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Managed Care All Plan & Policy Letters - Subject Listing 

A - D  |  E - H  |  I - L  |  M - P  |  Q - T  |  U - Z   

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 APL 02-001 (PDF)
  • Medi-Cal Managed Care Health Plan Capitated and Non-Capitated Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) and Antipsychotic Drugs  APL 03-004 (PDF - 4.9MB)   

 

Acupuncture Services

Advanced Directives

 

Affordable Care Act

  • Affordable Care Act (ACA) Section 1202 Final Rule on Increased Payments for Medi-Cal Primary Care Services  APL 13-009 (PDF)
  • Managed Care Compliance Plan for Section 1202 of the Affordable Care Act  APL 13-010 (PDF)    
  • Affordable Care Act Section 1202 Increased Payments for Medi-Cal Primary Care Services – Revised Guidance and Contractual Requirements APL 15-010 (PDF - 3.6MB)
     

Aged-Senior Services

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

 

Aid Codes

 

Amendments

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

 

Audits

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

 

Banking

 

Behavioral Health Treatment

  • Interim Policy for the Provision of Behavioral Health Treatment Coverage for Children Diagnosed with Autism Spectrum Disorder APL 14-011 (PDF)   
  • Responsibilities for Behavioral Health Treatment Coverage for Children Diagnosed with Autism Spectrum Disorder (Supersedes APL 14-011) APL 15-025 (PDF)   

 

Beneficiary Notices

 

Billing

  • Designated Public Hospitals: Billing for Beneficiaries with California Children's Services Eligible Conditions and/or Medi-Cal Managed Care APL 16-007 (PDF) (Supersedes APL 15-011)
  • Diagnosis Related Groups: Billing for Beneficiaries with California Children's Services Eligible Conditions and/or Medi-Cal Managed Care APL 16-008 (PDF) (Supersedes APL 13-012)
  • Diagnosis Related Groups: Billing for Beneficiaries with California Children's Services Eligible Conditions and/or Medi-Cal Managed Care APL 13-012 (PDF) 
  • Medi-Cal Billing Restriction on the Use of Social Security Numbers  APL 07-020 (PDF)
  • Payment of Invoices Beyond the Six-Month Billing Limit  PL 08-002 (PDF) 
  • Professional Fees for Office Visits Associated with Alcohol and Substances Use Disorder Treatment Services APL 15-008 (PDF)  
  • Proper Use of and Billing for Makena APL 15-009 (PDF)  (Supersedes APL 13-016)
  • Proper Use of and Billing for Makena APL 13-016 (PDF)
  • Treatment of Recoveries Made by the Managed Care Health Plan of Overpayments to Providers APL 17-003 (PDF)

 

Breast and Cervical Cancer Treatment

 

Breastfeeding

 

CAHPS Survey

 

Call Center

Cal MediConnect 

 

Capitation

 

Certified Nurse Midwife

  • Provision of Certified Nurse Midwife and Alternative Birth Center Facility Services (Supersedes APL 15-017) APL 16-017 (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)  APL 00-004 (PDF)
  • California Children Services Numbered Letters 01-0298 and 09-0598  APL 98-006 (PDF)
  • Data Request CHDP (Child Health Disability Prevention) Report for FY 2007-2008 and FY 2008-2009 PL 10-013 (PDF) 
  • Data Request Requirements for Child Health Disability Prevention Report Contained in Policy Letter 10-013  (Supersedes PL 10-013)
    APL 15-005 (PDF)  
  • Designated Public Hospitals: Billing for Beneficiaries with California Children's Services Eligible Conditions and/or Medi-Cal Managed Care APL 16-007 (PDF) (Supersedes APL 15-011) 
  • Designated Public Hospitals: Billing for Beneficiaries with California Children's Services Eligible Conditions and/or Medi-Cal Managed Care APL 15-011 (PDF)  
 

Clinical Laboratories Improvements Amendments of 1988 (CLIA)

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

 

Community Advisory Committee

 

Conlan Court Decisions

 

Continuity of Care

 

