​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

Managed Care All Plan Letters - 1998 to Current

2018 | 2017 | 2016 | 2015 | 2014 | 2013 | 2012 | 2011 | 2010 | 2009 | 2008 | 2007 | 2006 | 2005 | 2004 | 2003 | 2002 | 2001 | 2000 | 1999 | 1998



2021 - All Plan Letters



Letter NumberTitle (Subject) of LetterDate of Issue
APL 21-001​
2021-2022 Medi-Cal Managed Care Health Plan Meds/834 Cutoff and Processing Schedule
01/07/2021​
​​APL 21-002
​Cost Avoidance and Post-Payment Recovery for Other Health Coverage
(Supersedes Policy Letter 08-011)
​02/25/2021

Revised
07/14/2021​


​APL 21-003
​Medi-Cal Network Provider and Subcontractor Terminations (Supersedes APL 16-001)
​03/03/2021
​​APL 21-004
​Standards for Determining Threshold Languages, Nondiscrimination Requirements, and Language Assistance Services (Supersedes APL 17-011 and Policy Letters 99-003 and 99-004)
​04/08/2021
​APL 21-005​
​California Children’s Services Whole Child Model Program (Supersedes APL 18-023)
​04/15/2021
​​APL 21-006
​Network Certification Requirements (Supersedes APL 20-003)
​04/27/2021
​​APL 21-007
​Third Party Tort Liability Reporting Requirements
(Supersedes APLs 01-002, 11-012 AND 17-021)
AP 21-007 Attachments:
​05/10/2021
​APL 21-008​

​Tribal Federally Qualified Health Center Providers
APL 21-008 Attachments:

05/12/2021

Revised:
09/30/2021
​APL 21-009

​Collecting Social Determinants of Health Data
​08/10/2021
​APL 21-010​ (Revised)
​Medi-Cal COVID-19 Vaccination Incentive Program
APL 21-010 Attachments:
Attachment A: Vaccination Incentive Program - Health Plan Outcome Metrics​
​8/13/2021

Revised:
09/​​24/2021
​​APL 21-011​
​Grievance and Appeals Requirements, Notice and “Your Rights” Templates
(Supersedes APL 17-006)

APL 21-011 Member Notices:

Notice of Action (NOA)
Notice of Appeal Resolution (NAR)
​08/31/2021
​​APL 21-012
​Enhanced Care Management Requirements

​09/15/2021
​APL 21-013
​Dispute Resolution Process Between Mental Health Plans and Medi-Cal Managed Care Health Plans (Supersedes APL 15-007)​
​10/04/2021
​​APL 21-014
​Alcohol and Drug Screening, Assessment, Brief Interventions and Referral to Treatment (Supersedes APL 18-014)

​10/11/2021​
​​APL 21-015
​Benefit Standardization and Mandatory Managed Care Enrollment Provisions of the California Advancing and Innovating Medi-Cal Initiative

​10/18/2021
​

2020 - All Plan Letters​


​
Letter Number
Title (Subject) of LetterDate of Issue
APL 20-001​
2020-2021 Medi-Cal Managed Care Health Plan Meds/834 Cutoff And Processing Schedule​

01/03/2020
​APL 20-002​
​N​on-Contract Ground Emergency Medical Transport Payment Obligations
​01/31/2020
​APL 20-003
​Network Certification Requirements 
(Supersedes APL 19-002)​
APL 20-003 Attachments:
​02/27/2020
​APL 20-004​ (Revised)
​Emergency Guidance for Medi-Cal Managed Care Health Plans in Response to COVID-19 
​06/08/2020

Revised:
09/09/2021
​APL 20-005 ​
​Extension of the Adult Expansion Risk Corridor for State Fiscal Year 2017-18
​03/26/2020
​APL 20-006
​Site Reviews: Facility Site Review and Medical Record Review (Supersedes PLs 14-004 and 03-002, and APL 03-007)​
​03/04/2020
​​APL 20-007 (Revised)

​Policy Guidance for Community-Based Adult Services in Response to COVID-19 Public Health Emergency​

​03/30/2020

Revised: 04/13/2020

​APL 20-008​
​Mitigating Health Impacts of Secondary Stress Due to the COVID-19 Emergency

 


​04/07/2020
​APL 20-009​
​Preventing Isolation of and Supporting Older and Other At-Risk Individuals to Stay Home and Stay Healthy During COVID-19 Efforts
​04/15/2020
APL 20-010
​RETRACTED
​
​APL 20-011 (Revised)
​Governor's Executive Order N-55-20 in Response to COVID-19​

