This webpage provides answers to common questions regarding the Medi-Cal traditional health care practices benefit. If you are unable to find the answer to your question below, please contact traditionalhealing@dhcs.ca.gov.
The table below is a list of common acronyms/abbreviations used throughout the FAQ.
AIR | All-Inclusive Rate |
AI/AN | American Indian/Alaska Native |
AOD | Alcohol and Other Drug |
ASAM | American Society of Addiction Medicine |
BHIN | Behavioral Health Information Notice |
CMS | Centers for Medicare and Medicaid Services |
DHCS | Department of Health Care Services |
DMC | Drug Medi-Cal |
DMC-ODS | Drug Medi-Cal Organized Delivery System |
EBPs | Evidence-based practices |
IHS | Indian Health Service |
IHCP | Indian Health Care Provider (note: this term refers to the programs, not the individual health care practitioners) |
MAT | Medications for Addiction Treatment (also known as medication-assisted treatment) |
THCP | Traditional Health Care Practices |
STC | Special Terms and Conditions |
SUD | Substance Use Disorder |
How do IHCPs become eligible to provide, and receive payment for, Traditional Healer and Natural Helper services to Medi-Cal members?
In order for an IHCP to start providing and receiving payment for the provision of Traditional Healer and Natural Helper services to eligible Medi-Cal members, IHCPs must be enrolled as a Medi-Cal provider; submit an opt-in package to DHCS; and receive an approval letter.
Once an IHCP submits an opt-in package, DHCS will review and provide approval no earlier than 10 business days after submission. After DHCS approves the IHCP's opt-in package, the IHCP must share a copy of the opt-in package and the approval letter with the DMC-ODS counties in which they plan to provide services. This county notification is for informational purposes only; DHCS is solely responsible for approving each IHCP opt-in package. DHCS will provide the IHCP with the appropriate county contact information. DMC-ODS County Contacts are also posted on the on the Traditional Health Care Practices webpage.
IHCPs may submit claims to the county for services retroactive to the date the opt-in package was submitted to DHCS as long as DHCS approves the package.
How will a DMC-ODS county know when an IHCP is approved to bill for Traditional Healer and Natural Helper services?
DHCS will post and regularly update a list of opt-in IHCPs on the Traditional Health Care Practices webpage. The list will include each IHCP's effective date for claims submission. The IHCP must also share a copy of the approved opt-in package and DHCS approval letter with the DMC-ODS counties in which they plan to provide services.
DMC-ODS counties should communicate directly with IHCPs and may also, if needed, contact their DHCS liaison with questions about an IHCP's opt-in status.
How can IHCPs find contact information for DMC-ODS counties?
DHCS has DMC-ODS contact information for dedicated traditional health care practices points of contact available upon request. IHCPs are encouraged to coordinate with counties, including establishing payment mechanisms, as soon as possible if they are considering opting inor have submitted an opt-in package.
Do IHCPs need to contract with a DMC-ODS county to provide traditional health care services?
IHCPs providing traditional health care practices to only American Indian/Alaska Native (AI/AN) members are not required to contract with DMC-ODS counties to receive payment, consistent with federal law and existing Medi-Cal policy (see U.S. Code, title 25, Section 1647a, Code of Federal Regulations, title 42, section 438.14438.14(b)(4), and BHIN 22-053).
IHCPs are required to hold a contract with DMC-ODS counties to receive payment for the provision of traditional health care practices to non-AI/AN members.
Do IHCPs need to coordinate billing for traditional health care practices directly with the counties?
DMC-ODS counties are responsible for paying IHCPs for delivery of traditional health care practices. To support coordination, IHCPs must share a copy of their opt-in package and DHCS approval letter with relevant DMC-ODS Counties and coordinate with them directly to establish billing and payment processes, regardless of whether the IHCP enters into a network provider contract with the county.
Through the DMC-ODS Regional Model, Humboldt, Lassen, Mendocino, Modoc, Shasta, Siskiyou, and Solano counties delegate DMC-ODS administrator responsibilities, including billing and payment, to Partnership Healthplan (PHP). In these instances, PHP will administer the claims, but payments to IHCPs are still the responsibility of each county. For counties where PHP serves as the delegated administrator for DMC-ODS, the IHCP should share the opt-in package and DHCS approval letter with both the DMC-ODS county and PHP and work with both entities as needed to establish coordination around billing and payment. DMC-ODS County Points of Contact, posted on the on the Traditional Health Care Practices webpage, can assist IHCPs in coordinating and addressing billing and payment inquiries.
