All Plan Letters

• Clarifies contractual obligations for authorizing post-stabilization care services.

• The funding that was approved through June 2022 will be distributed following timely payment standards in the Contract for Clean Claims or accepted encounters that were received no later than one year after the date of service.
• DHCS requested approval from CMS for this directed payment arrangement for CY 2022 and CY 2023.
• Subject to future appropriation of funds by the California Legislature and the necessary federal approvals of the directed payment arrangement, DHCS intends to continue this directed payment arrangement on an annual basis for the duration of the program. The requirements of this APL may change if necessary to obtain CMS approvals applicable to this directed payment arrangement or to comport with future state legislation.
• This directed payment program is intended to enhance the quality of patient care by ensuring that Providers in California who offer family planning services receive enhanced payment for their delivery of family planning services. Timely access to vital family planning services is a critical component of Member and population health. In particular, this program is focused on the following categories of family planning services:
  • Long-acting contraceptives
  • Other contraceptives (other than oral contraceptives) when provided as a medical benefit
  • Emergency contraceptives when provided as a medical benefit
  • Pregnancy testing
  • Sterilization procedures (for females and males)

Telehealth Services Policy (Supersedes APL 19-009)

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

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)​

• 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.

• 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.

​California Advancing and Innovating Medi-Cal Incentive Payment Program (Supersedes APL 21-016)

2023-2024 Medi-Cal Managed Care Health Plan MEDS/834 Cutoff and Processing Schedule​

​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)

• 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.

• 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.

Initial Health Appointment (Supersedes APL 13-017 and Policy Letters 13-001 and 08-003)

• 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)

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.

• Please review this APL from the Department of Managed Health Care (DMHC) that lists multiple statutes that impact health plans and our partners.

Cost Avoidance and Post-Payment Recovery for Other Health Coverage (Supersedes APL 21-002)​

• Appendix A​
• Appendix B
• FAQs

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.

​Interoperability and Patient Access Final Rule

• 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.

​Population Health Management Program Guide (Supersedes APLs 17-012 and 17-013)