All Plan Letters
From time to time, the Department of Health Care Services (DHCS) posts All Plan Letters (APLs) informing CenCal Health of new guidelines and standards required by the state of California for Medi-Cal services. APLs provide instruction to CenCal Health’s contracted providers (if applicable) on how to implement these changes on an operational basis.
Please share these details with your staff and practitioners within your organization, or reference our Provider News Flash section of our website for published notifications.
The latest legislative updates are available from the Department of Health Care Services (DHCS).
APL |
Relevant Provider Takeaways |
| APL 23 – 017 Date: June 13, 2023 |
Directed Payments for Adverse Childhood Experiences Screening Services Date: June 13, 2023 The Budget Act of 2021 changed the source of the nonfederal share of the supplemental payments for trauma screenings to the state General Fund. In accordance with the State Plan Amendment (SPA) 21-0045,5 effective July 1, 2022, the ACEs program will become a benefit, and it will no longer be funded by Proposition 56. The ACEs Aware program must continue to be utilized to provide informational resources for ACE screening services. ACEs Aware Trainings: The “Becoming ACEs Aware in California” Core Training is a free, two-hour training for which clinicians and clinical team members will receive 2.0 Continuing Medical Education and/or 2.0 Maintenance of Certification credits upon completion. Please find the training here: https://www.acesaware.org/learn-about-screening/training/ Providers must complete this training and the DHCS ACEs Provider Training Attestation form to qualify for payment for completing ACE Screenings. More information about training is available at https://www.acesaware.org/learn-about-screening/training/. Allowed ACE Screening Tools: For Children and Adolescents: The Pediatric ACEs and Related Life-Events Screener (PEARLS) is used to screen children and adolescents ages 0-19 for ACEs. Three versions of the tool are available, based on age and reporter:
For Adults: The ACE questionnaire may be used for adults (ages 18 years and older). Members who are dually eligible for Medi-Cal and Medicare Part B will not qualify for reimbursement (regardless of enrollment in Medicare part A or Part D). Details pertaining to ACEs Aware Certification, Eligibility, Provider Requirements, ACE Screening Implementation, HCPCS Codes, Descriptions, Directed Payment, and notes can be found in the APL. |
| APL 23-016 Date: June 9, 2023 |
Directed Payments for Developmental Screening Services The Budget Act of 2021 changed the source of the nonfederal share of these payments to the state General Fund. |
| APL 23-015 Date: June 9, 2023 |
Proposition 56 Directed Payments for Private Services DHCS intends to continue this directed payment arrangement on an annual basis for the duration of the program.Please refer to the APL for Procedure Codes, Descriptions, Minimum Fee Schedule amounts, and Dates of services from July 1, 2017 to “Ongoing” which means the directed payment is in effect, subject to future budgetary authorization and appropriation by the California Legislature, until discontinued by DHCS via an amendment to this APL. |
| APL 23 – 014 Date: June 9, 2023 |
Proposition 56 Value-Based Payment (VBP) Program Directed Payments 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 up to June 30, 2022.Please see Appendix A of this APL to understand the Domain, Measure and Add-on Amounts from Dates of service between July 1, 2019 and June 30, 2022.Services performed after June 30, 2022, are not eligible for VBP directed payments. |
| APL 23-013 Date: May 18, 2023 |
Mandatory Signatories to the California Health and Human Services Agency Data Exchange Framework Mandatory Signatories to the California Health and Human Services Agency Data Exchange Framework |
| APL 23-012 Date: May 12, 2023 |
Enforcement Actions: Administrative and Monetary Sanctions Enforcement Actions: Administrative and Monetary Sanctions (Supersedes APL 22-015) |
| APL 23-011 Date: May 8, 2023 |
Treatment of Recoveries made by the Managed Care Health Plan of Overpayments to Providers Provides guidance and clarification regarding federal and state legal requirements for recovery of all Overpayments to Providers. All network Providers are to report to CenCal Health when they have received an overpayment and to return the overpayment to CenCal Health within 60 calendar days, in addition to a notification in writing of the reason of the overpayment. |
| APL 23-010 May 4, 2023 |
Responsibilities for Behavioral Health Treatment Coverage for Members Date: Under the Age of 21 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. |
| APL 23-009 Date: May 3, 2023 |
Authorization for Post-Stabilization Care Services Clarifies contractual obligations for authorizing post-stabilization care services. |
| APL 23-008 Date: April 28, 2023 |
Proposition 56 Directed Payments for Family Planning 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:
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| APL 23-007 Date: April 10, 2023 |
Telehealth Services Policy As technology continues to advance, the healthcare industry has embraced telehealth as a valuable modality for delivering services. In the state of California, providers and practitioners offering telehealth services to members must adhere to specific guidelines and requirements. Providers offering Covered Services via Telehealth in California must be licensed in the state and enrolled as a Medi-Cal Provider or affiliated with a Medi-Cal Provider group. If the provider is located outside of California, they need to be associated with a Medi-Cal enrolled Provider group in California or a border community. While telehealth can be a convenient and effective means of providing Covered Services, certain services are not suitable for remote delivery. Procedures requiring the in-person presence of a member, direct visualization or instrumentation of bodily structures, or sampling of tissues or medical device insertion/removal cannot be appropriately delivered via Telehealth. With the exception of Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), and Tribal Health Providers (THPs), all providers can be reimbursed for consultations offered via Telehealth. It’s important to note that e-consults can only be initiated by the provider and not the member. Additionally, providers, including FQHCs, RHCs, and THPs, are eligible for reimbursement for brief virtual communication with members who are not physically present. Starting January 1, 2024, providers offering applicable Covered Services through audio-only synchronous interactions must also offer the same service via video synchronous interactions. This change aims to preserve the member choice and ensure access to comprehensive telehealth services. To safeguard a member’s right to in-person care, providers delivering services through video or audio-only synchronous interactions must take the following steps:
Prior to initiating Covered Services via Telehealth, providers must inform members about the use of this modality and obtain their verbal or written consent. It is crucial to document this consent in the member’s medical record, as it may be requested for review by the Department of Health Care Services. During the consent process, providers must explain the following to members:
Telehealth offers providers and practitioners the opportunity to provide Covered Services remotely, expanding access to care for patients. Please reference the July Provider Pulse E-Newsletter for more information. |
| APL 23-006 Date: March 28, 2023 |
Delegation and Subcontractor Network CertificationDelegation and Subcontractor Network Certification (Supersedes APL 17-004)
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| APL 23-005 Date: March 16, 2023 |
Requirements for Coverage of Early and Periodic Screening, Diagnostic, and Treatment Services for Medical Members Under the Age of 21 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) |
| APL 23-004 March 14, 2023 |
Skilled Nursing Facilities – Long Term Care Benefit Standardization and Date: Transition of members to Managed Care 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 CenCal Health. |
| APL 23-003 Date: March 8, 2023 |
California Advancing and Innovating Medi-Cal Incentive Payment Program California Advancing and Innovating Medi-Cal Incentive Payment Program (Supersedes APL 21-016) |
| APL 23-002 Date: Jan. 17, 2023 |
2023-2024 Medi-Cal Managed Care Health Plan Meds/834 Cutoff and Processing Schedule 2023-2024 Medi-Cal Managed Care Health Plan MEDS/834 Cutoff and Processing Schedule
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