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) 
  • Provider Credentialing / Recredentialing and Screening / Enrollment (Supersedes APL 16-012) APL 17-019 (PDF)
  • Provider Credentialing and Recredentialing (Supersedes PL 02-003) APL 16-012 (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   APL 99-005 (PDF)
  • Cultural and Linguistic Contractual Requirements: Threshold and Concentration Standard Languages Update   APL 02-003 (PDF)
  • Cultural and Linguistic Contractual Requirements: Threshold and Concentration Standard Languages Update (Supersedes APL 02-003)   APL 14-008 (PDF)
  • Health Education and Cultural and Linguistic Group Needs Assessment (Supersedes Policy Letter 10-012) APL 17-002 (PDF)
  • Health Education and Cultural and Linguistic Group Needs Assessment (GNA)  PL 10-012 (PDF)   
  • Health Education and Cultural and Linguistic Group Needs Assessment  PL 99-002 (PDF) replaced by PL 10-012 (PDF)
  • Linguistic Services  PL 99-003 (PDF - 8.4MB)
  • Standards for Determining Threshold Languages and Requirements for Section 1557 of the Affordable Care Act (Supersedes All Plan Letter 14-008) APL 17-011 (PDF)
  • Translation of Written Informing Materials  PL 99-004 (PDF)

 

Data

 

Dental

 

DFMC - Delmarva Foundation for Medical Care Inc.

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Dual-Eligible

  • Coordination of Benefits: Medicare and Medi-Cal APL 13-001 (PDF)    
  • Coordination of Benefits: Medicare and Medi-Cal (Supersedes APL 13-001) APL 13-003 (PDF)
  • Contracts with Dual-Eligible Special Needs Plans  APL 12-001 (PDF)
  • Contracts with Dual-Eligible Special Needs Plans  APL 13-008 (PDF)  
  • Discharge Planning for Cal Mediconnect DPL 16-003 (PDF)
  • Dual-Eligible Special Needs Plans  APL 14-007 (PDF)  
  • Enrollment Requirements for Dual-Eligible Special Needs Plans in Alameda and Orange Counties APL 14-014 (PDF)     
  • Interdisciplinary Care Team and Individual Care Plan Requirements for Medicare-Medicaid Plans DPL 15-001 (PDF) 
    (Supersedes DPL 13-004) 
  • Interdisciplinary Care Team and Individual Care Plan Requirements for Medicare-Medicaid Plans DPL 13-004 (PDF)  
  • Performance Improvement Project Requirements DPL 16-001 (PDF)
  • Primary Care Provider Assignment in Medi-Cal Managed Care for Dual-Eligible Beneficiaries​ APL 14-015 (PDF)    
  • Requirements for Cal MediConnect Medicare-Medicaid Plans and Qualified Agency Contract DPL 15-004 (PDF)
  • Requirements for Medi-Cal Managed Care Health Plans and Qualified Agency Contract APL 15-013 (PDF)

Durable Medical Equipment 

  •  Criteria for Coverage of Wheelchairs and Applicable Seating and Positioning Components APL 15-018 (PDF)  

Early and Periodic Screening Diagnosis and Treatment Services

  • Blood Lead Screening of Young Children  PL 02-001 (PDF)  
  • Requirements for Coverage of Early and Periodic Screening, Diagnostic, and Treatment Services for Medi-Cal Beneficiaries under the Age of Twenty One  APL 14-017 (PDF)  

 

Eligibility

  • Addendum to Policy Letter 98-03 - Conversion to New Eligibility Report System  PL 99-005 (PDF - 3.0MB)
  • Conlan v. Bonta; Conlan v. Shewry: Court Ordered Medi-Cal Beneficiary Reimbursement Process  APL 07-002 (PDF - 5.5MB)
  • Conversion to New Eligibility Reporting System  PL 98-003 (PDF)
  • General Acute Care Inpatient Services:  Claiming for Beneficiaries Covered by Medi-Cal Managed Care and Medi-Cal Diagnosis Related Group Fee-For-Service  APL 15-021 (PDF)  
  • Memorandum of Understanding Requirements for Medi-Cal Managed Care Plans APL 13-018 (PDF)
  • Memorandum of Understanding Requirements for Medi-Cal Managed Care Health Plans and Regional Centers APL 15-022 (PDF)  
  • Medi-Cal Intercounty Transfers  APL 03-005 (PDF - 5.3MB)
  • Refugee Health Care  PL 98-007 (PDF)
  • Status of the Conversion to the Fiscal Intermediary Access to Medi-Cal Eligibility Data  APL 99-010 (PDF) 

 

Emergency Services (ER Care)

 

End of Life Option Act

Enrollments and Disenrollments

 

Expedited State Hearing (ESH)

 

External Accountability Set

 

FAME 

  • Transition to Updated HIPAA Transactions for Enrollment and Premium Payments APL 11-014 (PDF)   

 

Family Planning

 

Federal Deficit Reduction Act of 2005

  • Federal Deficit Reduction Act of 2005 (Reimbursement for Non-Contracted Emergency Services Providers)  APL 07-003 (PDF)
  • Federal Deficit Reduction Act of 2005 (Employee Education About False Claims)  APL 07-007 (PDF)
  • Federal Deficit Reduction Act of 2005, Section 6036 (Citizenship Verification Requirement)  APL 07-017 (PDF)   
  • Disclosure of Select Provider Contracting Program (SPCP) Rates APL 11-006 (PDF)  
  • Requirements for Employee Education Regarding False Claims Recovery  APL 08-007 (PDF) 

