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 MMCD All Plan & Policy Letters - Subject Listing

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Note: Please check back periodically as new letters are added. Policy Letters are preceded by 'PL'.  Policy Letters were not issued from 2003 - 2006.

 

Abortion Services

Acquired Immune Deficiency Syndrome/Acquired Immunodeficiency Virus AIDS/HIV

  • Medi-Cal HIV/AIDS Home and Community Based Services Waiver Program 02-001 (PDF)
  • Medi-Cal Managed Care Health Plan Capitated and Non-Capitated Human Immunodeficiency Virus/Acquired Immunie Deficiency Syndrom (HIV/AIDS) and Antipsychotic Drugs  03-004 (PDF - 4.9MB)

Advanced Directives

Aged-Senior Services

  • Concurrent Participation in the Medi-Cal Managed Care Program and the Multipurpose Senior Services Program  99-013 (PDF)

Aid Codes

Amendments

  • Draft 2000 Medi-Cal Managed Care Contract Amendments Package 00-01 00-010 (PDF)
  • Draft 1999 Medi-Cal Managed Care Contract Amendments 99-009 (PDF)
  • Invitation to All Plan Meeting on Year 2000 Proposed Contract Amendments 00-005 (PDF)

Audits

  • Corrective Action Plan (CAP) Standardized Format (Supersededs PL 92-20) PL 01-001 (PDF)
  • External Accountability Set (EAS) Performance Measure Audits 02-008 (PDF)

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Banking

Beneficiary Notices

  • Conlan v. Bonta; Conlan v. Shewry: Court Ordered Medi-Cal Beneficiary Reimbursement Process  07-002 (PDF - 5.5MB)

Billing

  • Medi-Cal Billing Restriction on the Use of Social Security Numbers  07-020 (PDF)
  • Payment of Invoices Beyond the Six-Month Billing Limit  PL 08-002 (PDF)

Breast and Cervical Cancer Treatment

  • Breast and Cervical Cancer Treatment Program  01-008 (PDF)

Breastfeeding

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CAHPS Survey

  • Quality and Performance Improvement Requirements for 2007  06-010 (PDF)

Children's Services

  • Blood Lead Screening of Young Children  PL 02-001 (PDF)
  • California Children’s Services (CCS) Policy Regarding the Requirement That All CCS Applicants Shall Make Application to the Medi-Cal Program (Health and Safety Code Section 123995)  00-004 (PDF)
  • California Children Services Numbered Letters 01-0298 and 09-0598  98-006 (PDF)

Capitation

  • Medi-Cal Managed Care Capitation Report  09-003 (PDF)
  • Recovery of Capitation Paid to Health Care Plans for Deceased Beneficiaries  04-002 (PDF - 4.1MB)
  • Same Day Banking  06-011 (PDF)
  • Workers’ Compensation (WC)- Notice Award of New Workers’ Compensation Recovery Program (WCRP) Contractor; Reporting and Other Requirements  04-004 (PDF - 4.9MB)

 

Clinical Laboratories Improvements Amendments of 1988 (CLIA)

  • Ensuring Beneficiaries Receive Laboratory Services From CLIA Certified Laboratories 00-011 (PDF)

Community Advisory Committee

Conlan Court Decisions

  • Conlan v. Bonta; Conlan v. Shewry: Court Ordered Medi-Cal Beneficiary Reimbursement Process  07-002 (PDF - 5.5MB)

Contraceptive Devices

Corrective Action Plan (CAP)

Credentialing

  • Credentialing & Re-Credentialing: Time Line Change, New Primary Source Verification Requirements and Verification of Credentials of Non-Physician Practitioners  PL 02-003 (PDF)

Cultural and Linguistics

  • Community Advisory Committee (CAC)  PL 99-001 (PDF)
  • Cultural Competency in Health Care - Meeting the Needs of a Culturally and Linguistically Diverse Population   99-005 (PDF)
  • Cultural and Linguistic Contractual Requirements: Threshold and Concentration Standard Languages Update   02-003 (PDF)
  • Health Education and Cultural and Linguistic Group Needs Assessment  PL 99-002 (PDF)
  • Linguistic Services  PL 99-003 (PDF - 8.4MB)
  • Translation of Written Informing Materials  PL 99-004 (PDF)

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Data

Dental

DFMC - Delmarva Foundation for Medical Care Inc.