Are DMC-ODS counties required to have a certain number of IHCPs providing traditional health care practices in their County?
While counties are not required to have a certain number of IHCPs providing traditional health care practices, counties are required to demonstrate there are sufficient IHCPs participating in the provider network to ensure timely access to services for eligible American Indian/Alaska Native (AI/AN) members as outlined in Code of Federal Regulations, section 438.14 and BHIN 25-013. Additionally, DMC-ODS counties are required to coordinate access to traditional health care practices for members in their county who meet eligibility criteria, consistent with Code of Federal Regulations, section 438.14; BHIN 22-053; and BHIN 25-036.
Reminder: IHCPs are not required to contract with counties to be paid for covered services delivered to eligible AI/AN members.
Can members receive traditional health care practices from IHCPs outside the DMC-ODS County they are enrolled in, such as a neighboring county?
Consistent with BHIN 22-053, American Indian/Alaska Native (AI/AN) members that are eligible to receive traditional health care practices per BHIN 25-036 may receive services from any IHCP approved to provide them, regardless of whether the IHCP has a contract with the county the member is enrolled in. DMC-ODS counties are not obligated to pay for services provided to non-AI/AN members by IHCPs that are not contracted with the county. DMC-ODS counties may choose to contract with IHCPs for the care of non-AI/AN members.
IHCPs should bill the DMC-ODS County that the member receiving services is enrolled in, regardless of where the IHCP is located. Prior to delivering services, providers should verify which county is responsible for payment of a member's care, as outlined in BHIN 24-008.
Is there a complete list of the Traditional Healer and Natural Helper practices covered by Medi-Cal?
DHCS recognizes that traditional health care practices encompass a wide variety of culturally appropriate health care practices and does not define specific covered services. Individual Indian Health Care Providers (IHCPs) may identify and offer a variety of culturally specific practices, as determined by the IHCP. The below descriptions in DHCS guidance are not intended to be exhaustive.
Traditional Healer services may use an array of interventions including music therapy (such as traditional music and songs, dancing, drumming), spirituality (such as ceremonies, rituals, herbal remedies) and other integrative approaches.
Natural Helper services may assist with navigational support, psychosocial skill building, self-management, and trauma support to individuals that restore the health of eligible Medi-Cal members.
Note that the Special Terms and Conditions (STCs), section 13.3(c), lists services and activities that are not covered.
Are traditional health care practices available to members under 21?
Traditional health care practices are covered for Medi-Cal members regardless of age who are 1) enrolled in Medi-Cal or CHIP in a DMC-ODS county; 2) receive services delivered by or through a participating Indian Health Care Provider (IHCP); and 3) meet DMC-ODS access criteria (detailed in BHIN 24-001).
Are traditional health care practices subject to federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements?
No. Federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) statutes and regulations apply to services coverable under Section 1905(a) of the Social Security Act. Since traditional health care practices are authorized under the 1115 CalAIM Waiver and not under Section 1905(a), the EPSDT mandate is not applicable. Members under the age of 21 must be enrolled in Medi-Cal or CHIP in a DMC-ODS county in order to be eligible for the traditional health care practices benefit at this time.
Will DHCS expand traditional health care practices to other delivery systems beyond the Drug Medi-Cal Organized Delivery System (DMC-ODS)?
Since 2015, when initial planning conversations for DMC-ODS began, DHCS worked closely with Tribal and Urban Indian health partners to develop and advance a proposal to cover Traditional Healer and Natural Helper services as a culturally responsive option for substance use disorder (SUD) treatment within DMC-ODS. Over the ensuing decade, DHCS collaborated with Tribes and Tribal partners to develop the proposed service, explore Indian Health Program ODS models, and request authorization from the federal government for Traditional Healer and Natural Helper services coverage under DMC-ODS. This work represents the collective acknowledgment that these services are vital to meeting the health and cultural needs of American Indian/Alaska Natives; facilitating access to care; and reducing the disparities in overdose deaths in Tribal communities.
