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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: 26-008
Date: Jul 29, 2026
DHCS APL 26-008: Interoperability Final Rules, Including Prior Authorization Requirements
  • The purpose of this All Plan Letter (APL) is to inform Medi-Cal managed care plans of the Centers for Medicare & Medicaid Services (CMS) interoperability requirements.
  • Beginning Jan. 1, 2027, contracted providers will be able to electronically access prior authorization information—including request status, approval or denial dates, expiration dates and supporting clinical documentation—through standardized Application Programming Interfaces (APIs).
  • Health plans will also be required to provide clear and specific reasons whenever a prior authorization request is denied, improving transparency and helping providers better understand coverage decisions.
  • Providers should ensure their demographic and practice information (including office locations, phone numbers, specialties, languages spoken, whether they are accepting new patients and accessibility accommodations) is accurate and up to date. Health plans are required to update provider directories at least weekly.
  • While this APL modernizes the electronic exchange of prior authorization and provider directory information, providers should continue to follow their health plan’s current prior authorization submission processes and timelines until the new interoperability requirements take effect or the health plan communicates updated procedures.
  • This APL supersedes 22-026. For more information, please refer to DHCS APL 26-008.
APL: 26-006
Date: Mar 30, 2026
DHCS APL 26-006: Skilled Nursing Facility Workforce Quality Incentive Program
  • The purpose of this All Plan Letter (APL) is to provide Medi-Cal managed care plans (MCPs) with instructions on the payment and data sharing process required for the Skilled Nursing Facility (SNF) Workforce and Quality Incentive Program (WQIP). This APL supersedes APL 25-002.
  • With this new APL, the program end date has changed. Under APL 25-002, the SNF WQIP was authorized through December 31, 2026. However under APL 26-006, the program end date was shortened to December 31, 2025 following state budget changes under AB116.
  • Since implementation of APL 25-002, DHCS has issued additional technical guidance, policy letters and reconciliation processes tied to staffing metrics, qualifying bed days and payment calculations. APL 26-006 reflects a more mature operational phase of the program with greater emphasis on accurate claims and encounter reporting.
  • For more information, please refer to DHCS APL 26-006.
APL: APL 26-005
Date: Mar 25, 2026
DHCS APL 26-005: Maternity Services for Pregnant and Postpartum Medi-Cal Members
  • The purpose of this All Plan Letter (APL) is to consolidate and update guidance for Medi-Cal managed care plans (MCPs) on the maternity benefits that MCPs are required to provide to pregnant and postpartum Members.
  • DHCS now defines postpartum members as individuals up to 12 months after pregnancy ends, including live birth, miscarriage, stillbirth, or abortion. Plans and providers must continue supporting members throughout the full postpartum period, not just the traditional 6–8 weeks.
  • This APL reinforces coverage requirements for comprehensive maternity services, including:
    • Prenatal and postpartum care
    • Hospital and obstetric services
    • Midwifery and doula services
    • Lactation support and breast pumps
    • Behavioral health and substance use treatment
    • Care coordination and transportation assistance
  • Managed care plans are expected to identify high-risk pregnant members earlier and coordinate services addressing medical, behavioral, and social needs. This includes referrals for housing supports, medically tailored meals, transportation, and Enhanced Care Management (ECM) or Community Supports when appropriate
  • For more information, please refer to DHCS APL 26-005
APL: APL 26-005
Date: Mar 20, 2026
DMHC APL 26-005 - Compliance with Assembly Bill 904, Maternal and Infant Health Equity Program
  • The purpose of this All-Plan Letter (APL) to inform health care service plans (plans) covering maternity services of the filing requirements necessary to demonstrate compliance with and implementation of Assembly Bill (AB) 904.
