifications for the BHI Program measures.

Measure 1 – Coordination with Primary Care Provider (PCP)

Measure Description	Providers will receive $25 for each BH Eligible Member where BH Eligible Provider communicates with the member’s PCP to share information relevant to the member’s care (e.g. treatment notes, care plan notes, etc.) within 30 days of BH Eligible Provider’s visit with BH Eligible Member (PCP Coordination).
Related Documentation and Deadline	This measure is based on claims data. BHI Eligible Providers are required to bill with an Alliance specified code to signify that provider communicated with the BH Eligible Member’s PCP within 30 days of BH Eligible Provider’s visit with the BHI Eligible Member. All applicable claims must be received by Plan no later than 30 days after quarter end and must be Complete Claims that are in a paid status to be counted toward this measure. All applicable claims must be complete claims that are in a paid status no later than February 14, 2026 for 2025 measurement quarters and February 14, 2027 for 2026 measurement quarters to be counted toward this measure.
Calculation Specification	Plan will pay Provider for PCP Coordination when code G9968 is billed with modifier U3.
Payment Frequency	Incentive to be paid quarterly within: 45 days for end of Q1 – Q3 No later than 90 days for end of Q4

Measure 2 – Provider Completion of Satisfaction Survey

Measure Description	Provider Completion of Activities to Support Regulatory Requirements - Eligible Providers will receive $100 for each Provider Satisfaction Survey submitted.
Related Documentation and Deadline	For the purposes of this measure, an Eligible Provider is a BHI Eligible Provider who has been contacted by Plan’s survey vendor to complete the 2025, and/or 2026 provider satisfaction survey is eligible for measure. This measure is based on submission of completed provider satisfaction surveys which have been completed by Plan’s survey vendor’s deadline. Plan’s provider satisfaction survey vendor will only share the identity of the providers who complete the survey, the rest of the survey is anonymous.
Calculation Specification	Plan will pay Provider for each provider satisfaction survey completed in calendar year 2025 and/or 2026 per Eligible Provider. Plan shall pay Provider $100 for every Eligible Provider satisfaction survey completed as verified by Plan’s vendor in calendar year 2025 and/or 2026.
Payment Frequency	Incentive payment will be made no later than 90 days after the end of 2025 or March 31, 2026, and 90 days after the end of 2026 or March 31, 2027.

Measure 3 – Provider Completion of Diversity, Equity, Inclusion, Belonging (DEIB) Training

Measure Description	Provider training on Health Equity to meet heath equity accreditation and NCQA/DHCS requirements.
Related Documentation and Deadline	Provider Completion of Activities to Support DHCS - Eligible Providers will receive $200 for each completed health equity training provided by the Alliance per DHCS requirements as noted in All Plan Letter (APL) 23-025. This measure will only be effective if DHCS makes it a requirement for Medi-Cal providers to complete health equity training within calendar year 2025.
Calculation Specification	Providers who participate in the Alliance DEIB training must complete one of the following trainings, the online learning management system (log in with name, email and attestation) training or attend an in-person Alliance specific DEIB training (sign in sheet attendance required). Eligible Provider must ensure that all documentation requirements specified by DHCS for health equity trainings are completed prior to the end of calendar year 2025 or 2026.
Payment Frequency	Incentive payment will be made no later than 90 days after the end of 2025 or March 31, 2026, or 90 days after the end of 2026 or March 31, 2027.

Measure 4 – Increase in Volume of Member Seen

Measure Description

Providers will receive payment for an increase in Members Seen in the Measurement Quarter as compared to the Baseline Quarter.

Related Documentation and Deadline

For the purposes of this measure, an Eligible Provider is a BHI Eligible Provider who is a LCSW, LMFT, LPCC, PsyD, PhD, NP, PA or MD.

Eligible Provider must submit claims for services provided in 2025 by no later than February 14, 2026, and claims for services provided in 2026 no later than February 14, 2027. All claims must be Complete Claims that are in paid status in order to count for this measure for each Measurement Quarter.

