Provider Digest | Issue 15

Provider Icon

Flu shots, how your clinic can earn more with the CBI program + more

It’s not too late to get the flu vaccine!

This winter, the Alliance is encouraging members to make a flu vaccine appointment or get a flu vaccine at a walk-in location today. Most years, flu activity peaks between December and February. Getting the flu vaccine is the best way to protect from getting sick.

Please join us and encourage your patients to get their flu vaccines. Alliance members can get a flu vaccine at no cost.

Additionally, we have a Health and Wellness Reward for flu vaccines available to our members. Children ages 7 to 24 months old who get their two flu vaccine doses between September and May will be entered into a monthly raffle for a $100 Target gift card.

Promote flu vaccines at your clinic

We have flu flyers available in English, Spanish and Hmong that are ready for you to print and distribute.

Members can also visit the flu page on our website.

2023 Care-Based Incentive program resources

Visit our Care-Based Incentive (CBI) webpage to learn what’s new in 2023. You can review current CBI program information and tools to support your clinic’s success in the new year.

  • What’s New includes changes in the 2023 CBI program, highlighting:
    • New Programmatic, Fee-For-Service and Exploratory Measures.
    • Programmatic Measure Changes.
    • Retired Measures.
  • Care-Based Incentives Resources include information to help your clinic perform well in the CBI program, including:
    • The Incentive Summary page featuring an overview of the 2023 CBI Program, a detailed payment timeline and information on the member Health and Wellness Rewards Program (member incentives).
    • Programmatic Measure Benchmarks and Performance Improvement: (note that separate plan goals and benchmarks are used in CBI 2022 and CBI 2023. The 2023 Programmatic Benchmarks and Performance Improvement Goals will be available in early 2023).
    • CBI Tip Sheets: There are several tip sheets on the website to help clinic staff understand each measure and improve clinic performance. Tip sheets have been updated for 2023, with noted differences if a change occurred for the new CBI year. Some 2023 updates include:
      • The Staying Healthy Assessment (SHA) requirement for Initial Health Assessments (IHA) was removed for the CBI 2023 program year only.
    • CBI Technical Specifications include the complete program year requirements for CBI 2022 and 2023.
    • Training resources.
    • General Resources including the Depression Tool Kit; Standards of Care Guidelines: Childhood Lead Poisoning; Member Satisfaction Toolkit and Health Education Programs.

If you have any questions or would like additional CBI support, please contact your Provider Relations Representative at 800-700-3874, ext. 5504.

As of Jan. 20, Medi-Cal Rx PA requirements reinstated for 39 drug classes

Beginning Jan. 20, 2023, Medi-Cal Rx prior authorization (PA) requirements will be reinstated for 39 additional drug classes. Requirements apply to new start medications in these drug classes for beneficiaries 22 years of age and older.

Medi-Cal Rx Reinstatement – Phase II, Wave I Drug Classes
All Other Dermatologicals Corticotropins Other Antibiotics
Anabolics Emollients Protectives Other Hormones
Androgens Erythromycins Penicillins
Anesthetic Local Topical Estrogens Progesterone
Antiarthritics Fat Soluble Vitamins Streptomycins
Antifungals Folic Acid Preparations Sulfonamides
Antimalarials General Antibacterials and Antiseptics Systematic Contraceptives
Antiparasitics Glucocorticoids TB Preparations
Antiparkinson Iodine Therapy Tetracyclines
Anti-Ulcer Preps/Gastrointestinal Preps Multivitamins Thyroid Preps
Antivirals Muscle Relaxants Topical Nasal and Otic Preparations
Biologicals Non-Opioid Analgesics Urinary Antibacterials
Cephalosporins Ophthalmic Preparations Vitamin K

For full details, please review the Dec. 20 notification from DHCS. You can also keep up to date on Medi-Cal reinstatement on the Medi-Cal Rx Education and Outreach webpage.

Additional resources

Important upcoming dates

  • Feb. 24, 2023: PA requirements will be reinstated for all remaining Standard Therapeutic Classes (STCs) for beneficiaries 22 and older (Phase II, Wave 2).
  • March 24, 2023: DHCS will begin to lift transition policies that were in place for beneficiaries ages 22 years and older (Phase III).


Call the Medi-Cal Rx Customer Service Center at 800-977-2273 (available 24/7) days a week or email Medi-Cal Rx Education & Outreach at [email protected].

Immigrants have more protections to access Medi-Cal benefits

As of Dec. 23, 2022, a new public charge regulation published by the U.S. Department of Homeland Security provides additional protections to help ensure that immigrants and their families can access critical public benefits without fear of immigration consequences. We hope that this will help more local families feel comfortable seeking the services they need, including health care.

Under this new regulation, health care, food and many other public benefits are not considered for the purposes of public charge. Medi-Cal/Medicaid is not considered under the new public charge regulation (except in the case of long-term institutionalized care, or skilled nursing home care).

The Alliance has published more details on public charge on our website.