At this time, coverage of traditional health care practices is limited to Medi-Cal/CHIP members who are seeking care for substance use and enrolled in Medi-Cal/CHIP in DMC-ODS counties. The 1115 waiver approval and Special Terms and Conditions permit DHCS to expand traditional health care practices to other delivery systems. This would require state budget action and additional financial resources; Medi-Cal coverage for traditional health care practices is not limited to members whose care is covered entirely by federal funds, so state funds must be authorized.
Due to expressed interest in expansion from Tribal partners, DHCS plans to engage with Tribes, Tribal partners, county behavioral health plans, managed care plans, and other stakeholders, as appropriate, regarding expansion to other delivery systems. Any expansion would follow CMS notification requirements, public notice, and Tribal consultation processes. DHCS will continue to communicate about opportunities for further engagement.
Which providers/practitioners can deliver services under this benefit?
Traditional health care practices are covered as a Medi-Cal benefit only when delivered by Traditional Healers and Natural Helpers employed or contracted by participating Indian Health Care Providers (IHCPs). The broad definitions for each were developed in partnership with Tribes and Tribal partners as a framework for reference and to encourage a shared understanding among IHCPs and DMC-ODS counties:
A Traditional Healer is a person currently recognized as a spiritual leader in good standing with a Native American Tribe, Nation, Band, Rancheria, or a Native community, and with two years of experience as a recognized Native American spiritual leader practicing in a setting recognized by a Native American Tribe, Nation, Band, Rancheria, or a Native community who is contracted or employed by the IHCP. A Traditional Healer is a person with knowledge, skills and practices based on the theories, beliefs, and experiences which are accepted by that Indian community as handed down through the generations and which can be established through the collective knowledge of the elders of that Indian community.
A Natural Helper is a health advisor contracted or employed by the IHCP who seeks to deliver health, recovery, and social supports in the context of Tribal cultures. A Natural Helper could be a spiritual leader, elected official, paraprofessional or other individual who is a trusted member of a Native American Tribe, Nation, Band, Rancheria, or Native community.
Does DHCS require Traditional Healers and Natural Helpers be crededntialed by the county or have certain qualifications, such as licensure or certification?
No. Traditional Healers or Natural Helpers are not required to be licensed or certified. Traditional Healers and Natural Helpers are not subject to DMC-ODS county provider credentialing requirements outlined in MHSUDS 18-019.
Participating IHCPs are required to establish methods for determining whether 1) employees or contractors are qualified to provide traditional health care practices; and 2) have the necessary experience and appropriate training. IHCPs must include their policies and procedures for developing, reviewing, and approving practitioner qualifications as part of their opt-in package submission to DHCS. DHCS is coordinating with Tribal partners to provide technical assistance for IHCPs on documenting practitioner qualifications.
Do Indian Health Care Providers (IHCPs) need to be Drug Medi-Cal (DMC) and/or Alcohol and Other Drug (AOD) certified?
IHCPs that provide traditional health care practices are required to enroll as Medi-Cal providers. If the IHCP is providing DMC-ODS services beyond traditional health care practices, it must also become Drug Medi-Cal (DMC) certified to deliver and receive payment for other, covered DMC-ODS services.
Only traditional health care practices (and no other DMC-ODS services) | Not required |
Traditional health care practices and other DMC-ODS services | Required
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See BHIN 24-001 and BHIN 25-036 for further details on DMC certification requirements.
Consistent with federal law, IHCPs enrolled as Medi-Cal providers are not required to obtain DHCS' certification for Alcohol and Other Drug (AOD) programs if they meet all applicable standards.
How do I know if my organization is an Indian Health Care Provider (IHCP) that is eligible to participate in the traditional health care practices benefit?
Consistent with BHIN 25-036, CMS' Special Terms and Conditions, and the Code of Federal Regulations, title 42, section 438.14, traditional health care practices are covered when received through IHCPs, which include Indian Health Service (IHS) facilities, facilities operated by Tribes or Tribal organizations (Tribal Facilities) under the Indian Self-Determination and Education Assistance Act, and facilities operated by urban Indian organizations (UIO facilities) under Title V of the Indian Health Care Improvement Act.
