Responses to questions about proposed State Plan Amendments and Waivers are developed at the time of submission; subsequent policy changes may impact these responses. Please contact DHCS for updates.
Public Health Emergency Proposals Related to COVID-19
Coverage for COVID-19 tests, counseling-only visits for COVID-19 vaccines for children and adults, counseling-only visits for non-COVID 19 pediatric vaccines, and reimbursement for eligible pharmacies administering COVID-19 tests.
SPA 25-0043: Removal of Sunset Date for Medication-Assisted Treatment (MAT) Services & SPA 25-0044: Alternative Benefit Plan (ABP) Alignment SPA adding school-linked services (SLS)
Proposed change to the Department of Health Care Services’ (DHCS) Medi-Cal Program that will be submitted to the Centers for Medicare and Medicaid Services (CMS).
Eliminates the “four walls” limitation for IHS-MOA providers and make a technical correction to update psychological assistants associates align with recent state law changes
Expands the continuum of community-based services and evidence-based practices available through the Medi-Cal specialty behavioral health delivery systems
Changes to the Rehabilitative Mental Health Services, Targeted Case Management, Substance Use Disorder Treatment Services, Expanded Substance Use Disorder Treatment Services, and Medication-Assisted Treatment Clinical Trainee provider type definition
Updating the Alternative Benefit Plan (ABP) to add Psychiatric Residential Treatment Facilities (PRTFs) as settings where inpatient psychiatric services can be provided to Medi-Cal members under 21 years of age
Continuation of the Public Provider Ground Emergency Medical Transportation Intergovernmental Transfer (PP-GEMT IGT) program in Calendar Year (CY) 2024
Doula services, associate marriage and family therapists (AMFTs) and associate clinical social workers (ACSWs) as covered services/benefits under the Alternative Benefit Plan (ABP)
Adds community health worker (CHW) services, asthma preventive services, and routine patient costs associated with participation in qualifying clinical trials as Medi-Cal covered benefits in the Alternative Benefit Plan (ABP)
Expansion of the definition of a health care “visit” at Federally Qualified Health Centers (FQHC), Rural Health Clinics (RHC), and Tribal Health Programs (THP)
The effective date of this SPA has been changed to “one day after the COVID-19 Public Health Emergency (PHE) ends.” Please note that the PHE is currently scheduled to end on April 16, 2022.
Termination of all active SPAs associated with the Health Homes Program (HHP) and transition HHP enrollees to the Enhanced Care Management (ECM) benefit
Clarifies Reimbursement Policies for Federally Qualified Health Center (FQHC) and Rural Health Clinics (RHC), and Adds Marriage and Family Therapists as a New FQHC/RHC Billable Provider
