Managed Care All Plan & Policy Letters – Subject Listing

All Plan Letters (APLs) and Policy Letters (PLs) are categorized under the headings and subheadings below.

Note: New letters are added periodically. PLs were not issued between 2003 and 2006, and have not been issued since 2014

Financial	Responsibilities	Benefits
Aid Codes Audits Billing Fraud Rates Reimbursement Sanctions Data Medi-Cal Eligibility Data System (MEDS)	Reporting Health Education Facility Site Review Programs and Services Administration and Operations Utilization Review Quality and Performance Improvement HIPAA Enrollment and Disenrollment Dual-Eligible Legislation/Legal	AIDS Children’s Services Dental Services Mental Health Advanced Directives, End of Life, Hospice Behavioral Health Treatment and Autism Spectrum Continuity of Care Cultural and Linguistics Grievances and Appeals Family Planning Immunization Services MSSP Pharmacy and Prescriptions

Aid Codes

Letter Number	Title
APL 11-005 (PDF)	Aid Codes 4H and 4L: Identifying Foster Care Children in the California Work Opportunity and Responsibility to Kids (CalWORKS) or 1931(b) Programs
APL 11-008 (PDF)	Aid Code 4T: Aid Code to Identify Children in the New Federal KIN-GAP Program
APL 11-022 (PDF)	Six New Derivative Foster Care Aid Codes
APL 11-023 (PDF)	Aid Code 0W
APL 09-002 (PDF)	Aid Code 06 and 46
APL 09-004 (PDF)	Aid Code 6G
APL 09-010 (PDF)	Aid Code 2H
APL 98-009 (PDF)	AID Code 38

Audits

Letter Number	Title
PL 01-001 (PDF)	Corrective Action Plan (CAP) Standardized Format
APL 05-008 (PDF)	Review and Analysis of Financial Status of Health Plans Proposed Request for Funding Augmentations

Billing

Letter Number	Title
APL 17-003 (PDF)	Treatment of Recoveries Made by the Managed Care Health Plan of Overpayments to Providers
APL 16-007 (PDF)	Designated Public Hospitals: Billing for Beneficiaries with California Children's Services Eligible Conditions and/or Medi-Cal Managed Care
APL 15-008 (PDF)	Professional Fees for Office Visits Associated with Alcohol and Substances Use Disorder Treatment Services
APL 15-009 (PDF)	Proper Use and Billing for Makena
PL 08-002 (PDF)	Payment of Invoices Beyond the Six-Month Billing Limit
APL 07-001 (PDF)	Conversion to Electronic Filing of Financial Reports
APL 07-005 (PDF)	Implementation of NPI Update
APL 07-020 (PDF)	Medi-Cal Billing Restriction on the Use of Social Security Numbers

Fraud

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

Rates

Letter Number	Title
APL 18-010 (PDF)	Proposition 56 Directed Payment Expenditures for Specified Services for State Fiscal Year 2017-18
APL 16-016 (PDF)	Rate Changes for Emergency and Post-Stabilization Services Provided by Out-of-Network “Border” Hospitals Under the Diagnosis Related Group Payment Methodology
APL 15-010 (PDF - 3.6MB)	Affordable Care Act Section 1202 Increased Payments for Medi-Cal Primary Care Services – Revised Guidance and Contractual Requirements
APL 13-004 (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 13-009 (PDF)	Affordable Care Act (ACA) Section 1202 Final Rule on Increased Payments for Medi-Cal Primary Care Services
APL 13-010 (PDF)	Managed Care Compliance Plan for Section 1202 of the Affordable Care Act
APL 12-003 (PDF)	2012-13 Rates For Emergency-Based Inpatient Services Provided By Out-Of-Network Acute Care Hospitals
APL 12-004 (PDF)	2012-13 Rates For Post-Stabilization Inpatient Services Provided By Out-Of-Network Acute Care Hospitals
APL 11-006 (PDF)	Disclosure of Select Provider Contracting Program Rates
APL 11-015 (PDF)	Rate Setting: Increased Percentage of Countywide Rates
APL 11-016 (PDF)	2011-2012 Rates for Emergency-Based Inpatient Services Provided by Out-of-Network Acute Care Hospitals
APL 11-017 (PDF)	2011-2012 Rates for Post-Stabilization Inpatient Services Provided by Out-of-Network Acute Care Hospitals
APL 10-003 (PDF)	Augmented Reimbursement for Family Planning Services
APL 10-007 (PDF)	2010-11 Rates for Emergency Inpatient Services Provided by Out-Of-Network Acute Care Hospitals
APL 10-008 (PDF)	2010-11 Rates for Post-Stabilization Inpatient Services Provided by Out-of-Network Acute Care Hospitals
APL 09-003 (PDF)	Medi-Cal Managed Care Capitation Report
APL 09-012 (PDF)	2009-10 Rates For Non-Contracted Hospital Emergency Inpatient Services
APL 09-013 (PDF)	2009-10 Rates For Hospital Payment for Medi-Cal Post-Stabilization Services
APL 08-004 (PDF)	Managed Care Rate Reductions for FY 2008-09
APL 08-005 (PDF)	Managed Care Rate Reductions for FY 2008-09; Technical Clarification to All Plan Letter NO. 08-004
APL 03-013 (PDF)	Non Contracted Emergency Room Rate Schedule