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Early and Periodic Screening Diagnosis and Treatment Services

Eligibility

Emergency Services (ER Care)

  • Emergency Services Medical Claim Coding and Documentation Guidelines  02-005 (PDF)
  • Emergency Services Claims  99-015 (PDF)
  • Non-Contracted Emergency Room Rate Schedule  03-013 (PDF)

Enrollments and Disenrollments

  • 2008-2009 Managed Care Plan MEDS/FAME/834+Supplemental Cutoff and Processing Schedule  07-019 (PDF)
  • 2007-2008 Managed Care Plan MEDS/FAME Cutoff and Processing Schedule  06-012 (PDF)
  • Amended Regulations for Enrollment and Disenrollment for Two-Plan Model Plans  00-013 (PDF)
  • Change of Children in Percent of Poverty Aid Categories to Mandatory Enrollment for Medi-Cal Managed Care  PL 00-003 (PDF)
  • Default Assignment for Beneficiaries  03-001 (PDF)
  • Enrollment Forms in Primary Care Provider Offices and Enrollment Packet Material Distribution  PL 98-004 (PDF)
  • Enrollment of Medi-Cal/Medicare Dual Eligibles and Medi-Cal Beneficiaries with Commercial Health Maintenance Coverage  PL 98-005 (PDF - 9.4MB)
  • Health Plan Choice Reminders (Annual Renotifications)  01-004 (PDF)
  • Implementation of New Enrollment Forms  04-007 (PDF)
  • Implementation of New Enrollment Forms  04-005 (PDF - 4.3MB)
  • LTC Guidelines/Policy Letters GMC/Two-Plan Letter  03-003 (PDF - 4.2MB)
  • Maximus Warehouse Relocation  00-006 (PDF)
  • Medi-Cal Managed Care Medical Exemptions  00-002 (PDF)
  • New Medi-Cal Managed Care Exemption Forms  99-011 (PDF - 12.9MB)
  • New Process for Transmitting Enrollment/Disenrollment Data  05-002 (PDF - 2.1MB)
  • Percent of Poverty Population  00-009 (PDF)
  • Potential Increase in New Enrollees Due to Changes in the Section 1931(b) Program  00-007 (PDF)
  •  

Expedited State Hearing (ESH)

External Accountability Set

  • Interim Procedures Until Execution of New EQRO Contract  08-006 (PDF)
  • External Accountability Set (EAS) Performance Measure Audits  02-008 (PDF)
  • Quality and Performance Improvement Requirements for 2007  06-010 (PDF)

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FAME 

  • 2009-2010 Managed Care Plan MEDS/FAME/834+Supplemental Cutoff and Processing Schedule  08-012 (PDF)
  • 2008-2009 Managed Care Plan MEDS/FAME/834+Supplemental Cutoff and Processing Schedule  07-019 (PDF)
  • 2007-2008 Managed Care Plan MEDS/FAME Cutoff and Processing Schedule  06-012 (PDF)
  • 2005-2006 Managed Care Plan (MCP) MEDS/FAME Cut-Off and Processing Schedule  05-011 (PDF - 2.3MB)
  • 2004-2005 Managed Care Plan (MCP) MEDS/FAME Cut-Off and Processing Schedule  04-008 (PDF)
  • 2004 Managed Care Plan (MCP) MEDS/FAME Cut-Off and Processing Schedule  04-001 (PDF)
  • 2003 Managed Care Plan (MCP) MEDS/FAME Cut-Off and Processing Schedule  02-009 (PDF)
  • 2002 Managed Care Plan (MCP) MEDS/FAME Cut-Off and Processing Schedule  01-006 (PDF)
  • 2001 Managed Care Plan (MCP) MEDS/FAME Cut-Off and Processing Schedule  00-014 (PDF)
  • 2000 Managed Care Plan (MCP) MEDS/FAME Cut-Off and Processing Schedule  00-001 (PDF - 10.1MB)
  • 1999 Managed Care Plan (MCP) MEDS/FAME Cut-Off and Processing Schedule  99-002 (PDF)
  • 1998 Managed Care Plan (MCP) MEDS/FAME Cut-Off and Processing Schedule  98-003 (PDF)
  • Possible Movement of FAME Files from the CA Health and Human Services (CHHS) Data Center to the Medi-Cal Web Site  02-002 (PDF)