 

Federally Qualified Health Centers and Rural Health Clinics 

  •  Podiatric and Chiropractic Services at Federally Qualified Health Centers and Rural Health Clinics  APL 15-003 (PDF)

    

Finance

 

Foster Care

 

Fraud

  • Actions Required Following Notice of a Credible Allegation of Fraud APL 15-026 (PDF)   
  • Fraud Referral Procedure to Audits and Investigations (A&I)  APL 03-011 (PDF)

 

Grievance

 

Health Assessments

  • Alcohol Misuse: Screening and Behavioral Counseling Interventions in Primary Care (Supersedes APL 14-004) APL 17-016 (PDF)
  • Health Risk Assessment and Risk Stratification Requirements for Cal Mediconnect (Supersedes DPL 15-005) DPL 17-001 (PDF)
  • Health Risk Assessment and Risk Stratification Requirements for Cal MediConnect (supersedes DPL 13-002) DPL 15-005 (PDF)   
  • Health Risk Assessment and Risk Stratification Requirements for Dual Demonstration Plans Under The Coordinated Care Initiative DPL 13-002 (PDF)              
  • Individual Health Education Behavioral Assessment PL 99-007 (PDF - 2.1MB)
  • Initial Comprehensive Health Assessment  PL 08-003 (PDF)   
  • Revision To Policy Letter 11-001 Regarding Requirements for Health Risk Assessment of Medi-Cal Seniors and Persons with Disabilities PL 11-007 (PDF)  
  • Requirements for Health Risk Assessment of Medi-Cal Seniors and Persons with Disabilities PL 12-004 (PDF) 
  • Requirements for Staying Healthy Assessment/Individual Health Education Behavioral Assessment PL 13-001 Revised (PDF)   
  • Screening, Brief Intervention, and Referral to Treatment for Misuse of Alcohol (SBIRT) APL 14-004 (PDF)  
  • Staying Healthy Assessment/Individual Health Education Behavioral Assessment for Enrollees from Low-Income Health Program APL 13-017 (PDF)              

 

Health Education

 

Hepatitis C

HIPAA - Health Insurance Portability and Accountability Act

  • Certificates of Creditable Coverage Under the Health Insurance Portability and Accountability Act of 1996  PL 98-002 (PDF - 3.6MB)
  • Exhibit G, Health Insurance Portability And Accountability Act (HIPAA)  APL 09-014 (PDF)
  • HIPAA Requirements: Notice of Privacy Practices and Notification of Breaches  APL 06-001 (PDF)
  • HIPAA Requirements: Plans' Reporting Responsibilities  APL 05-006 (PDF)
  • Protected Health Information (PHI) and Notification of Breaches APL 06-005 (PDF) 
  • Transition to Updated HIPAA Transactions for Enrollment and Premium Payments APL 11-014 (PDF)   

 

 HIV Counseling and Testing 

 

Hospice

  • Hospice Services and Medi-Cal Managed Care APL 13-014 (PDF)            
  • Hospice Services and Medi-Cal Managed Care APL 07-014 (PDF)
  • Hospice Services and Medi-Cal Managed Care APL 05-003 (PDF)  
  • The Implementation of Section 2302 of the Affordable Care Act, Entitled "Concurrent Care for Children." PL11-004 (PDF)  

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Indian Health

 

Immunization Services

 

