DHCS APL 26-013: H.R. 1 – Federal Payment to Prohibited Entities – Important Update: End of One–Year Restriction on Federal Payments
| Date: | July 15, 2026 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) |
| To: | Health Plan Providers |
| Type: | Regulatory |
| Subject: | DHCS APL 26-013: H.R. 1 – Federal Payment to Prohibited Entities – Important Update: End of One–Year Restriction on Federal Payments |
| Business: | Medi-Cal Managed Care |
The Department of Health Care Services (DHCS) issued All Plan Letter (APL) 26-013: H.R. 1 – Federal Payment to Prohibited Entities – Important Update: End of One–Year Restriction on Federal Payments, which provides updated guidance to Medi-Cal managed care plans (MCPs) on the handling of payments to Medi-Cal Providers who were impacted by Section 71113 of H.R. 1 between the dates of July 4, 2025, and July 3, 2026. This update is specific to claims or encounters with dates of service (DOS) on or after July 4, 2026.
For claims or encounters with DOS July 4, 2025 through July 3, 2026, please refer to guidance on APL 25-011 and the Provider Alert issued by Health Plan on November 11, 2025.
Payments and Claims/Encounter Processing
Effective July 4, 2026, the one-year restriction on federal payments to “Prohibited Entities” under H.R. 1 Section 71113 is no longer in effect. As such, Medi-Cal providers who meet the definition of “Prohibited Entity,” as described in H.R. 1 Section 71113 can resume submitting claims or encounters for all Medi-Cal covered services rendered to members with DOS on or after July 4, 2026. Health Plan will process and pay these claims or encounters, as appropriate, per the usual claims process.
For complete details regarding APL 26-013, please visit https://www.dhcs.ca.gov/wp-content/uploads/2026/06/APL26-013.pdf
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website www.hpsj-mvhp.org