Organizations that do not fall under the definition of IHCPs may enter into contracts with participating IHCPs to provide traditional health care practices, and are encouraged to engage with DHCS' Technical Assistance partners. Interested organizations may email traditionalhealing@dhcs.ca.gov or visit the TA portal to request additional support.
What are DHCS' criteria for approving or denying opt-in packages?
DHCS will approve opt-in packages that are complete and are aligned with BHIN 25-036 and relevant DMC-ODS policy requirements. DMC-ODS counties do not play a role in reviewing or approving opt-in packages.
An opt-in package is considered “complete" if all fields of the opt-in package are answered and appropriate materials are submitted. A package may be deemed complete if policies and procedures are submitted as draft. In this case, the Indian Health Care Provider (IHCP) will submit an explanation of the steps to finalize the P&Ps with projected date of completion.
An opt-in package will be approved no sooner than 10 business days after the date of submission if the package is complete and addresses all requirements.
If the opt-in package is deemed “incomplete," or does not address all requirements, DHCS will provide the IHCP with feedback to clarify how the opt-in materials must be revised and continue to work with the IHCP to achieve approval.
What is the process for an IHCP to submit and receive approval for alternate Evidence Based Practices (EBPs)?
For IHCPs providing only traditional health care practices (and no other DMC-ODS services): If an EBP(s) does not exist for the population(s) of focus and types of problems or disorders being addressed, the IHCP may notify DHCS that it intends to rely on complementary practices (such as culturally adapted practices, Community Defined Evidence Practices, and/or culturally promising practices). The submitted policies and procedures should reflect how the complementary practices have been shown to be effective for the population(s) of focus.
For IHCPs also offering other DMC-ODS services: IHCPs are required to implement at least two of the EBPs listed in BHIN 25-036.
What resources are available for IHCPs if they have questions about the opt-in process?
DHCS is coordinating with Tribal TA partners Kauffman and Associates, the California Consortium for Urban Indian Health (CCUIH) and the California Rural Indian Health Board (CRIHB) to provide technical assistance for IHCPs. TA resources are available on the Traditional Health Care practices webpage. Please email traditionalhealing@dhcs.ca.gov or visit the TA portal to request additional support.
How quickly will DHCS respond to IHCPs regarding their opt-in package submissions?
Average response and approval time will differ based upon volume of opt-in packages received. The Department aims to provide approval within 30 business days (and likely no earlier than 10 business days). DHCS is committed to reviewing as promptly as possible and will communicate with IHCPs if any further information or materials are needed.
What should Policies and Procedures (P&Ps) include to be approved by DHCS?
IHCPs should develop and submit P&Ps that account for all requirements outlined in BHIN 25-036 and Enclosure 1 of BHIN 25-036 and that are specific to the IHCP's organizational structure, resources, and community. IHCP P&P submissions should reflect how their individual organization will implement and meet these requirements and will be unique to each IHCP. In other words, re-stating the DHCS policy is not sufficient; the IHCP must describe its approach to implementing the policies and coordinating care for Medi-Cal members. IHCPs may submit draft P&Ps, as long as the IHCP includes an explanation of steps the IHCP must take to finalize them, along with the date the IHCP will submit the final materials.
The availability of Medi-Cal funds for traditional health care practices is contingent on IHCP's comprehensive implementation of these P&Ps and the requirements included in BHIN 25-036 and the CMS Special Terms and Conditions. For support with opt-in package and P&P development, IHCPs are encouraged to reach out to traditionalhealing@dhcs.ca.gov or visit the TA portal to request additional support.
What is the billing and claiming process for the delivery of Traditional Healer and Natural Helper services?
Step 1: IHCP and DMC-ODC County coordinate to develop billing processes, including:
A process for ensuring that IHCP bills submitted to DMC-ODS counties include all information the county needs to submit compliant claims to DHCS (see FAQ on this page with the list of items required to be included on claims for Traditional Healer and Natural Helper services).
A process for the county to accept bills from non-contracted (out-of-network) IHCPs. This may include an out-of-network payment agreement or other formal payment mechanism between the IHCP and County (note: Counties cannot require non-contracted IHCPs to submit bills or other data through a specified electronic health record).