Legislation

  • 2008 Chaptered Legislation Affecting, or of Interest to Medi-Cal Managed Care Plans  APL 09-001 (PDF)
  • All Plan Letter 04006 Regarding Senate Bill 59 Notice of Action Letter  APL 05-005 (PDF)
  • Assembly Bill 97 Implementation PL AB 97 (PDF)      
         PL AB 97 Attachment: Specialty Physician Services (PDF)   
  • Erectile Dysfunction Treatment for Known Sex Offenders  APL 05-007 (PDF)
  • Grievance and Appeal Requirements and Revised Notice Templates and “Your Rights” Attachments (Supersedes All Plan Letters 04-006 and 05-005 and Policy Letter 09-006) APL 17-006 (PDF)
  • List of Contracted Hospitals and Bed Days  APL 09-007 (PDF)
  • List of Contracted Hospitals and Bed Days APL 09-011 (PDF)
  • New Benefit - Voluntary Inpatient Detox APL 14-005 (PDF)  
  • New Laws from the 1997-98 Session of the California Legislature Affecting the Medi-Cal Program APL 99-004 (PDF) 
  • Newborns' and Mothers' Health Act of 1997  PL 98-001 (PDF)
  • Reporting On The Distribution Of Funds Pursuant To Assembly Bill 1653 PL 11-011 (PDF)         
         PL 11-011 Attachment: AB 1653 Plan Monitoring Schedules (MS Excel)
  • SB 59 (Stats. 1999, Chapter 539) Required Notices of Action  APL 04-006 (PDF)
  • SB 87 Medi-Cal Contact Information Release Form  APL 03-002 (PDF - 2.5 MB)
  • Summary of 2007 Chaptered Legislation Affecting, or of Interest to Medi-Cal Managed Care Plans  APL 08-001 (PDF)
  • Summary of 2006 Chaptered Legislation Affecting, or of Interest to Medi-Cal Managed Care Plans  APL 07-004 (PDF)
  • Summary of 2005 Chaptered Legislation Impacting or of Interest to Medi-Cal Managed Care Plans  APL 05-014 (PDF - 17.3MB)
  • Summary of 2003 and 2004 Chaptered Legislation Impacting or of Interest to Medi-Cal Managed Care Plans  APL 05-001 (PDF - 2.0MB)
  • Summary of 2002 Chaptered Legislation for Medi-Cal Managed Care Plans  APL 02-007 (PDF)
  • Summary of 2001 Chaptered Legislation Impacting or of Interest to Medi-Cal Managed Care Plans  APL 01-007 (PDF - 21.7MB)
  • Summary of 2000 Chaptered Legislation Impacting or of Interest to Medi-Cal Managed Care Plans  APL 01-001 (PDF)
  • Summary of 1999 Chaptered Legislation Impacting or of Interest to Medi-Cal Managed Care Plans  APL 99-014 (PDF)
  • Summary of 2013 Chaptered Legislation Impacting or of Interest to Medi-Cal Managed Care Plans  APL 14-002 (PDF)  
  • Summary of 2014 Chaptered Legislation Impacting or of Interest to Medi-Cal Managed Care Health Plans APL 14-016 (PDF)   
  • Update on California Department of Health Services Reorganization  APL 07-011 (PDF)

 

Local Education Agencies (LEAs)

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

 

Low Income Health Program (LIHP)   

  • Open Authorization and Scheduled Service Information for New Beneficiaries Transitioning from The Low-Income Health Program APL 13-020 (PDF)    

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Marketing

  • Dual-Eligible Special Needs Plans Marketing and Enrollment Restrictions DPL 13-001 (PDF)            
  • Marketing Requirements for Medi-Cal and Covered California APL 13-015 (PDF)    
  • Plan-Paid Advertising Extended Until January 31, 2001  PL 00-004 (PDF)

 

MEDS - Medi-Cal Eligibility Data System

  • 2017-2018 Medi-Cal Managed Care Health Plan Meds/834 Cutoff And Processing Schedule APL 17-001 (PDF)
  • 2016-2017 Medi-Cal Managed Care Health Plan MEDS/834 Cutoff and Processing Schedule APL 16-002 (PDF)  
  • 2015-2016 Medi-Cal Managed Care Health Plan MEDS/834 Cutoff and Processing Schedule APL 14-018 (PDF)  
  • 2014-2015 Medi-Cal Managed Care Health Plan MEDS/834 Cutoff and Processing Schedule APL 14-001 (PDF)   
  • 2013-2014 Managed Care Plan MEDS/834 Cutoff and Processing Schedule APL 12-005 (PDF)   
  • 2011-2012 Managed Care Plan MEDS/FAME/834+Supplemental Cutoff and Processing Schedule  APL 10-015 (PDF)
  • 2010-2011 Managed Care Plan MEDS/FAME/834+Supplemental Cutoff and Processing Schedule  APL 09-015 (PDF - 2MB)
  • 2009-2010 Managed Care Plan MEDS/FAME/834+Supplemental Cutoff and Processing Schedule  APL 08-012 (PDF)
  • 2008-2009 Managed Care Plan MEDS/FAME/834+Supplemental Cutoff and Processing Schedule  APL 07-019 (PDF)
  • 2007-2008 Managed Care Plan MEDS/FAME Cutoff and Processing Schedule  APL 06-012 (PDF)
  • 2005-2006 Managed Care Plan (MCP) MEDS/FAME Cut-Off and Processing Schedule  APL 05-011 (PDF - 2.3MB)
  • 2004-2005 Managed Care Plan (MCP) MEDS/FAME Cut-Off and Processing Schedule  APL 04-008 (PDF)
  • 2004 Managed Care Plan (MCP) MEDS/FAME Cut-Off and Processing Schedule  APL 04-001 (PDF)
  • 2003 Managed Care Plan (MCP) MEDS/FAME Cut-Off and Processing Schedule  APL 02-009 (PDF)
  • 2002 Managed Care Plan (MCP) MEDS/FAME Cut-Off and Processing Schedule  APL 01-006 (PDF)
  • 2001 Managed Care Plan (MCP) MEDS/FAME Cut-Off and Processing Schedule  APL 00-014 (PDF)
  • 2000 Managed Care Plan (MCP) MEDS/FAME Cut-Off and Processing Schedule  APL 00-001 (PDF - 10.2MB)
  • 1999 Managed Care Plan (MCP) MEDS/FAME Cut-Off and Processing Schedule  APL 99-002 (PDF)
  • 1998 Managed Care Plan (MCP) MEDS/FAME Cut-Off and Processing Schedule  APL 98-003 (PDF)
  • Changes to the Historical Utilization Data Provided to Medi-Cal Managed Care Health Plans for Seniors and Persons with Disabilities Effective February 1, 2014 PL 14-001 (PDF)  
  • Medicare Modernization Act; Medicare Part D Implementation System Changes  APL 05-013 (PDF)
  • Medicare Part D Update  APL 06-002 (PDF - 4.0MB), APL 06-003 (PDF - 2.4MB)
  • Member-Specific Data Files To Be Provided To Plans For New Medi-Cal Only SPD Members  PL 11-003 (PDF)
  • Possible Movement of FAME Files from the CA Health and Human Services (CHHS) Data Center to the Medi-Cal Web Site  APL 02-002 (PDF)

