What types of policy changes does L.A. Care Health Plan issue?

L.A. Care Health Plan regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does L.A. Care Health Plan update its policies?

L.A. Care Health Plan typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many L.A. Care Health Plan policy changes are tracked here?

This page currently tracks 48 documented L.A. Care Health Plan policy changes. New items are added as they are identified.

What should I do when L.A. Care Health Plan changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

L.A. Care Health Plan Policy Changes & Prior Auth Updates

We track 48 documented policy changes from L.A. Care Health Plan across CA. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original L.A. Care Health Plan notice. Use the related links below to narrow results by specialty or state, or sign up for a free daily alert to receive new L.A. Care Health Plan updates automatically.

Medium impact
Encounter Submissions for Medi-Cal Ground Emergency Medical Transportation (GEMT) Services
L.A. Care Health Plan·Effective Jan 1, 2023
L.A. Care Health Plan updated enhanced reimbursement rates for Ground Emergency Medical Transportation (GEMT) services under Medi-Cal, with different add-on amounts for private vs public GEMT providers. The policy requires all GEMT encounters to be submitted correctly and promptly to ensure proper Quality Assurance Fee remittance.
Medium impact
Clinical Care & Patient Experience Initiatives for 2024
L.A. Care Health Plan·Identified Jun 20, 2026
L.A. Care Health Plan has launched comprehensive clinical care and patient experience initiatives for 2024, including member outreach campaigns, preventive care reminders, at-home testing kits, and provider notifications. These initiatives primarily focus on improving preventive care compliance and patient engagement across multiple health conditions including ADHD, diabetes, cancer screenings, and medication management.
Medium impact
Blood Lead Screening Testing Report Posted on Provider Portal
L.A. Care Health Plan·Effective Apr 19, 2024
L.A. Care Health Plan now provides monthly reports via their provider portal listing current Medi-Cal members aged 12-72 months who need blood lead screening tests. Providers are strongly encouraged to follow up with these members to ensure screening compliance.
Low impact
Blood Lead Screening Testing Report Posted on Provider Portal
L.A. Care Health Plan·Effective Apr 19, 2024
L.A. Care Health Plan is now posting monthly Blood Lead Screening Test reports on their Provider Portal identifying Medi-Cal members ages 12-72 months who need blood lead screening tests. Providers are strongly encouraged to follow up with these members to ensure compliance with state requirements.
Medium impact
Important Update - New Contract with Office Ally and Service Restoration Progress
L.A. Care Health Plan·Effective Apr 29, 2024
L.A. Care Health Plan has contracted with Office Ally clearinghouse effective April 29, 2024, allowing providers to submit claims electronically at no cost using Payer ID LACAR. Change Healthcare services are being restored following a cyberattack, with claims submission now available through Optum Intelligent EDI and Relay Exchange.
Medium impact
Behavioral Health Treatment (BHT) – Applied Behavioral Analysis (ABA) Authorization Request Form
L.A. Care Health Plan·Identified Jun 20, 2026
L.A. Care has updated their Behavioral Health Treatment (BHT) Applied Behavioral Analysis (ABA) authorization request form for members under 21. The form requires prior authorization for ABA services including diagnostic evaluations, functional behavioral assessments, and continuity of care services, with specific eligibility criteria and documentation requirements.
Low impact
Health Information Exchange (HIE) Adoption Incentive Program for Skilled Nursing Facilities (SNFs)
L.A. Care Health Plan·Effective Jun 17, 2024
L.A. Care Health Plan is offering a $7,000 incentive program for skilled nursing facilities to adopt Health Information Exchange (HIE) systems through LANES or CMT/PCC platforms. This is an invitation-only program requiring facilities to complete three milestones within 12 months including data sharing agreements and exchanging patient ADT and continuity of care documents.
Low impact
Enterprise Performance Optimization (EPO) Rebrand Email Addresses
L.A. Care Health Plan·Effective May 6, 2024