Calculation Specification

Measure Period: This measure is applicable to net new Member visits conducted during each Measurement Quarter

Measurement Quarter: The quarters Q3 and Q4 of 2025 and Q1 through Q4 of 2026 are being used to calculate the measure.

Baseline Quarter: The corresponding quarter of calendar year preceding the applicable Measurement Quarter (e.g. Baseline Quarter Q3 2024 vs. Measurement Quarter Q3 2025).

Baseline Number: The total Number of distinct BHI Eligible Members seen by Eligible Provider during the Baseline Quarter. All data used by Plan to determine the Baseline Number in a Baseline Quarter shall be captured using paid claims received as of the date the Improvement Number comparison is run.

Measurement Number: The total Number of distinct BHI Eligible Member during the Measurement Quarter. All data used by Plan to determine the Measurement Number in a Measurement Quarter shall be captured using paid claims received as of the date the Improvement Number comparison is run.

Improvement Number: The Measurement Number minus the corresponding Baseline Number. Example: 24 Member Visits in Q1 2026 – 10 Member visits in Q1 2025 = 14.

Percent of Improvement: Improvement Number divided by the Baseline Number.

Tiers: There are five tiers associated with this measure, which have corresponding percentages and rates.

Tier	Percent Range	Lower Percent	Upper Percent	Rate/ Improvement Number
1	1-5%	1%	5%	$50
2	6-10%	6%	10%	$100
3	11-15%	11%	15%	$150
4	16-20%	16%	20%	$200
5	Over 20%	>20%	100%	$200

Measure Calculation: The Improvement Number shall be distributed into the above Tier(s) based on the Improvement Percent for each Measurement Quarter, rounding to the nearest full number. If rounding results in a full member that falls between the upper range of a lower Tier and lower range of a higher Tier, the number will be rounded up into the higher Tier.

For Tiers 1-4:

If the Percent of Improvement is greater than the Tier’s Upper Percent, a portion of the Improvement Number shall be distributed to the Tier using the following formula: (Baseline Number * (1+Upper Percent)) - Baseline Number.
If the Percent of Improvement is greater than or equal to the Tier’s Lower Percent but below the Tier’s Upper Percent, the total Improvement Number less distribution to lower tiers, where applicable, shall be distributed to the Tier.
If the Percent of Improvement is less than the Tier’s Lower Percent, no portion of the Improvement Number shall be allocated to the Tier.
If there is no Baseline Number, five percent of the Measurement Number shall be allocated to Tiers 1-4.

For Tier 5:

If the Percent of Improvement is over 20%, the remaining portion of the Improvement Number shall be added to Tier 5.

Payment Examples:

Example 1: Provider with 20% improvement

Baseline Number: 50

Measurement Number: 60

Improvement Number: 10

Improvement Percent: 20%

Tier	Allocation	Rate	Total Earned
1	2	$50	$100
2	3	$100	$300
3	2	$150	$300
4	3	$200	$600
5	0	$200	$0
Total Payment			$1,300

Example 2: Provider with 5% improvement

Baseline Number: 100

Measurement Number: 105

Improvement Number: 5

Improvement Percent: 5%

Tier	Allocation	Rate	Total Earned
1	5	$50	$250
2	0	$100	$0
3	0	$150	$0
4	0	$200	$0
5	0	$200	$0
Total Payment			$250

Example 3: Provider with 13% improvement

Baseline Number: 100

Measurement Number: 113

Improvement Number: 13

Improvement Percent: 13%

Tier	Allocation	Rate	Total Earned
1	5	$50	$250
2	5	$100	$500
3	3	$150	$450
4	0	$200	$0
5	0	$200	$0
Total Payment			$1,200

Example 4: Provider with 22.22% improvement

Baseline Number: 90

Measurement Number: 110

Improvement Number: 20

Improvement Percent: 22.22%

Tier	Allocation	Rate	Total Earned
1	4	$50	$200
2	5	$100	$500
3	4	$150	$600
4	5	$200	$1,000
5	2	$200	$400
Total Payment			$2,700