 

Mental Health

  • Crossover Claiming Responsibility for Mental Health Services Provided to Cal MediConnect Beneficiaries  DPL 15-006 (PDF) 
    (Supersedes DPL 14-003) 
  • Crossover Claiming Responsibility for Mental Health Services Provided to Cal MediConnect Beneficiaries  DPL 14-003 (PDF)  
  • Dispute Resolution Process for Mental Health Services APL 15-007 (PDF)   
  • Medi-Cal Managed Care Health Plan Responsibilities for Outpatient Mental Health Services (Supersedes APL 13-021) APL 17-018 (PDF)
  • 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)      
  • Medi-Cal Managed Care Plan Responsibilities for Outpatient Mental Health Services  APL 13-021 (PDF)   
  • Physical Health Care Covered Services Provided for Members Who Are Admitted to Inpatient Psychiatric Facilities APL 15-015 (PDF) 

 

MLTSS - Managed Long-Term Services and Supports

  • Care Coordination Requirements for Managed Long-Term Services and Supports (Supersedes APL 14-010) APL 17-012 (PDF)
  • Care Coordination Requirements for Managed Long-Term Services and Supports  APL 14-010 (PDF)  
  • Discharge Planning for Cal Mediconnect DPL 16-003 (PDF)

 

MSSP - Multipurpose Senior Services Program 

  •  Multipurpose Senior Services Program Complaint, Grievance, Appeal, and State Hearing Responsibilities in Coordinated Care Initiative Counties  APL 15-002 (PDF) 

National Provider Identifier (NPI)

 

Notice of Action

 

Nursing Facility Services

  • Discharge Planning for Cal Mediconnect DPL 16-003 (PDF)
  • Requirements for Nursing Facility Services DPL 14-002 (PDF)   
  • Medi-Cal Managed Care Health Plan Requirements for Nursing Facility Services in Coordinated Care Initiative Counties for Beneficiaries not Enrolled in Cal Mediconnect  APL 15-004 (PDF)  

 

Optometry Services

 

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  APL 00-008 (PDF)  
  • Designating Non-Qualified Health Plan Medi-Cal Managed Care Plans as Medicaid Certified Application Counselors APL 13-024 (PDF)  

 

Palliative Care

Percent of Poverty

 

Personal Injury

 