Reimbursement

Letter Number	Title
APL 13-003 (PDF)	Coordination of Benefits: Medicare and Medi-Cal
APL 13-022 (PDF)	Medi-Cal Managed Care Health Plan Implementation of Primary Care Provider Assignment and Reimbursement for New Adult Expansion Members
APL 10-014 (PDF)	Correction to All Plan Letter 10-003 Regarding Augmented Reimbursement for Family Planning Services
APL 08-008 (PDF)	Reimbursement for Non-contracted Hospital Emergency Inpatient Services
APL 08-010 (PDF)	Hospital Payment for Post Medi-Cal Post-Stabilization Services
APL 07-003 (PDF)	Federal Deficit Reduction Act of 2005 (Reimbursement for Non-Contracted Emergency Services Providers)
APL 06-011 (PDF)	Same Day Banking
APL 04-002 (PDF - 4.1MB)	Recovery of Capitation Paid to Health Care Plans for Deceased Beneficiaries
PL 98-008 (PDF)	Fee-For-Service Reimbursement Rate Assistance

Sanctions

Letter Number	Title
APL 18-003 (PDF)	Administrative and Financial Sanctions
APL 04-003 (PDF - 7.6MB)	Medi-Cal Providers on Probation
APL 03-012 (PDF)	Medi-Cal Providers on Probation

Data

Letter Number	Title
APL 17-005 (PDF)	Certification of Document and Data Submissions
APL 16-005 (PDF)	Requirements for Use of Non-Monetary Member Incentives for Incentive Programs, Focus Groups, and Member Surveys
APL 16-019 (PDF)	Managed Care Provider Data Requirements
APL 15-005 (PDF)	Data Request Requirements for Child Health Disability Prevention Report Contained in Policy Letter 10-013
APL 14-019 (PDF)	Encounter Data Requirements
APL 14-009 (PDF)	Transition of Encounter Data Submission to National Standard Transactions (ASC X12 837 5010, NCPDP 2.2 or 4.2)
APL 14-020 (PDF)	Quality Measures for Encounter Data APL 14-020 Attachment: DHCS Quality Measures for Encounter Data (PDF)
APL 13-019 (PDF)	Utilization Data File to be Provided to Medi-Cal Managed Care Health Plans for Transitioning Low-Income Health Program Beneficiaries
APL 13-020 (PDF)	Open Authorization and Scheduled Service Information for New Beneficiaries Transitioning from The Low-Income Health Program
APL 10-002 (PDF)	Rogers Amendment Data Request
APL 10-009 (PDF)	Utilization and Payment Data for Safety-Net Providers
APL 07-012 (PDF)	Identification of Regional Center Consumers
APL 06-009 (PDF)	Supplemental Data Request 06-009 Attachment: CA Information Request 06-009 (Excel) Attachment: Lookup Table (Excel)
APL 05-002 (PDF - 2.1MB)	New Process for Transmitting Enrollment/Disenrollment Data
APL 02-004 (PDF)	Health Plan Employer Data and Information Set (HEDIS) and Consumer Assessment of Health Plans (CAHPS) Reports Are Now Available on the DHCS Internet Site
APL 01-005 (PDF - 6.2MB)	Implementation of a New Process Which Will Reject Encounter Data At Record Level
APL 99-003 (PDF)	Year 2000 Readiness Certification and Business Continuation Plan
APL 99-006 (PDF)	Encounter Data Work Group
APL 99-010 (PDF)	Status of the Conversion to the Fiscal Intermediary Access to Medi-Cal Eligibility
APL 99-016 (PDF)	Year 2000 Contingency Plan Update
PL 14-001 (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 01-002 (PDF)	Conversion of MESH to the Medi-Cal Web Site
PL 01-002Rev (PDF)	Errata of Policy Letter 01-001 Dated October 30, 2001
PL 00-004 (PDF)	Plan-Paid Advertising Extended Until January 31, 2001
PL 99-006 (PDF)	Date for Conversion to Fiscal Intermediary Access to Medi-Cal Eligibility Data

Medi-Cal Eligibility Data System (MEDS)

