All Plan Letters

• Qualified CBAS providers are required to provide Emergency Remote Services (ERS) as a mode of service delivery when members experience emergencies for up to three consecutive months. Emergencies may be public (state/local disasters) or personal (serious illness/injury, crisis, care transition)
• Contracted CBAS providers must obtain ERS approval and provide each participant’s discharge plan to the Alliance within 30 days of discharge. Additional reporting & documentation requirements are within the APL.
• ERS for an emergency occurrence may not exceed three consecutive months, either within or crossing over an authorized period, without assessment and review for possible continued need for remote/telehealth delivery of services and supports as part of the reauthorization of the individual’s care plan.

This is in the Alliance Provider Manual: Section 6, pages 45-48

​Proposition 56 Value-Based Payment Program Directed Payments (Supersedes APL 20-014)​

Skilled Nursing Facilities — Long Term Care Benefit Standardization and Transition of Members to Managed Care

Superseded by 23-004

Primary Care Provider Site Reviews: Facility Site Review and Medical Record Review (Supersedes APL 20-006)

• ​Facility Site Review Standards
• Medical Record Review Standards​

• Provides guidance regarding the qualifications for becoming a Community Health Worker (CHW), the definitions of eligible populations for CHW services, and descriptions of applicable conditions for the CHW benefit.
• CHW services can be provided as individual or group sessions. The services can also be provided virtually or in-person with locations in any setting including, but not limited to, outpatient clinics, hospitals, homes, or community settings. There are no service location limits. Supervising Providers should refer to the Telehealth section in Part 2 of the Provider Manual for guidance regarding providing services via telehealth. Services include Health Education, Health Navigation, Screening and Assessment, Individual Support or Advocacy.
• The Alliance encourages Network Providers to communicate about the availability of these services with Alliance members.
• Watch for a new Provider Training that will review the referral process and billing requirements in the coming months.
• Please refer to the Provider Manual and following Policies for more information.

Enforcement Actions: Administrative and Monetary Sanctions (Supersedes APL 18-003)​

Superseded by 23-012

​Electronic Visit Verification Implementation Requirements​

Provider Credentialing/Re-Credentialing and Screening/Enrollment (Supersedes APL 19-004)

Governor’s Executive Order N-01-19, Regarding Transitioning Medi-Cal Pharmacy Benefits from Managed Care to Medi-Cal RX (Supersedes APL 20-020)

• Appendix A – Medi-Cal Rx Transition and NCQA Requirements​

Proposition 56 Directed Payments for Family Planning Services (Supersedes APL 20-013)​

Superseded by 23-008

​Cancer Biomarker Testing​

​COVID-19 Guidance for Medi-Cal Managed Care Health Plans​

Update 7/2/25: APL 22-009 has been retired. For current guidance on COVID-19-related benefits and services, refer to the Immunizations section of the Medi-Cal Provider Manual, DHCS provider bulletins and updates and DHCS APL 24-008: Immunization Requirements.

Non-Emergency Medical and Non-Medical Transportation Services and Related Travel Expenses (Supersedes APL 17-010)

• Non-Emergency Medical and Non-Medical Transportation Services and Related Travel Expenses Frequently Asked Questions​

​California Housing and Homelessness Incentive Program​

Medi-Cal Managed Care Health Plan Responsibilities for Non-Specialty Mental Health Services (Supersedes APL 17-018)​

• This APL provides Medi-Cal managed care health plans (MCP) with guidance and clarification regarding the No Wrong Door for Mental Health Services policy. This policy ensures that members receive timely mental health services without delay regardless of the delivery system where they seek care and that members can maintain treatment relationships with trusted providers without interruption. You can find corresponding guidance to County Mental Health Plans (MHP) in Behavioral Health Information Notice (BHIN) No: 22-011.
• With the California Advancing and Innovating Medi-Cal (CalAIM) initiative, the Department of Health Care Services (DHCS) aims to address Medi-Cal beneficiaries’ needs across the continuum of care to ensure that all beneficiaries receive coordinated services and improve beneficiary health outcomes. DHCS’ goal is to ensure that beneficiaries have access to the right care, in the right place, at the right time.
• MCP criteria
  • Members who are 21 years and older with mild to moderate distress, or mild to moderate impairment of mental, emotional or behavioral functioning resulting from mental health disorders as defined by the current Diagnostic and Statistical Manual of Mental Disorders.
  • Members who are under 21 years, to the extent they are eligible for services through the Medicaid Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, regardless of the level of distress or impairment, or the presence of a diagnosis.
  • Members of any age with potential mental health disorders not yet diagnosed.
• Required Services for Non-Specialty Mental Health Services (NSMHS)
  • Mental health evaluation and treatment, including individual, group and family psychotherapy.
  • Psychological and neuropsychological testing, when clinically indicated to evaluate a mental health condition.
  • Outpatient services for purposes of monitoring drug therapy.
  • Psychiatric consultation.
  • Outpatient laboratory, drugs, 4 supplies and supplements.
  • Consistent with W&I Code section 14184.402(f), clinically appropriate and covered NSMHS are covered by the Alliance even when:
• Services are provided prior to determination of a diagnosis, during the assessment period or prior to determination of whether NSMHS or SMHS access criteria are met.
• Services are not included in an individual treatment plan.
• The member has a co-occurring mental health condition and Substance Use Disorder (SUD).
• NSMHS and SMHS services are provided concurrently, if those services are coordinated and not duplicated.
• To facilitate the appropriate placement of Medi-Cal clients to either the SMHS or NSMHS system of care, DHCS is developing a set of statewide screening and transition tools which will go into effect in 2023. Using these tools, it is anticipated that most clients will then be assessed within the same system in which they receive treatment. Further details related to the statewide screening and transition tools, refer to pages 4-6 of DHCS APL 22-005.
• For more information, please refer to DHCS APL 22-005.
• Please watch out for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL.

Strategic Approaches for Use By Managed Care Plans to Maximize Continuity of Coverage as Normal Eligibility and Enrollment Operations Resume ​

​Medi-Cal Managed Care Health Plan Responsibility to Provide Services to Members with Eating Disorders​

Alternative Format Selection for Members with Visual Impairments

2022-2023 Medi-Cal Managed Care Health Plan Meds/834 Cutoff and Processing Schedule​