Pharmacy

  • Carve out Erectile Dysfunction Drugs  APL 05-009 (PDF)
  • Contraceptive Devices  APL 06-008 (PDF)
  • Enteral Nutrition Products (supersedes PL 07-006 and PL 07-016) PL 12-005 (PDF)     
  • Enteral Nutrition Products PL 14-003 (PDF)     
  • Managed Care Plan Utilization of Therapeutic Pharmaceutical Agents-Certified Optometrist  APL 99-001 (PDF)
  • Medi-Cal Managed Care Plan Requirements for Provision of Contraceptive Drug Services and Supplies  APL 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  APL 03-004 (PDF - 4.9MB)
  • Medi-Cal Managed Care Health Plan Pharmaceutical Formulary Comparability Requirement APL 16-010 (PDF)
  • Medicare Modernization Act; Medicare Part D Prescription Drug Plan  APL 05-012 (PDF)
  • Mifepristone (RU-486) as a Medi-Cal Benefit  APL 01-003 (PDF)
  • Pharmacy Prior Authorization Requests by California Licensed Pharmacists APL 08-013 (PDF)
  • Recombinant Growth Hormone Injections  APL 98-007 (PDF)
  • Requirement to Participate in the Medi-Cal Drug Utilization Review Program APL 17-008 (PDF)
  • Requirement to Use Food and Drug Administration Approved Drugs, Rather Than Compounded Alternatives PL 14-002 (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) Policy Letter 07-006 dated April 2, 2007  PL 07-016 (PDF)

 

Policy and Procedure

 

Post Stabilization

 

Prenatal Care

  • Breastfeeding Promotion  PL 98-010 (PDF)
  • Newborn and Prenatal Genetic Screening Services PL 98-006 (PDF - 38.2MB)     
  • Obstetrical Care-Perinatal Services PL 12-001 (PDF)      
  • Obstetrical Care-Perinatal Services (supersedes PL 12-001 and PL 96-01) PL 12-003 (PDF)                                        
  • Utilization Review of Initial Risk Assessments for Pregnant Women  APL 00-012 (PDF)

 

Primary Care Physician (PCP)

  • Primary Care Physician Selection and Assignment Policy  PL 98-012 (PDF)   
  • Primary Care Provider Assignment in Medi-Cal Managed Care for Dual-Eligible Beneficiaries​ APL 14-015 (PDF)   

 

Prescriptions (Rx)

  • Carve out Erectile Dysfunction Drugs  APL 05-009 (PDF)
  • Contraceptive Devices  APL 06-008 (PDF)
  • Enteral Nutrition Products (supersedes PL 07-006 and PL 07-016) PL 12-005 (PDF)         
  • Managed Care Plan Utilization of Therapeutic Pharmaceutical Agents-Certified Optometrist  APL 99-001 (PDF)
  • Medi-Cal Managed Care Plan Requirements for Provision of Contraceptive Drug Services and Supplies  APL 03-010 (PDF)
  • Medi-Cal Managed Care Health Plans Carved-Out Drugs  APL 16-004 (PDF)
  • Medi-Cal Managed Care Health Plan Capitated and Non-Capitated Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) and Antipsychotic Drugs  APL 03-004 (PDF - 4.9MB)
  • Medi-Cal Managed Care Health Plan Pharmaceutical Formulary Comparability Requirement APL 16-010 (PDF)
  • Medicare Modernization Act; Medicare Part D Prescription Drug Plan  APL 05-012 (PDF)
  • Mifepristone (RU-486) as a Medi-Cal Benefit  APL 01-003 (PDF)
  • Pharmacy Prior Authorization Requests by California Licensed Pharmacists APL 08-013 (PDF)
  • Recombinant Growth Hormone Injections  APL 98-007 (PDF)
  • Requirement to Participate in the Medi-Cal Drug Utilization Review Program APL 17-008 (PDF)
  • Requirement to Use Food and Drug Administration Approved Drugs, Rather Than Compounded Alternatives PL 14-002 (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) Policy Letter 07-006 dated April 2, 2007  PL 07-016 (PDF)

 

Probation

 

Provider Directory & Networks

  • Health Plan Provider Directory Policy, Guidelines and Delivery Standards PL 00-002 (PDF)
  • Managed Care Provider Data Reporting Requirements (Supersedes APL 14-006) APL 16-019 (PDF)    
  • Medi-Cal Managed Care Plan Ongoing Provider File Updates APL 10-006 (PDF) 
  • Medi-Cal Managed Care Plan Ongoing Provider File Submission Requirements APL 14-006 (PDF)    
  • Medi-Cal Managed Care Plan Ongoing Provider File Submission Requirements APL 11-020 (PDF)      
  • Update to Health Plan Provider Directory Policy and Guidelines PL 11-009 (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 APL 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  APL 03-006 (PDF)
  • Implementation of Medi-Cal Managed Care Policy Letter 02-002  APL 02-006 (PDF)
  • Procedures for Submitting QIP Documents and New Resources for Plans APL 09-008 (PDF)
  • Quality and Performance Improvement Program  PL 03-001 (PDF)
  • Quality and Performance Improvement Requirements (Supersedes APL 16-018) APL 17-014 (PDF)
  • Quality and Performance Improvement Requirements for 2007  APL 06-010 (PDF)
  • Quality and Performance Improvement Requirements for 2008  APL 07-013 (PDF)
  • Quality and Performance Improvement Requirements for 2009  APL 08-009 (PDF)
  • Quality and Performance Improvement Requirements for 2010  APL 10-001 (PDF)
  • Quality and Performance Improvement Requirements for 2011  APL 11-002 (PDF)
  • Quality and Performance Improvement Requirements for 2012  APL 11-021 (PDF)    
  • Quality and Performance Improvement Requirements (Supersedes APL 14-003) APL 15-024 Revised (PDF)    
  • Quality and Performance Improvement Requirements (Supersedes APL 15-024) APL 16-018 (PDF)
  • Quality & Performance Improvement Program Requirements for 2013 (Supersedes APL 11-021) APL 13-005 (PDF)     
  • Quality and Performance Improvement Program Requirements for 2014 (supersedes APL 13-005) APL 14-003 (PDF)   
  • Site Review  PL 02-002 (PDF - 28.4MB)
  • Use of Services Measures APL 03-015 (PDF)