L.A. Care Health Plan has rebranded their Enterprise Performance Optimization (EPO) department to Compliance Delegation Oversight (DO) and changed their email addresses effective May 6, 2024. All future correspondence must use the new email addresses: Compliance_DOCommunications@lacare.org and Compliance_DOdata&reporting@lacare.org.
Medium impact
Behavioral Health Treatment (BHT) Timely Access Standards
L.A. Care Health Plan·Effective May 14, 2024
L.A. Care Health Plan requires BHT (Behavioral Health Treatment) providers to offer first available appointments within 10 business days of authorization requests for initial services including assessments and Functional Behavior Assessments. Providers must document the first available appointment offered using L.A. Care's specific reporting template.
Medium impact
Skilled Nursing Facility (SNF) Services Agreement Amendment
L.A. Care Health Plan·Effective May 1, 2024
L.A. Care has implemented new rate tiers for Skilled Nursing Facility (SNF) services effective May 1, 2024, with over 100 SNF partners already signed. The insurer is updating systems to capture new rates and has established monthly cutoff dates (15th of each month) to reduce retroactive claims processing.
Low impact
Care Management & Enhanced Care Management -Transitional Care Services
L.A. Care Health Plan·Identified Jun 20, 2026
L.A. Care Health Plan has updated their Care Management, Enhanced Care Management, and Transitional Care Services programs for Direct Network patients. The policy provides contact information and referral processes for coordinating patient care, including post-discharge support within 30 days.
Medium impact
Initial Health Appointment (IHA) for Newly Enrolled Medi-Cal Members
L.A. Care Health Plan·Effective May 21, 2024
L.A. Care Health Plan requires Initial Health Appointments (IHA) for newly enrolled Medi-Cal members to be completed within 120 days of enrollment. Providers must document comprehensive health assessments and use specific billing codes, with monthly reporting available through the Provider Portal to track compliance.
Medium impact
Initial Health Appointment (IHA) for Newly Enrolled Medi-Cal Members
L.A. Care Health Plan·Effective Jan 1, 2024
L.A. Care updated requirements for Initial Health Appointments (IHA) for newly enrolled Medi-Cal members, removing the IHEBA/SHA requirement but maintaining comprehensive physical/mental health assessments within 120 days of enrollment. Providers must use specific billing codes and document all IHA components in medical records.
Medium impact
Important Notice Transportation Communication - Call the Car System Outage
L.A. Care Health Plan·Effective May 22, 2024
L.A. Care's transportation vendor Call the Car experienced a system outage due to potential malware/ransomware on May 22, 2024, causing delays in scheduling non-emergency medical transportation. Providers should limit calls and schedule only within specified advance timeframes to reduce call volume during system recovery.
Medium impact
Annual Acknowledgement and Adherence to L.A. Care Blood Lead Screening Guidelines
L.A. Care Health Plan·Effective May 24, 2024
L.A. Care Health Plan requires Direct Network providers to download quarterly blood lead screening reports, distribute them to contracted providers, ensure proper documentation of screening refusals and anticipatory guidance, and follow up on abnormal results for Medi-Cal children under 6. Providers must complete and return an attestation form by June 7, 2024.
Low impact
Important Notice Update to Transportation Communication - Call the Car System Outage
L.A. Care Health Plan·Effective Jun 5, 2024
L.A. Care Health Plan has resolved the Call the Car transportation system outage that was causing long hold times for scheduling patient transportation reservations. The system returned to normal operations as of June 5, 2024.
Medium impact
Clarification on Submitted Corrected Claims
L.A. Care Health Plan·Identified Jun 20, 2026
L.A. Care Health Plan has clarified requirements for submitting corrected claims, specifying that providers must include the exact L.A. Care claim number (including suffixes like A1) and use specific billing codes and forms. Corrected claims must be submitted within 365 days of initial determination and include all previously billed line items.
Low impact
IMPORTANT - New Address and Phone Number
L.A. Care Health Plan·Effective Sep 1, 2024
