ACEs Provider Attestation Data Request Form

In order to receive payment for ACE screenings, eligible Medi-Cal providers must self-attest to completing the certified training. The Department of Health Care Services will release a limited set of provider attestation data to Medi-Cal billing entities using the data for program implementation purposes.

female doctor smiling at young patient

Effective January 1, 2020, eligible Medi-Cal providers began receiving payment for screening children and adults for Adverse Childhood Experiences (ACEs). As of July 1, 2020, eligible Medi-Cal providers must self-attest to completing certified training to continue receiving payment for ACE screenings using the ACEs Provider Attestation Form.

Entities that bill Medi-Cal may now submit a request for the list of providers that have completed the ACEs Aware training and are eligible to bill Medi-Cal. This attestation data should be used for program implementation purposes only, such as confirming that your participating providers have submitted an attestation form and are eligible to bill Medi-Cal. The Department of Health Care Services will release the First Name, Last Name, and National Provider Identifier (NPI) to approved requestors. Please complete the form below.