Family Planning

Federal Deficit Reduction Act of 2005

  • Federal Deficit Reduction Act of 2005 (Reimbursement for Non-Contracted Emergency Services Providers)  07-003 (PDF)
  • Federal Deficit Reduction Act of 2005 (Employee Education About False Claims)  07-007 (PDF)
  • Federal Deficit Reduction Act of 2005, Section 6036 (Citizenship Verification Requirement)  07-017 (PDF)
  • Requirements for Employee Education Regarding False Claims Recovery  08-007 (PDF)

Finance

  • Conversion to Electronic Filing of Financial Reports  07-001 (PDF)
  • New Financial Reporting Requirements  07-009 (PFD)
  • Review and Analysis of Financial Status of Health Plans Proposed Request for Funding Augmentations  05-008 (PDF)
  • Same Day Banking  06-011 (PDF)

Fraud

  • Fraud Referral Procedure to Audits and Investigations (A&I)  03-011 (PDF)

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Grievance

Health Assessments

Health Education

HIPAA - Health Insurance Portability and Accountability Act of 1996

  • Certificates of Creditable Coverage Under the Health Insurance Portability and Accountability Act of 1996  PL 98-002 (PDF - 3.6MB)
  • HIPAA Requirements: Notice of Privacy Practices and Notification of Breaches  06-001 (PDF)
  • HIPAA Requirements: Plans' Reporting Responsibilities  05-006 (PDF)
  • Protected Health Information (PHI) and Notification of Breaches 06-005 (PDF)
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Hospice

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Indian Health

Legislation

  • 2008 Chaptered Legislation Affecting, or of Interest to Medi-Cal Managed Care Plans  09-001 (PDF)
  • All Plan Letter 04006 Regarding Senate Bill 59 Notice of Action Letter  05-005 (PDF)
  • Erectile Dysfunction Treatment for Known Sex Offenders  05-007 (PDF)
  • List of Contracted Hospitals and Bed Days  09-007 (PDF)
  • List of Contracted Hostipals and Bed Days 09-011 (PDF)
  • Newborns' and Mothers' Health Act of 1997  PL 98-001 (PDF)
  • New Laws from the 1997-98 Session of the California Legislature Affecting the Medi-Cal Program  99-004 (PDF)
  • SB 59 (Stats. 1999, Chapter 539) Required Notices of Action  04-006 (PDF)
  • SB 87 Medi-Cal Contact Information Release Form  03-002 (PDF - 2.5 MB)
  • Summary of 2007 Chaptered Legislation Affecting, or of Interest to Medi-Cal Managed Care Plans  08-001 (PDF)
  • Summary of 2006 Chaptered Legislation Affecting, or of Interest to Medi-Cal Managed Care Plans  07-004 (PDF)
  • Summary of 2005 Chaptered Legislation Impacting or of Interest to Medi-Cal Managed Care Plans  05-014 (PDF - 17.3MB)
  • Summary of 2003 and 2004 Chaptered Legislation Impacting or of Interest to Medi-Cal Managed Care Plans  05-001 (PDF - 2.0MB)
  • Summary of 2002 Chaptered Legislation for Medi-Cal Managed Care Plans  02-007 (PDF)
  • Summary of 2001 Chaptered Legislation Impacting or of Interest to Medi-Cal Managed Care Plans  01-007 (PDF - 21.7MB)
  • Summary of 2000 Chaptered Legislation Impacting or of Interest to Medi-Cal Managed Care Plans  01-001 (PDF)
  • Summary of 1999 Chaptered Legislation Impacting or of Interest to Medi-Cal Managed Care Plans  99-014 (PDF)
  • Update on California Department of Health Services Reorganization  07-011 (PDF)

Local Education Agencies (LEAs)