 

Quality Improvement Projects (QIPs)

  1. Quality and Performance Improvement Requirements for 2007  APL 06-010 (PDF)
  2. Quality and Performance Improvement Requirements for 2008  APL 07-013 (PDF)
  3. Quality and Performance Improvement Requirements for 2009  APL 08-009 (PDF)
  4. Quality and Performance Improvement Requirements for 2010  APL 10-001 (PDF)
  5. Quality and Performance Improvement Requirements for 2011  APL 11-002 (PDF)      
  6. Quality and Performance Improvement Requirements for 2012  APL 11-021 (PDF)    
  7. Quality & Performance Improvement Program Requirements for 2013 (Supersedes APL 11-021) APL 13-005 (PDF)     
  8. Quality and Performance Improvement Program Requirements for 2014 (supersedes APL 13-005) APL 14-003 (PDF)

 

Rates

  • 2009-10 Rates For Hospital Payment for Medi-Cal Post-Stabilization Services  APL 09-013 (PDF)
  • 2009-10 Rates For Non-Contracted Hospital Emergency Inpatient Services  APL 09-012 (PDF)
  • 2010-11 Rates for Emergency Inpatient Services Provided by Out-Of-Network Acute Care Hospitals APL 10-007 (PDF) 
  • 2011-12 Rates for Emergency Inpatient Services Provided by Out-Of-Network Acute Care Hospitals APL 11-016 (PDF)   
  • 2012-13 Rates for Emergency Inpatient Services Provided by Out-Of-Network Acute Care Hospitals APL 12-003 Revised (PDF) 
  • 2010-11 Rates for Post-Stabilization Inpatient Services Provided by Out-of-Network Acute Care Hospitals APL 10-008 (PDF) 
  • 2011-12 Rates for Post-Stabilization Inpatient Services Provided by Out-of-Network Acute Care Hospitals APL 11-017 (PDF) 
  • 2012-13 Rates for Post-Stabilization Inpatient Services Provided by Out-of-Network Acute Care Hospitals APL 12-002 (PDF) 
  • 2012-13 Rates for Post-Stabilization Inpatient Services Provided by Out-of-Network Acute Care Hospitals
    (Supersedes APL 12-002) APL 12-004 Revised (PDF) 
  • Augmented Reimbursement for Family Planning Services APL 10-003 (PDF)
  • Correction to All Plan Letter 10-003 Regarding Augmented Reimbursement for Family Planning Services APL 10-014 (PDF)   
  • Disclosure of Select Provider Contracting Program (SPCP) Rates APL 11-006 (PDF)   
  • Fee-For-Service Reimbursement Rate Assistance  PL 98-008 (PDF)
  • Managed Care Rate Reductions for FY 2008-09; Technical Clarification to All Plan Letter NO. 08-004  APL 08-005 (PDF)
  • Managed Care Rate Reductions for FY 2008-09  APL 08-004 (PDF)
  • Non-Contracted Emergency Room Rate Schedule  APL 03-013 (PDF)
  • Rate Changes for Emergency and Post-Stabilization Services Provided by Out-of-Network “Border” Hospitals Under the Diagnosis Related Group Payment Methodology APL 16-016 (PDF)
  • Rates For Emergency And Post-Stabilization Acute Inpatient Services Provided By Out-Of-Network General Acute Care Hospitals Based On Diagnosis Related Groups Effective July 1, 2013 APL 13-004 (PDF)    
  • Rate Setting: Increased Percentage of Countywide Rates APL 11-015 (PDF)        
  • Reimbursement for Non-contracted Hospital Emergency Inpatient Services APL 08-008 (PDF)
  • Senate Bill (SB) 94 - Family Planning Services  PL 07-018 (PDF)
  • Supplemental Data Request  APL 06-009 (PDF)
    1. APL 06-009 Attachment: California Information Request (Excel)
    2. APL 06-009 Attachment: Lookup Tables (Excel)