L.A. Care Health Plan is relocating offices effective September 1, 2024. The new address is 1200 W. 7th Street, Los Angeles, CA 90017 and the new phone number is (213) 428-5500. Billing teams need to update their contact records to ensure proper communication with the payer.
Medium impact
Important Update - DEI Training Program Requirements for Medi-Cal Providers
L.A. Care Health Plan·Effective Sep 3, 2024
California Medi-Cal providers must complete mandatory Diversity, Equity, and Inclusion (DEI) training through one health plan. Established providers have until end of 2025, while new providers must complete training within 90 days of starting.
Medium impact
Help Your Patients Protect Themselves with The Flu Shot!
L.A. Care Health Plan·Identified Jun 20, 2026
L.A. Care Health Plan is promoting flu and COVID-19 vaccinations for the upcoming flu season, encouraging providers to actively offer vaccines to all patients 6 months and older using the SHARE method. The policy emphasizes that flu shots are free for L.A. Care members and recommends offering vaccines starting in September.
Low impact
Clinical Care & Patient Experience Initiatives for 2024
L.A. Care Health Plan·Identified Jun 20, 2026
L.A. Care Health Plan has launched multiple clinical care and patient experience initiatives for 2024, including medication adherence programs, preventive care outreach campaigns, and member incentives for screenings. These initiatives primarily focus on member outreach and care coordination rather than direct billing changes.
High impact
Direct Network FFS Targeted Rate Increases Unilateral Notification
L.A. Care Health Plan·Effective Jan 1, 2024
L.A. Care is implementing Targeted Rate Increases (TRI) retroactive to January 1, 2024, which will automatically pay the higher of your contracted rate or the new TRI rate for specific CPT codes. For 2024 services, they will make one-time true-up payments by December 31, 2024, and starting January 1, 2025, claims systems will automatically pay the higher rate while discontinuing separate Prop 56 payments.
Medium impact
Targeted Rate Increases (TRI)
L.A. Care Health Plan·Identified Jun 20, 2026
L.A. Care Health Plan has announced targeted rate increases (TRI) for certain services. This policy appears to be specific to L.A. Care members and involves reimbursement rate adjustments, though specific details about which services or the percentage increases are not available in the summary.
Medium impact
How to Access the L.A. Care Health Plan (L.A. Care) New Provider Portal
L.A. Care Health Plan·Identified Jun 20, 2026
L.A. Care Health Plan is launching a new Provider Portal with enhanced features including real-time status tracking for Service Authorization Requests and claims. Providers will need to register through their Provider Portal Administrator or Provider Network Account Manager to access the new system.
Low impact
Health Information Exchange (HIE) Adoption Incentive Program for SNFs
L.A. Care Health Plan·Effective Oct 25, 2024
L.A. Care Health Plan launched a Health Information Exchange (HIE) Adoption Incentive Program offering up to $7,000 for contracted Skilled Nursing Facilities that participate in data sharing frameworks. SNFs must complete three milestones within 12 months including executing data sharing agreements and exchanging patient transfer documents.
Medium impact
Child Health and Disability Prevention Program (CHDP) Transition Provider Training Information
L.A. Care Health Plan·Effective Jul 1, 2024
L.A. Care is transitioning the Child Health and Disability Prevention Program (CHDP) effective July 1, 2024, introducing new provider portals and requiring mandatory training for all providers serving children and youth under 21. Providers must complete training to access the Children's Presumptive Eligibility (CPE) portal and use the Newborn Gateway Presumptive Eligibility (NGPE) portal within 72 hours of birth.
Medium impact
Depression Screening and Follow-Up (DSF) Measure
L.A. Care Health Plan·Effective Jan 23, 2025
L.A. Care Health Plan has issued new requirements for depression screening documentation and billing to improve HEDIS DSF measure compliance. Providers must use specific LOINC codes (44261-6 for PHQ-9, 55758-7 for PHQ-2) when submitting screening data and ensure positive screenings have follow-up within 30 days.
Low impact
REMINDER - Fire Recovery Resources and Support Event -
L.A. Care Health Plan·Effective Feb 23, 2025
L.A. Care is hosting a free Fire Recovery Resources and Support Event on February 23rd, 2025, to help healthcare providers affected by the Palisades and Eaton fires. The event will connect providers with FEMA, SBA, insurance representatives, and other recovery resources.
