All Plan Letters

Mandatory Signatories to the California Health and Human Services Agency Data Exchange Framework.

Network Providers are required to sign the California Health and Human Services Agency (CalHHS) Data Exchange Framework (DxF) Data Sharing Agreement (DSA) as outlined in the California Health and Safety Code § 130290. The California Health and Human Services Agency (CalHHS) Data Exchange Framework (DxF) Data Sharing Agreement (DSA) ensures that every Californian, as well as the health and human service and governmental entities who serve them, can access information needed to provide safe and effective care for all Californians, regardless of where in the state they are located.

The Department of Health Care Services (DHCS) published the CalAIM Data Sharing Authorization Guidance[1] in March of 2022, which supports data sharing between Managed Care Plans, health care providers, community-based social and human service providers, local health jurisdictions, and county and other public agencies that provide services and manage care under CalAIM.

The DxF advances health equity for all Californians by facilitating the secure and appropriate exchange of health and social services information. The DxF will, in addition to other goals, identify gaps in, and propose solutions to gaps, in the life cycle of health information, including:

• Health information creation, including the use of national standards in clinical documentation, health plan records, and social services data.
• Translation, mapping, controlled vocabularies, coding, and data classification.
• Storage, maintenance, and management of health information.
• Linking, sharing, exchanging, and providing access to health information.

Sign the Data Sharing Agreement today at https://signdxf.powerappsportals.com/.

Network Providers can also work with their County Health Information Exchange organizations. Please see the established County Health Information Exchange organizations below:

Monterey County
Central Coast Connect
Website: https://centralcoasthealthconnect.org/
Phone Number: (831) 644-7494
Email: [email protected]

Santa Cruz County
Serving Communities HIO
Website: https://schio.org/
Phone Number: (831) 610-3700
Email: [email protected]

Network Providers are required to sign the California Health and Human Services Agency (CalHHS) Data Exchange Framework (DxF) Data Sharing Agreement (DSA) as outlined in the California Health and Safety Code § 130290. The California Health and Human Services Agency (CalHHS) Data Exchange Framework (DxF) Data Sharing Agreement (DSA) ensures that every Californian, as well as the health and human service and governmental entities who serve them, can access information needed to provide safe and effective care for all Californians, regardless of where in the state they are located.

The Department of Health Care Services (DHCS) published the CalAIM Data Sharing Authorization Guidance^[1] in March of 2022, which supports data sharing between Managed Care Plans, health care providers, community-based social and human service providers, local health jurisdictions, and county and other public agencies that provide services and manage care under CalAIM.

The DxF advances health equity for all Californians by facilitating the secure and appropriate exchange of health and social services information. The DxF will, in addition to other goals, identify gaps in, and propose solutions to gaps, in the life cycle of health information, including:

• Health information creation, including the use of national standards in clinical documentation, health plan records, and social services data.
• Translation, mapping, controlled vocabularies, coding, and data classification.
• Storage, maintenance, and management of health information.
• Linking, sharing, exchanging, and providing access to health information.

Sign the Data Sharing Agreement today at https://signdxf.powerappsportals.com/.

Network Providers can also work with their County Health Information Exchange organizations. Please see the established County Health Information Exchange organizations below. 

Monterey County

Central Coast Connect
Website: https://centralcoasthealthconnect.org/
Phone Number: (831) 644-7494
Email: [email protected]

Santa Cruz County

Serving Communities HIO
Website: https://schio.org/
Phone Number: (831) 610-3700
Email: [email protected]

^[1] CalAIM – Data Sharing Authorization Guidance: https://www.dhcs.ca.gov/Documents/MCQMD/CalAIM-Data-Sharing-Authorization-Guidance.pdf

• ​Enforcement Actions: Administrative and Monetary Sanctions (Supersedes APL 22-015)
• The purpose of this APL provides clarification of DHCS’s policy regarding the imposition of administrative and monetary sanctions, which are among the enforcement actions DHCS may take to enforce compliance with contractual provisions and applicable state and federal laws. This APL supersedes APL 22-015.

• Provides guidance and clarification regarding federal and state legal requirements for recovery of all Overpayments to Providers.

• Provides guidance about the provision of Medically Necessary Behavioral Health Treatment (BHT) services for Members under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit in accordance with mental health parity requirements.
• Clarifies responsibility of coordination with other entities, and ensures all of a Member’s needs for Medically Necessary BHT services are met across environments, including on-site at school or during virtual school sessions.
• This APL clarifies Medically Necessary Behavioral Health Treatment services covered under Medicaid.

• 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.