  • AB 904 requires health plans covering maternity services to develop programs addressing racial disparities in maternal and infant outcomes through the use of doulas by January 1, 2025. These services may be integrated into existing maternal health programs or expand existing doula initiatives.
  • The APL reinforces expectations that doulas play an important role in improving maternal outcomes, especially for Black, Native American, and underserved populations disproportionately impacted by maternal morbidity and mortality. Providers should expect increased integration of doulas into prenatal, delivery, and postpartum care coordination workflows.
  • For more information, please refer to DMHC APL 26-005
APL: 26-003
Date: Mar 13, 2026
DHCS APL 26-003: Quality Measures for Encounter Data Update: Quality Measures for Encounter Data 2.0
  • The purpose of this All Plan Letter (APL) is to notify Medi-Cal managed care plans (MCPs) about an update to the Department of Health Care Services (DHCS) Quality Measures for Encounter Data (QMED) requirements. This APL supersedes APL 14-020.
  • For managed care encounters submitted on or after Jan. 1, 2026, the quality of managed care encounter data will be measured on a quarterly basis as “Pass” or “Fail” in accordance with QMED 2.0 requirements.
  • Providers may see increased outreach regarding coding accuracy, provider identifiers, required fields, duplicate encounters, and claim/encounter corrections to meet stricter validation standards.
  • Delayed claims and encounter submissions may negatively impact health plan compliance scores, leading plans to enforce stricter submission timelines and monitoring processes.
  • For more information, please refer to DHCS APL 26-003.
APL: APL 25-021
Date: Feb 23, 2026
DMHC APL 25-021 – Implementation of Senate Bill 729 (2024)
  • Expanded infertility coverage: This APL implements Senate Bill 729 (2024), which expands infertility treatment coverage requirements for certain health care service plans, including coverage for assisted reproductive technologies such as in vitro fertilization (IVF).
  • Who is impacted: The requirements apply to large group health care service plans regulated by the Department of Managed Health Care (DMHC), with limited statutory exemptions for qualifying religious employers.
  • Implementation and compliance expectations: Health plans must update benefits, policies and operational processes to ensure coverage is provided in accordance with the new law and applicable timelines.
  • Consumer and provider transparency: Plans are expected to clearly communicate benefit changes to enrollees and providers and ensure access to covered infertility services consistent with SB 729 and DMHC oversight.
  • Please watch out for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL.
APL: APL 26-002
Date: Feb 2, 2026
DHCS APL 26-002 - Medi-Cal Managed Care Plan Responsibilities for Non-Specialty Mental Health Services (supersedes APL 22-006)
  • This APL outlines MCP responsibilities for referring to and coordinating with county mental health plans (MHPs) for the delivery of specialty mental health services (SMHS), including providing a list of California Department of Health Care Services (DHCS)-approved youth trauma screening tools to determine access criteria for the SMHS delivery system. This APL supersedes APL 22-006.
  • The federal EPSDT mandate requires states to furnish all medically necessary services to correct or ameliorate health conditions for children under the age of 21. This includes behavioral health conditions discovered by a screening service, regardless of whether those services are covered in the state’s Medicaid State Plan.
  • For more information, please refer to DHCS APL 26-002 and APL 26-002 Attachment A: Department of Health Care Services-Approved Youth Trauma Screening Tools for Specialty Mental Health Services Access Criteria.
APL: APL 26-001
Date: Jan 7, 2026
DHCS APL 26-001 - Initial Health Appointment (supersedes APL 22-030)
  • The purpose of this APL (All Plan Letter) is to provide guidance to Medi-Cal managed care plans (MCPs) regarding the requirements of the Initial Health Appointments (IHA). This APL supersedes APL 22-030.