  • Managed Care Relationship with Local Education Agency Providers  PL 00-006 (PDF)

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Marketing

MEDS - Medi-Cal Eligibility Data System

  • 2009-2010 Managed Care Plan MEDS/FAME/834+Supplemental Cutoff and Processing Schedule  08-012 (PDF)
  • 2008-2009 Managed Care Plan MEDS/FAME/834+Supplemental Cutoff and Processing Schedule  07-019 (PDF)
  • 2007-2008 Managed Care Plan MEDS/FAME Cutoff and Processing Schedule  06-012 (PDF)
  • 2005-2006 Managed Care Plan (MCP) MEDS/FAME Cut-Off and Processing Schedule  05-011 (PDF - 2.3MB)
  • 2004-2005 Managed Care Plan (MCP) MEDS/FAME Cut-Off and Processing Schedule  04-008 (PDF)
  • 2004 Managed Care Plan (MCP) MEDS/FAME Cut-Off and Processing Schedule  04-001 (PDF)
  • 2003 Managed Care Plan (MCP) MEDS/FAME Cut-Off and Processing Schedule  02-009 (PDF)
  • 2002 Managed Care Plan (MCP) MEDS/FAME Cut-Off and Processing Schedule  01-006 (PDF)
  • 2001 Managed Care Plan (MCP) MEDS/FAME Cut-Off and Processing Schedule  00-014 (PDF)
  • 2000 Managed Care Plan (MCP) MEDS/FAME Cut-Off and Processing Schedule  00-001 (PDF - 10.2MB)
  • 1999 Managed Care Plan (MCP) MEDS/FAME Cut-Off and Processing Schedule  99-002 (PDF)
  • 1998 Managed Care Plan (MCP) MEDS/FAME Cut-Off and Processing Schedule  98-003 (PDF)
  • Medicare Modernization Act; Medicare Part D Implementation System Changes  05-013 (PDF)
  • Medicare Part D Update  06-002 (PDF - 4.0MB), 06-003 (PDF - 2.4MB)
  • Possible Movement of FAME Files from the CA Health and Human Services (CHHS) Data Center to the Medi-Cal Web Site  02-002 (PDF)

Mental Health

  • Med-Cal Managed Care Plan Responsibilities Under the Medi-Cal Specialty Mental Health Services Consolidation Program  PL 00-001 Rev (PDF - 4.3MB)
  • Medi-Cal Managed Care Plan Responsibilities Under the Medi-Cal Specialty Mental Health Services Consolidation Program  PL 00-001 (PDF)

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National Provider Identifier (NPI)

  • Implementation of NPI Update  07-005 (PDF)
  • Update to All Plan Letter 06-04 re: Implementation of National Provider Identifier (NPI)  06-006 (PDF)
  • National Provider Identifier (NPI)  06-004 (PDF)

Notice of Action

Other Health Coverage

  • Cost Avoidance and Post-Payment Recovery for Other Health Coverage PL 08-011 (PDF)

Outreach

  • Importance of Increased Outreach to New Eligibles Under the Section 1931(b) Program  00-008 (PDF)

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Percent of Poverty

Personal Injury

Pharmacy

  • Carve out Erectile Dysfunction Drugs  05-009 (PDF)
  • Contraceptive Devices  06-008 (PDF)
  • Managed Care Plan Utilization of Therapeutic Pharmaceutical Agents-Certified Optometrist  99-001 (PDF)
  • Medi-Cal Managed Care Plan Requirements for Provision of Contraceptive Drug Services and Supplies  03-010 (PDF)
  • Medi-Cal Managed Care Health Plan Capitated and Non-Capitated Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) and Antipsychotic Drugs  03-004 (PDF - 4.9MB)
  • Medicare Modernization Act; Medicare Part D Prescription Drug Plan  05-012 (PDF)
  • Mifepristone (RU-486) as a Medi-Cal Benefit  01-003 (PDF)
  • Pharmacy Prior Authorization Requests by California Licensed Pharmacists 08-013 (PDF)
  • Recombinant Growth Hormone Injections  98-007 (PDF)
  • Therapeutic Enteral Formulas for Medical Conditions in Infants and Children (Note: revised 11/07/07, see APL 07-016)  PL 07-006 (PDF)
  • Therapeutic Enteral Formulas for Medical Conditions in Infants and Children (revised) MMCD Policy Letter 07-006 dated April 2, 2007  PL 07-016 (PDF)