High impact
Provider Payment Reductions and Billing Guidelines
L.A. Care Health Plan·Effective Feb 20, 2025
L.A. Care Health Plan implements a 1% automatic payment reduction on most claims per state mandate, with specific exemptions for family planning, pediatric sub-acute facilities, and services under the new Targeted Rate Increase (TRI) Fee Schedule. Provider Administered Drugs (PADs) billing requirements have been clarified with specific coverage verification responsibilities for providers.
High impact
Provider Payment Reductions and Billing Guidelines
L.A. Care Health Plan·Identified Jun 20, 2026
L.A. Care Health Plan implemented a 1% automatic payment reduction on claims per state mandate, with exemptions for certain services including family planning and services under the new TRI Fee Schedule. Provider Administered Drugs (PADs) billing requirements changed - they must now be verified against specific drug lists to determine if they should be billed as pharmacy or medical claims.
Medium impact
DHCS Telehealth Modifier Requirements
L.A. Care Health Plan·Effective Sep 30, 2024
DHCS now requires FQHC, RHC, IHS-MOA, and Tribal FQHC providers to include specific telehealth modifiers (93, 95, or GQ) on the informational line of telehealth claims. L.A. Care will remediate previously denied claims back to January 1, 2023.
Low impact
Updates and Improvements to the L.A. Care Online Provider Directory
L.A. Care Health Plan·Identified Jun 20, 2026
L.A. Care Health Plan has updated their online provider directory with improved accuracy, full integration of UCLA locations and Children's Hospital Los Angeles clinics, and new pediatric age restrictions to help identify physicians who accept pediatric members.
High impact
Southern California Fires and Flexibilities to Impacted Providers
L.A. Care Health Plan·Effective Mar 19, 2025
L.A. Care Health Plan has implemented emergency flexibilities for Los Angeles and Ventura County providers affected by wildfires, extending prior authorization durations by 180 days, claims submission timeframes to 365 days, and overpayment dispute periods to 180 days. These measures remain in effect until the state of emergency is lifted.
High impact
Southern California Fires and Flexibilities to Impacted Providers
L.A. Care Health Plan·Effective Mar 19, 2025
L.A. Care Health Plan has implemented emergency flexibilities for providers affected by Southern California wildfires, extending prior authorization durations by 180 days, claims submission timeframes to 365 days, and overpayment dispute periods to 180 days. These measures remain in effect until the state of emergency is lifted.
Medium impact
Maternal Mental Health Screening Requirements
L.A. Care Health Plan·Effective Jan 1, 2025
L.A. Care Health Plan now requires providers to conduct maternal mental health screenings during pregnancy and postpartum periods using validated tools like EPDS or PHQ-9, with specific referral protocols for different risk levels.
Low impact
Medicaid Data Shared with the U.S. Department of Homeland Security and Immigration and Customs Enforcement
L.A. Care Health Plan·Identified Jun 20, 2026
L.A. Care Health Plan notified providers that CMS may have shared Medicaid member data (including names, addresses, SSNs) with ICE on June 13, 2025. This is an informational alert encouraging providers to offer virtual care options and support resources to affected members, but does not change billing procedures or requirements.
Medium impact
L.A. Care Removes the Prior Authorization Requirement for Long Term Care (LTC) Service Codes (An)
L.A. Care Health Plan·Identified Jun 20, 2026
L.A. Care Health Plan has eliminated the prior authorization requirement for Long Term Care (LTC) service codes. This means billing teams can now submit LTC claims directly without obtaining prior approval, streamlining the billing process for these services.
Medium impact
Qtr 4 Direct Network Regional JOM - Central
L.A. Care Health Plan·Effective Oct 14, 2025
L.A. Care Health Plan is requiring all Direct Network providers in the Central region to attend mandatory quarterly Joint Operations Meetings (JOMs) on October 14, 2025. The meeting covers performance metrics, incentive programs, and clinical initiatives, with presentations on closing gaps in care and behavioral health services.
Low impact