Letter Number	Title
APL 18-002 (PDF)	2018-2019 Medi-Cal Managed Care Health Plan MEDS/834 Cutoff and Processing Schedule
APL 17-001 (PDF)	2017-2018 Medi-Cal Managed Care Health Plan Meds/834 Cutoff And Processing Schedule
APL 16-002 (PDF)	2016-2017 Medi-Cal Managed Care Health Plan MEDS/834 Cutoff and Processing Schedule
APL 14-001 (PDF)	2014-2015 Medi-Cal Managed Care Health Plan Meds/834 Cutoff And Processing Schedule
APL 14-018 (PDF)	015-2016 Medi-Cal Managed Care Health Plan MEDS/834 Cutoff and Processing Schedule
APL 12-005 (PDF)	2013-2014 Managed Care Plan MEDS/834 Cutoff and Processing Schedule
APL 11-024 (PDF)	2012-2013 Managed Care Plan MEDS/FAME/5010 834 Cutoff and Processing Schedule
APL 10-015 (PDF)	2011-2012 Managed Care Plans MEDS/FAME/834+Supplemental Cutoff and Processing Schedule
APL 09-015 (PDF - 2MB)	2010-2011 Managed Care Plan MEDS/FAME/834+Supplemental Cutoff and Processing Schedule
APL 08-012 (PDF)	2009-2010 Managed Care Plan MEDS/FAME/834+Supplemental Cutoff and Processing Schedule
APL 07-019 (PDF)	2008-2009 Managed Care Plan MEDS/FAME/834+Supplemental Cutoff and Processing Schedule
APL 06-012 (PDF)	2007-2008 Managed Care Plan MEDS/FAME Cutoff and Processing Schedule
APL 05-011 (PDF - 2.3MB)	2005-2006 Managed Care Plan (MCP) MEDS/FAME Cutoff and Processing Schedule
APL 05-013 (PDF)	Medicare Modernization Act; Medicare Part D Implementation System Changes
APL 04-001 (PDF)	2004 Managed Care Plan (MCP) MEDS/FAME Cut-off and Processing Schedule
APL 04-008 (PDF)	2004-2005 Managed Care Plan (MCP) MEDS/FAME Cut-off and Processing Schedule
APL 02-009 (PDF)	2003 Managed Care Plan (MCP) MEDS/FAME Cut-off and Processing Schedule
APL 01-006 (PDF)	2002 Managed Care Plan (MCP) MEDS/FAME Cut-off and Processing Schedule
APL 00-001 (PDF - 10.1MB)	2000 Managed Care Plan (MCP) MEDS/FAME Cut-off and Processing Schedule
APL 99-002 (PDF)	1999 Managed Care Plan (MCP) MEDS/FAME Cut-off and Processing Schedule
APL 00-014 (PDF)	2001 Managed Care Plan (MCP) MEDS/FAME Cut-off and Processing Schedule
APL 98-003 (PDF)	1998 Managed Care Plan (MCP) MEDS/FAME Cut-off and Processing Schedule

Reporting

Letter Number	Title
APL 17-009 (PDF)	Reporting Requirements Related To Provider Preventable Conditions
APL 17-021 (PDF)	Workers’ Compensation – Notice of Change to Workers’ Compensation Recovery Program; Reporting and Other Requirements
APL 11-012 (PDF)	Reporting Responsibilities Regarding Third-Party Tort Liability
APL 10-005 (PDF)	Financial Reporting Requirements
APL 09-011 (PDF)	List of Contracted Hospitals and Bed Days
APL 07-009 (PDF)	New Financial Reporting Requirements
APL 05-006 (PDF)	HIPAA Requirements: Plans’ Reporting Responsibilities
APL 03-015 (PDF)	Use of Services Measures
APL 01-002 (PDF - 7.9MB)	Reporting and Other Requirements Regarding Workers’ Compensation Recovery
PL 99-005 (PDF - 3.0MB)	Addendum to Policy Letter 98-03-Conversion to New Eligibility Reporting System
PL 98-003 (PDF)	Conversion to New Eligibility Reporting System

Health Education

Letter Number	Title
APL 16-014 (PDF)	Comprehensive Tobacco Prevention and Cessation Services for Medi-Cal Beneficiaries
APL 13-017 (PDF)	Staying Healthy Assessment/Individual Health Education Behavioral Assessment for Enrollees from Low-Income Health Program
APL 11-018 (PDF)	Readability and Suitability of Written Health Education Materials
APL 99-007 (PDF)	Medi-Cal Managed Care Health Education Work Group and the “Staying Healthy” Assessment Subcommittee
APL 99-008 (PDF)	Updates to Managed Care Data Dictionary
PL 13-001 (PDF)	Requirements for the Staying Healthy Assessment/Individual Health Education Behavioral Assessment
PL 02-004 (PDF)	Health Education

Facility Site Review

Letter Number	Title
APL 15-023 (PDF)	Facility Site Review Tools for Ancillary Service and Community-Based Adult Services Providers
APL 03-006 (PDF)	Facility Site Review Clarification #2
APL 03-007 (PDF)	Certified Quality Provider Site Certificate
APL 02-006 (PDF)	Implementation of Medi-Cal Managed Care Policy Letter 02-02
PL 14-004 (PDF)	Site Reviews: Facility Site Review and Medical Record Review
PL 12-006 (PDF)	Revised Facility Site Review Tool
PL 10-016 (PDF)	Revised Facility Site Review Tool
PL 03-002	Certification of Managed Care Plan Staff Responsible for the Conduct of Primary Care Provider Site Reviews

Last modified date: 3/23/2021 12:50 AM

​​​​​​​​​​​​​​​​​​​​Managed Care All Plan & Policy Letters – Subject Listing

​Aid Codes

​Audits

​Billing

​ Fraud

​ Rates

​ Reimbursement

​Sanctions

​ Data

​Medi-Cal Eligibility Data System (MEDS)

​​ Reporting

​ Health Education

​ Facility Site Review