Acknowledgement of the date to which IHCPs can retroactively bill for delivery of traditional health care practices, following DHCS approval of the IHCP's opt-in package.
Step 2: IHCP bills member's DMC-ODS County. The IHCPs must bill the member's DMC-ODS County of responsibility, as outlined in BHIN 24-008, following delivery of a Traditional Healer or Natural Helper service.
Step 3: DMC-ODS County submits a claim to DHCS. Once the DMC-ODS County receives the bill from the IHCP, it must submit a claim to DHCS.
When Traditional Healer and Natural Helper services are provided by an IHCP that is eligible to receive the All-Inclusive Rate (AIR), the DMC-ODS County shall claim payment at the AIR. The claim should include the taxonomy code and an NPI for the AIR-eligible practitioner (as well as the IHCP facility NPI).
For non-AIR eligible Traditional Healer and Natural Helper services, taxonomy codes and practitioner NPIs are not required. See rates for non-AIR eligible services in the Medi-Cal Behavioral Health Fee Schedule.
See BHIN 25-036 for complete THCP billing guidance.
Step 4A: DMC-ODS County pays IHCP. DMC-ODS Counties must provide payment to IHCPs that provide traditional health care practices to Medi-Cal members in a timely and expeditious manner retroactive to the date noted in the IHCP's approval letter. In accordance with federal and state laws, DMC-ODS Counties must pay IHCPs for the delivery of traditional health care practices to American Indian/Alaska Native members regardless of whether the IHCP holds a contract with the county.
Step 4B: DHCS processes claims and pays the DMC-ODS county.
Who is responsible for paying for Traditional Healer and Natural Helper services?
Consistent with federal law and BHIN 22-053, DMC-ODS Counties must pay approved IHCPs for qualifying THCP services, even if they are out-of-network.
Specifically, for out-of-network IHCPs, DMC-ODS Counties must provide payment if traditional health care practices were provided to an American Indian/Alaska Native Medi-Cal member who meets all other eligibility requirements outlined in BHIN 25-036.
What information must be included on THCP claims submitted to DHCS by DMC-ODS Counties?
Member CIN (Client Index Number)
Member date of birth
Member sex
Procedure code (H0051 for Traditional Healer and T1016 for Natural Helper)
Date of service
Number of units
Place of service (note: traditional health care practices are allowed across all places of service)
Billing amount
IHCP NPI
For Encounters Eligible for the All-Inclusive Rate only: Rendering provider NPI and taxonomy code (see BHIN 25-036 for information on AIR eligibility)
Bills submitted by the IHCP shall include all information needed for DMC-ODS Counties to submit a complete claim to DHCS.
Should specific taxonomy codes be used when billing for Traditional Healer and Natural Helper services?
In order to receive payment at the All-Inclusive Rate (AIR), claims for services provided by Traditional Healers and Natural Helpers eligible to bill at the AIR should include the appropriate taxonomy code (see list of eligible health professionals in Supplement 6 Attachment 4.19-B of the State Plan).
Claims for services provided by non-AIR eligible Traditional Healer and Natural Helper do not require specific taxonomy codes be included for rendering providers in order to receive payment; rates for non-AIR eligible services are listed on the Fee Schedule (see 2025-2026 DMC-ODS Traditional Health Care Practices Fee Schedule).
The DHCS MedCCC library contains further guidance on billing and claiming for traditional health care practices in the DMC-ODS Services Tables.
Are IHCPs required to include NPIs for Traditional Healers and Natural Helpers when billing Counties for traditional health care services?
NPIs must be included for Traditional Healers/Natural Helpers who are AIR-Eligible practitioners when an IHCP seeks payment at the All Inclusive-Rate (AIR). The practitioner's NPI is required for the claim to be paid at the AIR. The AIR-eligible practitioner must be enrolled in Medi-Cal as an Ordering, Referring, and Prescribing (ORP) provider via the PAVE system.
Practitioner NPIs do not need to be provided on bills if the IHCP is not seeking payment at the AIR.
When can IHCPs begin billing for traditional health care practices?