  • Providers are to confirm that the IHA is not performed if the member’s medical record contains complete and updated information within the previous 12 months, as determined by the primary care provider.
  • The IHA is to be proactively scheduled and completed promptly in a setting that supports comprehensive care.
  • The IHA must be completed in an appropriate clinical setting.
  • For more information, please refer to DHCS APL 26-001.
APL: APL 25-020
Date: Dec 19, 2025
DMHC APL 25-020 (OPL) – Newly Enacted Statutes Impacting Health Plans (2025 Legislative Session)
  • This All Plan Letter explains new laws passed in 2025 that apply to health care service plans regulated by the Department of Managed Health Care. It includes an overview of the 12 enacted bills and how they affect plan requirements.
  • Please watch out for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL.
APL: APL 25-016
Date: Nov 13, 2025
DHCS APL 25-016: Alternative Format Selection (AFS) for Members with Visual Impairment (Supersedes 22-002)
  • Purpose & Scope: APL 25-016 (effective November 13, 2025) replaces APL 22-002 and updates requirements for providing accessible written communications to Medi-Cal members with visual impairments or other disabilities, emphasizing the tracking and use of member-selected Alternative Format Selections (AFS).
  • Legal & Communication Requirements: Reaffirms MCP obligations under the ADA and related civil rights laws to provide effective communication, give primary consideration to members’ preferred alternative formats (e.g., Braille, audio, large print, accessible electronic), and ensure due process notices are delivered in the member’s selected accessible format.
  • System & Process Changes: Discontinues use of the AFS screens; members must select or update alternative formats through BenefitsCal, Covered California, or county offices, with MEDS becoming the system of record beginning with the September 24, 2025 change cycle (October 2025 enrollment).
  • Data, Compliance & Oversight: MCPs must rely on the 834 enrollment files (including a new written language field) to obtain AFS data, update internal workflows and policies within required timelines, ensure subcontractor and provider compliance, and are subject to monitoring, corrective action plans, and sanctions for non-compliance.
  • Replaces APL 22-002. For more information, please refer to DHCS APL 25-016.
APL: APL 25-013
Date: Sep 18, 2025
DHCS APL 25-013: Medi-Cal RX Pharmacy Benefits and Cell Gene Therapy Coverage
  • Medi-Cal Rx now handles the statewide pharmacy benefit, replacing managed-care plans for outpatient pharmacy services.
  • This APL defines how the coverage is split, which includes Medi-Cal Rx coverings outpatient drugs/supplies and managed-care plans (MCPs) covering provider-administered drugs.
  • It details formal appeals steps for pharmacies and providers on claim and PA decisions.
  • Under this APL, Medi-Cal Rx will cover out select cell and gene therapies while MCPs will keep care-coordination duties.
  • For more information refer to DHCS Cell and Gene Therapy access model website.
  • This APL supersedes all plan letter 22-012.
  • For more information, please refer to DHCS APL 25-013.
APL: DHCS APL 25-010
Date: Sep 3, 2025
DHCS APL 25-010: Adult and Youth Screening and Transition of Care Tools for Medi-Cal Mental Health Services
  • This All Plan Letter (APL) provides guidance to Medi-Cal managed care plans (MCP) on standardized, statewide screening and transition of care tools to guide referring adult and youths to the appropriate Medi-Cal mental health delivery system and guide timely care coordination for members transitioning between delivery systems. This APL supersedes APL 22-028.  
  • The tools are to be used by MCPs, Behavioral Health Plans and contracted providers when making or receiving referrals for mental health services. DHCS provided tools which include the Adult Screening Tool (21+), Youth Screening Tool (<21) and Transition of Care Tool.  
  • Tools are required for referrals and care coordination unless the member is already receiving mental health services or the member self-refers to mental health services. The tools should NOT be used during psychiatric emergencies or crises. 
  • For more information, please refer to DHCS APL 25-010. 
  • Please watch out for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL. 

