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.
- All
- 2024
- 2023
- 2022
Date: Apr 10, 2023
Telehealth Services Policy (Supersedes APL 19-009)
Date: Mar 28, 2023
Delegation and Subcontractor Network Certification (Supersedes APL 17-004)
- Attachment A: Subcontractor Network Certification Instruction Manual
- Attachment B: Subcontractor Network Exemptions Request
- Attachment C: Network Adequacy and Access Assurances Report
Date: Mar 16, 2023
Requirements For Coverage of Early and Periodic Screening, Diagnostic, and Treatment Services for Medi-Cal Members Under the Age of 21 (Supersedes APL 19-010)
Date: Mar 14, 2023
- Provides requirements on the Skilled Nursing Facility (SNF) Long Term Care (LTC) benefit standardization provisions of the California Advancing and Innovating Medi-Cal (CalAIM) initiative, including the mandatory transition of beneficiaries to managed care plans such as the Alliance.
Date: Mar 14, 2023
- The California Advancing and Innovating Medi-Cal (CalAIM) Initiative seeks to move Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility through benefit standardization.
- Please refer to this APL for detailed requirements for all Medi-Cal managed care health plans (MCPs) regarding Skilled Nursing Facility (SNF) Long Term Care (LTC) benefit standardization provisions of the CalAIM initiative, including the mandatory transition of beneficiaries to managed care.
- Effective January 1, 2024, institutional LTC Members receiving institutional LTC services in a Subacute Care Facility or Intermediate Care Facility for the Developmentally Disabled (ICF/DD) must be enrolled in a managed care plan such as the Alliance.
- The Alliance is conducting outreach to regional and statewide subacute and ICF/DD providers to ensure network adequacy.
Date: Mar 8, 2023
California Advancing and Innovating Medi-Cal Incentive Payment Program (Supersedes APL 21-016)
Date: Jan 17, 2023
2023-2024 Medi-Cal Managed Care Health Plan MEDS/834 Cutoff and Processing Schedule
Date: Jan 6, 2023
Network Certification Requirements (Supersedes APL 21-006)
- Attachment A: Network Adequacy Standards (PDF)
- Attachment B: Annual Network Certification Instruction Manual (PDF)
- Attachment C: Alternative Access Standard (AAS) Request Template (.xls)
Date: Dec 27, 2022
- Beneficiaries who mandatorily transition from Medi-Cal FFS to enroll as members in the Alliance or transition from the Alliance with contracts expiring or terminating to a new health plan on or after January 1, 2023, have the right to request Continuity of Care with Providers in accordance with federal and state law and the health plan contract, with some exceptions.
Date: Dec 27, 2022
- Effective January 1, 2023, the Alliance covers doula services for prenatal, perinatal, and postpartum members.
- Doula services can be provided virtually or in-person with locations in any setting including, but not limited to, homes, office visits, hospitals, or alternative birth centers.
- The Alliance covers doula services to include personal support to pregnant individuals and families throughout pregnancy, labor, and the postpartum period.
- To be eligible for doula services, and be covered under Medi-Cal managed care, a beneficiary must be eligible for Medi-Cal, enrolled with the Alliance, and have a recommendation for doula services from a physician or other licensed practitioner.
- Doula Providers must meet the requirements and qualifications (i.e., training/experience pathway, continuing education, etc.), as outlined in APL 22-031 linked below.
Date: Dec 27, 2022
Initial Health Appointment (Supersedes APL 13-017 and Policy Letters 13-001 and 08-003)
Date: Dec 27, 2022
- The Alliance covers dyadic care services for members and their caregivers that are medically necessary.
- A dyad refers to a child and their parent(s) or caregiver(s). Dyadic care refers to serving both parent(s) or caregiver(s) and child together as a dyad and is a form of treatment that targets family well-being as a mechanism to support healthy child development and mental health. It is provided within pediatric primary care settings whenever possible and can help identify behavioral health interventions and other behavioral health issues, provide referrals to services, and help guide the parent-child or caregiver-child relationship. Dyadic care fosters team-based approaches to meeting family needs, including addressing mental health and social support concerns, and it broadens and improves the delivery of pediatric preventive care.
- The Alliance covers family therapy for at least two family members when medically necessary. .
- Family therapy is a type of psychotherapy covered under Medi-Cal’s Non-Specialty Mental Health Services (NSMHS) benefit since 2020 Family therapy sessions, which must have at least two family members, address family dynamics as they relate to mental status and behavior(s). It is focused on improving relationships and behaviors in the family and between family members, such as between a child and parent(s) or caregiver(s).
- Examples of family therapy include but not limited to:
- Child-parent psychotherapy (ages 0 through 5)
- Parent child interactive therapy (ages 2 through 12)
- Cognitive-behavioral couple therapy (adults)
Date: Dec 27, 2022
The Department of Health Care Services (DHCS) California Advancing and Innovating Medi-Cal (CalAIM) initiative for “Screening and Transition of Care Tools for Medi-Cal Mental Health Services” aims to ensure all Medi-Cal members receive timely, coordinated services across Medi-Cal mental health delivery systems and improve member health outcomes. The goal is to ensure member access to the right care, in the right place, at the right time.
Date: Dec 22, 2022
- Please review this APL from the Department of Managed Health Care (DMHC) that lists multiple statutes that impact health plans and our partners.
Date: Dec 6, 2022
Cost Avoidance and Post-Payment Recovery for Other Health Coverage (Supersedes APL 21-002)
Prior to delivering services to members, Providers must review the Medi-Cal Eligibility Record for the presence of OHC. If the requested service is covered by the OHC, Managed care health plans must ensure Providers instruct the member to seek the service from the OHC carrier. Regardless of the presence of OHC, Providers must not refuse a covered Medi-Cal service to a Medi-Cal member.
Date: Nov 29, 2022
Interoperability and Patient Access Final Rule
Date: Nov 28, 2022
- Provider Training and Payment for Annual Cognitive Health Assessments
- Managed care health plans must cover an annual cognitive health assessment for their members who are 65 years of age or older and who do not have Medicare coverage. The annual cognitive health assessment is intended to identify whether the patient has signs of Alzheimer’s disease or related dementias, consistent with the standards for detecting cognitive impairment under the Medicare Annual Wellness Visit and the recommendations by the American Academy of Neurology (AAN).
- In order to be reimbursed for this assessment, providers must have previously completed the DHCS Dementia Care Aware cognitive Health Assessment training. More details are available within the APL.
Date: Nov 28, 2022
Population Health Management Program Guide (Supersedes APLs 17-012 and 17-013)
Date: Nov 8, 2022
- Street medicine refers to a set of health and social services developed specifically to address the unique needs and circumstances of individuals experiencing unsheltered homelessness, delivered directly to them in their own environment. The fundamental approach of street medicine is to engage people experiencing unsheltered homelessness exactly where they are and on their own terms to maximally reduce or eliminate barriers to care access and follow through.
- The Alliance will operate a street medicine program, and associated criteria. There are certain training, systems and data sharing requirements. Members may select a street medicine provider as their PCP if appropriate requirements are met.
Date: Oct 28, 2022
- Abortion services are a covered benefit. There is no medical justification or utilization management required for outpatient abortion services. However, non-emergency inpatient hospitalization may require prior authorization.
- Member confidentiality should be safeguarded in accessing abortion services, including for minors.
- No physician, provider or person is required to participate in an abortion and no person refusing to participate is subject to penalty for such choice. The Alliance will assist members in accessing timely access to abortion services if a provider refuses to perform them.