IHCPs that meet all requirements to provide traditional health care practices may submit bills to DMC-ODS counties back to the date their complete opt-in package was submitted to DHCS, as long as DHCS approves the package. Counties must submit claims to DHCS within 12 months of the month of services (per W&I Code, Section 14021.6(g)). IHCPs and counties should coordinate to ensure counties are able to submit timely and complete claims.
How can IHCPs receive payment for Traditional Healer and Natural Helper services?
Approved IHCPs must submit bills to the DMC-ODS county in which the member is enrolled in Medi-Cal or CHIP, consistent with BHIN 24-008. IHCPs should communicate directly with the county's point of contact for traditional health care practices to establish processes for claiming and payment.
DMC-ODS counties must pay participating IHCPs delivering Traditional Healer and Natural Helper services consistent with the methodologies established by the state as outlined in BHIN 25-036 and any applicable federal and state policies described in BHIN 22-053.
What are the rates for traditional health care practices?
When Traditional healer and Natural helper services are provided by an IHCP that is eligible to receive the All-Inclusive Rate (AIR) and by a practitioner listed in California's Medicaid State Plan, the DMC-ODS county shall claim and provide payment to the IHCP at the AIR, consistent with BHIN 22-053 and CMS' Special Terms and Conditions. For State Fiscal Year (SFY) 2025-2026, rates for Traditional Healer and Natural Helper services eligible for the AIR are $801.00. For services not eligible for the AIR, rates depend on the Indian Health Care Provider's (IHCP's) contract status with the DMC-ODS county. See table below for more detail.
IHCPs with a DMC-ODS County contract | AI/AN | Rates are determined based on negotiation between IHCP and DMC-ODS county. |
IHCPs with a DMC-ODS County contract | Non-AI/AN | Rates are determined based on negotiation between IHCP and DMC-ODS county. |
IHCPs without a DMC-ODS County contract | AI/AN | The rates the IHCP receives are not subject to negotiation. DMC-ODS counties must pay at the rate established by DHCS via the DMC-ODS fee schedule.
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IHCPs without a DMC-ODS County contract | Non-AI/AN | DMC-ODS selective contracting policy applies. Counties are generally not obligated to pay IHCPs for services provided to non-AI/AN members if they do not have a contract with the IHCP. |
The Traditional Healer and Natural Helper rates that DMC-ODS counties may claim for services not eligible for the AIR are posted under the Drug Medi-Cal Organized Delivery System section of the Medi-Cal Behavioral Health Fee Schedules page.
For SFY 2025-2026, these rates are:
How should group services be claimed?
For both AIR-eligible and non-AIR eligible services, claims should use HCPCS H0051 for Traditional Healer services and HCPCS T1016 for Natural Helper services. When providing Traditional Healer or Natural Helper services in a group setting, claims must contain the modifier HQ to distinguish group visits.
For Traditional Healers or Natural Helpers providing a group service, the provider and county shall claim for one member in the group either at one AIR (when applicable) or one DMC-ODS fee schedule encounter rate. While this policy differs from the group claiming requirements for other DMC-ODS services, it aligns with the group billing guidance that is used for non-specialty mental health services.
Medi-Cal will cover up to one Traditional Healer and one Natural Helper service per member per day. However, a member may receive both group and individual services in a day. For example, a member can receive an individual service from a Traditional Healer in the morning and then join a group service with a Traditional Healer later in the afternoon. In this scenario, the IHCP and DMC-ODS county would claim for the individual service provided to the member in the morning. For the group service in the afternoon, the claim should identify a different member of the group who did not receive an individual Traditional Healer service that day.
For group billing of Traditional Healer/Natural Helper services, is there an “upper limit" on group sizes?
No. Group services for Traditional Healer and/or Natural Helper services are not subject to “upper limits" on group sizes. Detailed guidance on billing for group services is outlined in BHIN 25-036, Section IV. Claiming and Payment.
Can Traditional Healer and/or Natural Helper group services include non-Medi-Cal enrolled participants?
Yes. Group services provided by Traditional Healers and/or Natural Helpers can include non-Medi-Cal members, as long as there is a Medi-Cal member in attendance that the IHCP and county can claim.
Can residential facilities provide traditional health care practices?