 

 

 

 

 

APL: DMHC APL 25-011
Date: Aug 1, 2025
DMHC APL 25-011- Health Plan Coverage of HIV Preexposure Prophylaxis
  • This All Plan Letter (APL) applies to all full-service commercial health and Medi-Cal managed care plans in California and requires coverage of all United States Preventative Services Task Force, USPSTF, “A” or “B” preventive services—including PrEP—with no cost sharing.
  • Since June 2019, USPSTF recommends PrEP (“A” grade) for certain high-risk individuals. Plans must cover all FDA-approved PrEP formulations (daily oral and long-acting injectable) without cost-sharing.
  • Prior authorization and step therapy for PrEP are prohibited and plans must also cover, at no cost, all services essential to PrEP initation and monitoring.
  • For more information, please refer to DMHC APL 25-011.
  • Please watch out for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL.
APL: DHCS APL 25-009
Date: Aug 1, 2025
DHCS APL 25-009 - Community Advisory Committee
  • The purpose of this All Plan Letter (APL) is to ensure engagement from members, families and the community to advise Managed Care Plans on cultural, linguistic and health equity needs. The Community Advisory Committee(CAC) supports MCP’s cultural and linguistically appropriate services program, helping shape member-centered care.
  • The CAC provides ongoing feedback on the MCP’s outreach, communications, cultural competence and services.
  • For more information, please refer to DHCS APL 25-009.
  • Please watch out for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL.
APL: DHCS APL 25-008
Date: Jul 14, 2025
DHCS APL 25-008: Hospice Services and Medi-Cal Managed Care
  • This APL highlights contractual, regulatory and statutory requirements applicable to Medi-Cal managed care plans (MCPs) with respect to their responsibilities to provide medically necessary hospice services to their members.
  • When a member elects hospice care, the MCP must authorize and cover care promptly and continue oversite to ensure care meets medical standards. MCPs must also coordinate coverage and billing appropriately.
  • Hospice does not disenroll members from the MCP, and MCP will remain responsible for non-hospice services such as PCP care, medications and DME supplies.
  • The hospice provider is responsible for coordinating hospice services. The hospice provider must submit the appropriate Department of Health Care Services’ (DHCS) election form (Medi-Cal Hospice Program Election Notice) to the member’s respective MCP within five calendar days of certification and election of hospice care. Refer to the footnotes on page 3 of the APL to review the required forms.
  • For more information, please refer to DHCS APL 25-008.
  • Please watch out for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL.
APL: DHCS APL 25-007
Date: Jul 14, 2025
DHCS APL 25-007: Enforcement Actions, CAP, Admin & Monetary Sanctions
  • This APL clarifies the Department of Health Care Services’ (DHCS) policy regarding the enforcement actions, including corrective action plans, administrative and monetary sanctions. DHCS may take these actions to enforce compliance with Medi-Cal managed care Plans’ (MCPs) contractual provisions and applicable state and federal laws. This APL supersedes APL 23-012.
  • MCPs are responsible for ensuring that they comply with all contractual obligations and applicable state and federal laws and regulations. MCPs must also ensure that all subcontractors comply with all contract requirements.
  • For more information, please refer to DHCS APL 25-007.
  • Please watch out for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL.
APL: DHCS APL 25-006
Date: Jul 14, 2025
DHCS APL 25-006: Timely Access Requirements
  • This APL provides Medi-Cal managed care plans with guidance regarding the ongoing requirement to meet timely access standards and outlines the required minimum performance levels which go into effect measurement year 2025.
  • For more information regarding the changes to the Timely Access Requirements, please refer to DHCS APL 25-006.
  • Visit our Timely Access to Care webpage for more information.
  • Please watch out for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL.
APL: DMHC APL 25-007
Date: Jul 14, 2025
DMHC APL 25-007 - Assembly Bill 3275 Guidance (Claim Reimbursement)
  • Beginning Jan. 1, 2026, plans must reimburse claims that are paid, denied or contested within 30 calendar days of receipt. These changes apply to all health care service plans—including HMOs, Medi‑Cal managed care, EAP plans—as well as health insurers.
  • If a claim is contested due to missing info and more details are submitted, the plan has 30 calendar days to reevaluate and process it. Plans must notify the claimant in writing within 30 calendar days of a claim being denied or contested.
    • For more information, please refer to DMHC APL 25-007.
    • Please watch out for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL.
APL: APL 25-004 (AB 118)
Date: May 2, 2025
DMHC APL 25-004 (AB 118) - Pt 1 Compliance with Large Group Standardized EOC/Disclosure
  • The objective of this APL is to ensure that health plans provide clear, consistent and comprehensive information regarding benefits, exclusions, limitations and member rights.
  • Content requirements:
    • Exclusions and limitations: Detailed listing of services not covered or with coverage limits.
    • Members’ rights and responsibilities: Information on enrollee entitlements and obligations.
    • Definitions: Clear explanations of terms used within the EOC/disclosure form.
  • Formatting standards:
    • Uses plain language to ensure understandability. Consistent structure and layout.
  • For more information, please refer to DMHC APL 25-004.
  • Please watch out for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL.
APL: 25-006
Date: May 2, 2025
DMHC APL 25-006: Health plan coverage of mobile crisis services
  • This APL provides guidance on the coverage requirements for mobile crisis services under Medi-Cal, ensuring timely and appropriate behavioral health crisis intervention for beneficiaries.
  • Mobile Crisis Services provides community-based interventions for individuals experiencing behavioral health crises, delivered wherever the individual is located (e.g., home, work, school).
  • The service delivery is provided by multidisciplinary teams comprising behavioral health professionals such as clinicians, peer support specialists and other trained personnel. Teams are trained in trauma-informed care, de-escalation techniques and harm reduction strategies.
  • Medi-Cal Managed Care Plans (MCPs) are required to cover mobile crisis services as a Medi-Cal benefit. MCPs cannot require prior authorization for behavioral health crisis stabilization services that mobile crisis teams provide.
  • The Medi-Cal Mobile Crisis Training and Technical Assistance Center (M-TAC) offers training, resources and ongoing support to counties and mobile crisis teams to provide additional training and support for providers. The training focus areas include crisis assessment, trauma-informed care, de-escalation techniques, harm reduction, safety planning and strategies for special populations.
  • For more information, please refer to DMHC APL 25-006.
  • Please watch out for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL.

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