Supporting Your Patients Impacted by CalFresh Interruption
L.A. Care Health Plan·Effective Nov 1, 2025
L.A. Care is providing $5.4 million in emergency nutrition support due to federal government shutdown suspending CalFresh benefits. This is informational for providers to help direct patients to food assistance resources.
Medium impact
Provider Responsibilities for Accessibility of Grievance & Appeals Forms Upon Member Request
L.A. Care Health Plan·Effective Dec 19, 2024
L.A. Care is reminding providers that they must have grievance and appeals forms readily available in their offices for members upon request, as required by California regulations. Providers must maintain documented policies supporting member access to these forms and can direct members to online forms or call L.A. Care's Customer Solution Center.
High impact
Modernizing Prior Authorization and Interoperability Requirements Effective 2026–2027
L.A. Care Health Plan·Effective Jan 1, 2026
L.A. Care Health Plan is implementing major prior authorization and interoperability changes in two phases: 2026 requirements include faster PA decision timeframes (7 days standard, 72 hours expedited), enhanced denial transparency, and public reporting of PA metrics. 2027 requirements mandate FHIR-based electronic PA APIs and real-time decision capabilities with 80% automation goals.
Medium impact
2026 Annual Training Initial Health Appointments (IHAs) Presentation
L.A. Care Health Plan·Effective Jan 1, 2026
L.A. Care has released 2026 training requirements for Initial Health Appointments (IHAs) for Medi-Cal members, emphasizing that IHAs must be completed within 120 days of enrollment with specific documentation requirements. The policy includes detailed requirements for pediatric patients including mandatory blood lead screenings and EPSDT compliance.
Medium impact
Let’s Keep Claims Moving – Helpful Billing Reminders
L.A. Care Health Plan·Effective Feb 27, 2026
L.A. Care Health Plan issued billing reminders emphasizing that authorization details must exactly match claim submissions, including provider NPIs, service dates, CPT/HCPCS codes, and quantities. They also highlighted issues with improper data entry in claim form fields that interfere with automated processing.
Medium impact
Clinical Connections 2026
L.A. Care Health Plan·Effective Jan 1, 2026
L.A. Care has updated their Clinical Connections policy to prioritize Provider Portal use for authorization requests and status updates, while designating the UM Call Center (877-431-2273) specifically for clinical discussions and discharge planning. The policy also includes process reminders emphasizing that over 18,000 services are now exempt from authorization and introduces new Recuperative Care services for homeless members.
High impact
Complete Hospital Admission Notification & Authorization Request Submissions
L.A. Care Health Plan·Effective Apr 28, 2026
L.A. Care Health Plan now requires hospitals to submit complete clinical documentation (H&P, ED notes, progress notes, lab results, etc.) along with the admission face sheet for all inpatient authorization requests. Face sheets alone will no longer be processed, and incomplete submissions will cause delays or denials.
High impact
Maternal Mental Health Screening Requirement Update
L.A. Care Health Plan·Effective Jun 2, 2026
L.A. Care Health Plan now requires mandatory maternal mental health screening during pregnancy and postpartum periods under Assembly Bill 1936. Providers must use specific billing codes for depression screening and ensure documented follow-up within 30 days for positive screens.
High impact
Maternal Mental Health Screening Requirement Update
L.A. Care Health Plan·Effective Jun 2, 2026
L.A. Care Health Plan now requires providers to conduct and document maternal mental health screenings during pregnancy and up to 1 year postpartum using validated tools like EPDS or PHQ-9. Positive screens require documented follow-up within 30 days and specific referrals to behavioral health services within 10 days.
High impact
Maternal Mental Health Screening Requirement Update
L.A. Care Health Plan·Effective Jun 2, 2026
L.A. Care Health Plan requires providers to conduct and document maternal mental health screenings during pregnancy and postpartum using validated tools like EPDS or PHQ-9, with specific billing codes for enhanced HEDIS reporting. Positive screens must have documented follow-up within 30 days and appropriate referrals within 10 days.