Traditional Healer and/or Natural Helper services may be delivered as part of a Medi-Cal covered treatment program in an IHCP that provides residential SUD treatment and receives a daily rate for residential treatment services. The daily rate can support programs in offering an array of therapeutic and educational interventions. To further support access to traditional health care practices, additional Traditional Healer and/or Natural Helper services may be billed and claimed on top of the residential daily rate as supplemental services in residential IHCPs. Residential providers may bill DMC-ODS counties for traditional health care practices, at the rates outlined in BHIN 25-036, for up to twelve (12) supplemental Traditional Healer and/or Natural Helper services per calendar month. Supplemental Traditional Healer or Natural Helper services may exceed twelve visits per month when medically necessary for the member. See BHIN 25-036 for detailed coverage, payment and service limitations policy guidance.
How many qualifying Traditional Healer/Natural Helper visits per day can be billed at the All-Inclusive Rate (AIR)?
Consistent with Supplement 6 Attachment 4.19-B to California's State Plan, Traditional Healer and Natural Helper services qualify as ambulatory services.
Traditional Healer or Natural Helper visits that qualify for the AIR at IHS/Tribal 638 facilities can count as the one ambulatory visit allowable per day that can be paid at the AIR (IHS/Tribal 638 facilities can bill 3 visits at the AIR per day, one medical, one ambulatory, and one mental health).
Tribal FQHCs may be reimbursed for up to three visits per day, per recipient, in any combination of medical, mental health, dental and/or ambulatory services (see further guidance in DHCS Provider Manual: Tribal FQHCs). Tribal FQHCs with an AIR-eligible Traditional Healer and an AIR-eligible Natural Helper may be eligible to provide up to 3 billable ambulatory services provided the services are for distinct reasons.
What is the timeframe for IHCPs to receive payment from DMC-ODS counties for traditional health care practices?
DHCS expects that DMC-ODS Counties pay IHCPs in a timely and expeditious manner, regardless of contract status. DMC-ODS County Points of Contact can assist IHCPs in addressing billing and payment inquiries. These contacts are posted on the on the Traditional Health Care Practices webpage (see BHIN 25-036 for detailed guidance regarding claiming and payment for traditional health care practices).
Can traditional health care practices be provided outside of a clinical setting?
Yes. Traditional health care practices services, like other DMC-ODS services, may be provided in field-based locations (as long as the rendering Indian Health care Provider (IHCP) meets all relevant requirements). Traditional health care practices are not considered “clinic services" and do not fall under the “four walls" rule (see Section 1905(a)(9) of the Act, Code of Federal Regulations, title 42, section 440.90, and 1115 CalAIM amendment approval letter).
Are traditional health care practices available via telehealth?
Yes, traditional health care practices delivered via telehealth are covered under DMC-ODS consistent with BHIN 23-018.
What are the documentation requirements for traditional health care services?
IHCPs are required to follow the progress note and problem list documentation requirements Sections (c) and (d) of BHIN 23-068. Individual Traditional Healer/Natural Helper practitioners are not solely responsible for developing or maintaining the member's clinical records. Other licensed or non-licensed practitioners may document on behalf of the Traditional Healer or Natural Helper, as needed.
Will DHCS or DMC-ODS counties provide oversight of IHCPs providing traditional health care services?
DHCS worked in consultation with Tribal partners to ensure the department's approach to oversight and monitoring is appropriate and clearly laid out in policy (see BHIN 25-036 for detailed guidance). IHCPs will be monitored to ensure compliance with the requirements specified in BHIN 25-036 and the DHCS-approved "opt-in package."
For IHCPs contracted with a DMC-ODS county, standard DHCS policy for county oversight of contracted providers applies, as outlined in BHIN 24-001. Counties are responsible for oversight and monitoring which can include compliance with basic program integrity requirements (for example, compliant claiming and service documentation) and other requirements outlined in the BHIN.
For IHCPs that do not have a contract with a DMC-ODS county, DHCS is responsible for ongoing oversight and monitoring. This will involve adherence to policies in the BHIN and opt-in package submission. DHCS may issue Corrective Action Plans to IHCPs found out of compliance.
Neither DHCS nor DMC-ODS counties may determine whether a traditional health care practice is culturally or clinically appropriate for an individual Medi-Cal member. This is an individualized determination made by the Traditional Healer or Natural Helper with oversight from the IHCP.