Example 5: Provider with 100% improvement (no baseline)

Baseline Number: No Baseline

Measurement Number: 10

Improvement Number: 10

Improvement Percent: 100%

Tier	Allocation	Rate	Total Earned
1	1	$50	$50
2	1	$100	$100
3	1	$150	$150
4	1	$200	$200
5	6	$200	$1,200
Total Payment			$1,700

Payment Frequency

Plan shall allocate the Improvement Number across the Tier(s). Each number in a tier (the allocated Improvement Number) will be paid per the rate indicated in the above table. Plan shall pay Provider the sum of the total rates for Improvement Numbers allocated in each Tier no later than 45 days after the end of quarters 1-3 of calendar year 2026 and no later than 90 days after the end of quarter 4 of calendar year 2027.

Measure 5 – Provider Completion of Adverse Childhood Experiences (ACEs) Training and Attestation

Measure Description	Provider will complete an ACEs screening, document in chart, and receive $200 payment for completion in support of regulatory requirements.
Related Documentation and Deadline	Eligible Provider: Eligible Provider for this measure shall be a BHI Eligible Provider who is a LCSW, LMFT, LPCC, PsyD, PhD, NP, PA or MD. Provider Completion of Adverse Childhood Experiences (ACEs) Training and Attestation. Provider will receive $200 for Plan’s receipt of documentation, substantiating a BHI Eligible Provider’s achievement of a valid Adverse Childhood Experiences (ACEs) Training accompanied by the attestation of such training to DHCS.
Calculation Specification	Plan will pay provider for each ACEs Training completed per Eligible Provider, limited to one payment of $200 per each Eligible Provider. Eligible Provider must ensure that all documentation requirements specified by DHCS for health equity trainings are completed prior to the end of calendar year 2026.
Payment Frequency	Plan shall pay Provider $200 for every eligible ACE’s Training completed. Payment for this measure shall be made to Provider quarterly no later than 45 days after the end of each quarter Q1-Q3 and no later than 90 days after the end of Q4.

Measure 6 – Increase Access to Community Settings

Measure Description

BH provider to render service in community-based, non-office setting (street, home, school, library, church, etc.) and bill the service using a claims modifier. Provider will be paid an incentive of $25.00 per visit for seeing the member outside of an office.

Measure 7 – Emergency Department Follow-Up Visit

Measure Description	Provider will receive $50 for each Eligible Member who was seen by an Eligible Provider related to a mental health or substance abuse disorder within 7 or 30 days after being discharged from an emergency department (ED) visit.
Related Documentation and Deadline	Eligible Provider for this measure shall be a BHI Eligible Provider who is a LCSW, LMFT, LPCC, PsyD, PhD, NP, PA or MD. This measure is based on claims data. Eligible Providers who billed a claim within the 30-days ED post-discharge period will receive credit. Eligible Member: A BHI Eligible Member who was discharged from an ED for a mental health or substance abuse disorder within 7 or 30 days of seeing Eligible Provider.
Calculation Specification	This measure is applicable to visits occurring from July 1, 2025, through December 31, 2026. Plan will pay Provider under this measure for each eligible visit that occurs within 30 days of an Eligible Member’s discharge from an ED visit related to a mental health or substance abuse disorder. Plan will identify eligible visits via claims which are Complete Claims that are in a paid status no later than February 14, 2026 for measure year 2025 and February 14, 2027 for measure year 2026. This measure is based on claims data. All appliable claims must be received by Plan no later than February 14, 2026 for measure year 2025, and February 14, 2027 for measure year 2026 and must be Complete Claims that are in paid status to be counted toward this measure.
Payment Frequency	Plan shall pay Provider $50 for every eligible visit under this measure. Incentive payment will be made no later than 90 after the end of 2025 or March 31, 2026 and 90 days after the end of 2026 or March 31, 2027.

Please note: Not all measures listed above apply to every provider type. For complete and accurate information, please check your Agreement and/or Behavioral Health Incentive Program Amendment.