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Encounter Submissions for Medi-Cal Ground Emergency Medical Transportation (GEMT) Services

Clinical Care & Patient Experience Initiatives for 2024

Blood Lead Screening Testing Report Posted on Provider Portal

Blood Lead Screening Testing Report Posted on Provider Portal

Important Update - New Contract with Office Ally and Service Restoration Progress

Behavioral Health Treatment (BHT) – Applied Behavioral Analysis (ABA) Authorization Request Form

Health Information Exchange (HIE) Adoption Incentive Program for Skilled Nursing Facilities (SNFs)

Enterprise Performance Optimization (EPO) Rebrand Email Addresses

Behavioral Health Treatment (BHT) Timely Access Standards

Skilled Nursing Facility (SNF) Services Agreement Amendment

Care Management & Enhanced Care Management -Transitional Care Services

Initial Health Appointment (IHA) for Newly Enrolled Medi-Cal Members

Initial Health Appointment (IHA) for Newly Enrolled Medi-Cal Members

Important Notice Transportation Communication - Call the Car System Outage

Annual Acknowledgement and Adherence to L.A. Care Blood Lead Screening Guidelines

Important Notice Update to Transportation Communication - Call the Car System Outage

Clarification on Submitted Corrected Claims

IMPORTANT - New Address and Phone Number

Important Update - DEI Training Program Requirements for Medi-Cal Providers

Help Your Patients Protect Themselves with The Flu Shot!

Clinical Care & Patient Experience Initiatives for 2024

Direct Network FFS Targeted Rate Increases Unilateral Notification

Targeted Rate Increases (TRI)

How to Access the L.A. Care Health Plan (L.A. Care) New Provider Portal

Health Information Exchange (HIE) Adoption Incentive Program for SNFs

Child Health and Disability Prevention Program (CHDP) Transition Provider Training Information

Depression Screening and Follow-Up (DSF) Measure

REMINDER - Fire Recovery Resources and Support Event -

Provider Payment Reductions and Billing Guidelines

Provider Payment Reductions and Billing Guidelines

DHCS Telehealth Modifier Requirements

Updates and Improvements to the L.A. Care Online Provider Directory

Southern California Fires and Flexibilities to Impacted Providers

Southern California Fires and Flexibilities to Impacted Providers

Maternal Mental Health Screening Requirements

Medicaid Data Shared with the U.S. Department of Homeland Security and Immigration and Customs Enforcement

L.A. Care Removes the Prior Authorization Requirement for Long Term Care (LTC) Service Codes (An)

Qtr 4 Direct Network Regional JOM - Central

Supporting Your Patients Impacted by CalFresh Interruption

Provider Responsibilities for Accessibility of Grievance & Appeals Forms Upon Member Request

Modernizing Prior Authorization and Interoperability Requirements Effective 2026–2027

2026 Annual Training Initial Health Appointments (IHAs) Presentation

Let’s Keep Claims Moving – Helpful Billing Reminders

Clinical Connections 2026

Complete Hospital Admission Notification & Authorization Request Submissions

Maternal Mental Health Screening Requirement Update

Maternal Mental Health Screening Requirement Update

Maternal Mental Health Screening Requirement Update