06/12/2020​

Revised 07/08/2021
​APL 20-012
​Private Duty Nursing Case Management Responsibilities tor Medi-Cal Eligible Members Under the Age of 21​
​05/15/2020
​APL 20-013
​Proposition 56 Directed Payments for Family Planning Services​
​05/13/2020
​APL 20-014
​Proposition 56 Value-Based Payment Program Directed Payments​
​05/15/2020
​APL 20-015​
​State Non-Discrimination and Language Assistance Requirements

​06/24/2020
​APL 20-016 (Revised)
​Blood Lead Screening of Young Children (Supersedes APL18-017​)

​09/29/2020

Revised:
11/02/2020
​APL 20-017​
​Requirements for Reporting Managed Care Program Data (Supersedes APLs 14-013 (Revised) and 14-012)​
​10/14/2020
​APL 20-018​
​Ensuring Access to Transgender Services (Supersedes APL16-013)​
​10/26/2020
​APL 20-019
​RETRACTED
​
​APL 20-020​
​Governor’s Executive Order N-01-19, Regarding Transitioning Medi-Cal Pharmacy Benefits from Managed Care to Medi-Cal Rx​
​11/04/2020
​APL 20-021 (Revised)
​Acute Hospital Care at Home

​12/28/2020

Revised 01/19/2021
​APL 20-022​ (Revised)
​COVID-19 Vaccine Administration
​12/28/2020

Revised 09/29/2021​

​
2019 - All Plan Letters

Letter Number Title (Subject) of LetterDate of Issue
Medi-Cal Managed Care Health Plan Guidance on Network Provider Status
01/17/2019
​APL 19-002​Network Certification Requirements (Supersedes APL 18-005)
APL 19-002 Attachments:
​​01/30/2019
​APL 19-003​Providing Informing Materials to Medi-Cal Beneficiaries in an Electronic Format​05/02/2019
​APL 19-004​Provider Credentialing / Recredentialing and Screening / Enrollment (Supersedes APL 17-019)

Medi-Cal Provider Enrollment Frequently Asked Questions​​
​06/12/2019
​APL 19-005

​Federally Qualified Health Centers and Rural Health Clinics Financial Incentive and Pay For Performance Payment Policy

​06/12/2019
​APL 19-006​Proposition 56 Physicians Directed Payments for Specified Services for State Fiscal Years 2017-18 & 2018-19 (Supersedes APL 18-010)​06/13/2019
​APL 19-007​Non-Contract Ground Emergency Medical Transport Payment Obligations for State Fiscal Year 2018-19​06/14/2019
​APL 19-008​​Rate Changed for Emergency and Post-Stabilization Services Provided by Out-of-Network Border Hospitals Under the Diagnosis Related Group Payment Methodology: Outcome of Federal Court Litigation Rejecting A Challenge to State Plan Amendment 15-020 (Supersedes APL 16-016) ​06/18/2019

​APL 19-009 (Revised)​

​Telehealth Services Policy


​08/05/2019

Revised: 03/18/2020

​APL 19-010​Requirements for Coverage of Early and Periodic Screening, Diagnostic, and Treatment Services for 
Medi-Cal Members Under the Age of 21 (Supersedes APL 18-007 and 07-008)
​08/14/2019
​APL 19-011​
​Health Education and Cultural and Linguistic Population Needs Assessment (Supersedes APL 17-002)​09/30/2019
​APL 19-012​​
​Federal Drug Utilization Review Requirements Designed to Reduce Opioid Related Fraud, Misuse and Abuse​09/30/2019

Revised: 11/15/2019
​APL 19-013​
​Proposition 56 Hyde Reimbursement Requirements for Specified Services 

​10/17/2019​
​​APL 19-014​
​Responsibilities for Behavioral Health Treatment Coverage for Members Under the Age of 21 (Supersedes APL 18-006)​
​11/12/2019
​APL 19-015​Proposition 56 Directed Payments for Physician Services (Supersedes APL 19-006)​12/24/2019
​APL 19-016
​Proposition 56 Directed Payments for Developmental Screening Services​12/26/2019
​APL 19-017​Quality and Performance Improvement Requirements (Supersede​s APL 17-014)

​12/26/2019
​APL 19-018 ​Proposition 56 Directed Payments for Adverse Childhood Experiences Screening Services ​12/26/2019