 

    Regional Center Consumers

     

    Reimbursement

    • Augmented Reimbursement for Family Planning Services  APL 10-003 (PDF)
    • Correction to All Plan Letter 10-003 Regarding Augmented Reimbursement for Family Planning Services APL 10-014 (PDF)   
    • Conlan v. Bonta; Conlan v. Shewry: Court Ordered Medi-Cal Beneficiary Reimbursement Process  APL 07-002 (PDF - 5.5MB)
    • Medi-Cal Managed Care Health Plan Implementation of Primary Care Provider Assignment and Reimbursement for New Adult Expansion Members  APL 13-022 (PDF) 
    • Reimbursement for Non-contracted Hospital Emergency Inpatient Services APL 08-008 (PDF)

     

    Rogers Amendment

    • The Rogers Amendment and Tertiary Hospitals APL 10-011 (PDF)     
    • Rogers Amendment Data Request APL 10-002 (PDF)  
    • 2010-11 Rates for Emergency Inpatient Services Provided by Out-Of-Network Acute Care Hospitals APL 10-007 (PDF) 
    • 2011-12 Rates for Emergency Inpatient Services Provided by Out-Of-Network Acute Care Hospitals APL 11-016 (PDF)   
    • 2012-13 Rates for Emergency Inpatient Services Provided by Out-Of-Network Acute Care Hospitals APL 12-003 Revised (PDF) 
    • 2010-11 Rates for Post-Stabilization Inpatient Services Provided by Out-of-Network Acute Care Hospitals APL 10-008 (PDF) 
    • 2011-12 Rates for Post-Stabilization Inpatient Services Provided by Out-of-Network Acute Care Hospitals APL 11-017 (PDF) 
    • 2012-13 Rates for Post-Stabilization Inpatient Services Provided by Out-of-Network Acute Care Hospitals APL 12-002 (PDF) 
    • 2012-13 Rates for Post-Stabilization Inpatient Services Provided by Out-of-Network Acute Care Hospitals
      (Supersedes APL 12-002) APL 12-004 Revised (PDF) 

      

    Senior and Persons with Disabilities

    • Changes to the Historical Utilization Data Provided to Medi-Cal Managed Care Health Plans for Seniors and Persons with Disabilities Effective February 1, 2014 PL 14-001 (PDF) 
    • Competency and Sensitivity Training Required In Serving The Needs of Seniors and Persons with Disabilities APL 11-010 (PDF)      
    • Discharge Planning for Cal Mediconnect DPL 16-003 (PDF)
    • Extended Continuity of Care for Seniors and Persons with Disabilities  APL 11-019 (PDF)    
    • Member-Specific Data Files To Be Provided To Plans For New Medi-Cal Only SPD Members  PL 11-003 (PDF)
    • Revision To Policy Letter 11-001 Regarding Requirements for Health Risk Assessment of Medi-Cal Seniors and Persons with Disabilities PL 11-007 (PDF)      
    • Requirements for Health Risk Assessment of Medi-Cal Seniors and Persons with Disabilities (Supersedes PL 14-005) APL 17-013 (PDF)
    • Requirements for Health Risk Assessment of Medi-Cal Seniors and Persons with Disabilities PL 12-004 (PDF)   
    • Requirements for Health Risk Assessment of Medi-Cal Seniors and Persons with Disabilities PL 14-005 (PDF)   

     

    Sexually Transmitted Disease Services

     

    Site Review   

     

    State Hearings

    Third Party Liability

     

    Tobacco

    • Comprehensive Tobacco Cessation Services for Medi-Cal Members: Preventing Tobacco use in Children and Adolescents PL 14-006 (PDF)  
    •  Comprehensive Tobacco Prevention and Cessation Services for Medi-Cal Beneficiaries (Supersedes PL 14-006) APL 16-014 (PDF)
       

    Transgender Services 

    • Ensuring Access to Medi-Cal Services for Transgender Beneficiaries (Supersedes APL 13-011) APL 16-013 (PDF)
    • Ensuring Access to Transgender Services APL 13-011 (PDF)   

     

    Transportation

     

    Utilization Review (UR)

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

       

    Vaccines

     

    Year 2000 (Y2K)


     

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    Last modified on: 11/14/2017 3:47 PM