Policy and Procedure

Post Stabilization

Prenatal Care

Primary Care Physician (PCP)

Prescriptions (Rx)

  • Carve out Erectile Dysfunction Drugs  05-009 (PDF)
  • Contraceptive Devices  06-008 (PDF)
  • Managed Care Plan Utilization of Therapeutic Pharmaceutical Agents-Certified Optometrist  99-001 (PDF)
  • Medi-Cal Managed Care Plan Requirements for Provision of Contraceptive Drug Services and Supplies  03-010 (PDF)
  • Medi-Cal Managed Care Health Plan Capitated and Non-Capitated Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) and Antipsychotic Drugs  03-004 (PDF - 4.9MB)
  • Medicare Modernization Act; Medicare Part D Prescription Drug Plan  05-012 (PDF)
  • Mifepristone (RU-486) as a Medi-Cal Benefit  01-003 (PDF)
  • Pharmacy Prior Authorization Requests by California Licensed Pharmacists 08-013 (PDF)
  • Recombinant Growth Hormone Injections  98-007 (PDF)
  • Therapeutic Enteral Formulas for Medical Conditions in Infants and Children (Note: revised 11/07/07, see APL 07-016)  PL 07-006 (PDF)
  • Therapeutic Enteral Formulas for Medical Conditions in Infants and Children (revised) MMCD Policy Letter 07-006 dated April 2, 2007  PL 07-016 (PDF)

Probation

Provider Directory

  • Health Plan Provider Directory Policy, Guidelines and Delivery Standards PL 00-002 (PDF)

Provider Participation

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QIP- Quality and Performance Improvement Program

  • Certification of Managed Care Plan Staff Responsible for the Conduct of Primary Care Provider site Reviews  PL 03-002 (PDF)
  • Certified Quality Provider Site Certificate 03-007 (PDF)
  • Credentialing & Re-Credentialing: Time Line Change, New Primary Source Verification Requirements and Verification of Credentials of Non-Physician Practitioners  PL 02-003 (PDF)
  • Facility Site Review Clarification #2  03-006 (PDF)
  • Implementation of Medi-Cal Managed Care Division (MMCD) Policy Letter 02-002  02-006 (PDF)
  • Procedures for Submitting QIP Documents and New Resources for Plans 09-008 (PDF)
  • Quality and Performance Improvement Program  PL 03-001 (PDF)
  • Quality and Performance Improvement Requirements for 2009  08-009 (PDF)
  • Quality and Performance Improvement Requirements for 2008  07-013 (PDF)
  • Quality and Performance Improvement Requirements for 2007  06-010 (PDF)
  • Site Review  PL 02-002 (PDF - 28.4MB)
  • Use of Services Measures 03-015 (PDF)

Quality Improvement Projects (QIPs)

  • Quality and Performance Improvement Requirements for 2007  06-010 (PDF)

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Rates

Regional Center Consumers

Reimbursement

  • Conlan v. Bonta; Conlan v. Shewry: Court Ordered Medi-Cal Beneficiary Reimbursement Process  07-002 (PDF - 5.5MB)
  • Reimbursement for Non-contracted Hospital Emergency Inpatient Services 08-008 (PDF)

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Site Review

State Hearings

Third Party Liability

Utilization Review (UR)

  • Utilization Review of Initial Risk Assessments for Pregnant Women  00-012 (PDF)
  • Workers’ Compensation (WC)- Notice Award of New Workers’ Compensation Recovery Program (WCRP) Contractor; Reporting and Other Requirements  04-004 (PDF - 5.9MB)

Vaccines

Year 2000 (Y2K)

  • Year 2000 Contingency Plan Update  99-016 (PDF)
  • Revision to MMCD All Plan Letter 99-003 Re: Year 2000 Readiness  99-012 (PDF)
  • Year 2000 Readiness Certification and Business Continuation Plan  99-003 (PDF)

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