2018​ - All Plan Letters

Letter Number Title (Subject) of LetterDate of Issue
Voluntary Inpatient Detoxification (Supersedes APL 14-005)
01/11/2018
​APL 18-002​
​2018-2019 Medi-Cal Managed Care Health Plan MEDS/834 Cutoff and Processing Schedule
01/11/2018
​APL 18-003​Administrative and Financial Sanctions (Supersedes APL 15-014)​01/25/2018
​APL 18-004​Immunization Requirements (Supersedes PL 96-013 and APL 07-015)​01/31/2018
​APL 18-006​Responsibilities for Behavioral Health Treatment Coverage for Members Under the Age of 21 (Supersedes APL 15-025)​03/02/2018
​APL 18-007​Requirements for Coverage of Early and Periodic Screening, Diagnostic, and Treatment Services for Medi-Cal Members Under the Age of 21 (Supersedes APL 14-017)​03/02/2018
​APL 18-008 (Revised)​Continuity of Care for Medi-Cal Members Who Transition into Medi-Cal Managed Care (Supersedes APL 15-019)

​​03/02/2018

Revised: 12/07/2018

​APL 18-009​Memorandum of Understanding Requirements for Medi-Cal Managed Care Health Plans and Regional Centers (Supersedes APL 15-022)​​​03/02/2018
​APL 18-010​Proposition 56 Directed Payment Expenditures for Specified Services for State Fiscal Year 2017-18​05/01/2018
​APL 18-011​California Children’s Services Whole Child Model Program​06/07/2018
​APL 18-012​Health Homes Program Requirements​06/28/2018
​APL 18-013 ​Hepatitis C Virus Treatment Policy Update (Supersedes APL 15-016)​08/14/2018
​APL 18-014​Alcohol Misuse: Screening and Behavioral Counseling Interventions in Primary Care (Supersedes APL 17-016)​09/14/2018
​APL 18-015

​Memorandum of Understanding Requirements for Medi-Cal Managed Care Plans

APL 18-015 Attachments:

​09/19/2018
​APL 18-016

​Readability and Suitability of Written Health Education Materials (Supersedes APL 11-018)

APL 18-016 Attachments:                  

​10/05/2018
​APL 18-017​Blood Lead Screening of Young Children (Supersedes PL 02-01)​10/22/2018
​APL 18-018​Diabetes Prevention Program​11/16/2018
​APL 18-019

​Family Planning Services Policy for Self-Administered Hormonal Contraceptives

(Supersedes APL 16-003)

​11/21/2018
​APL 18-020​Palliative Care (Supersedes APL 17-015) 12/07/2018
​APL 18-021​2019-2020 Medi-Cal Managed Care Health Plan Meds/834 Cutoff and Processing Schedule​12/19/2018
​APL 18-022​Access Requirements for Freestanding Birth Centers and the Provision of Midwife Services (Supersedes APL 16-017)​12/19/2018
​APL 18-023 

​California Children’s Services Whole Child Model Program (Supersedes APL 18-011)

​12/23/2018

2017​ - All Plan Letters

Letter Number Title (Subject) of LetterDate of Issue
2017-2018 Medi-Cal Managed Care Health Plan MEDS/834 Cutoff And Processing Schedule
01/03/2017
​APL 17-002

​Health Education and Cultural and Linguistic Group Needs Assessment (Supersedes PL10-012)

​02/03/2017
​APL 17-003​Treatment of Recoveries Made by the Managed Care Health Plan of Overpayments to Providers​03/30/2017
​APL 17-004​Subcontractual Relationships and Delegation​04/18/2017
​APL 17-005​Certification of Document and Data Submissions​05/02/2017
​APL 17-006

​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)

Supplement to APL 17-006: Emergency State Fair Hearing Timeframe Changes​

APL 17-006 Member Notices: 
 
1557 Notices
Notice of Action (NOA)
Notice of Appeal Resolution (NAR)
​05/09/2017
​APL 17-007Continuity of Care for New Enrollees Transitioned to Managed Care After Requesting a Medical Exemption and Implementation of Monthly Medical Exemption Review Denial Reporting (Supersedes All Plan Letter 15-001) ​05/11/2017
​APL 17-008​Requirement to Participate in the Medi-Cal Drug Utilization Review Program​05/10/2017
​APL 17-009​Reporting Requirements Related To Provider Preventable Conditions (Supersedes All Plan Letter 16-011)​05/23/2017
​APL 17-010 (Revised)

​Non-Emergency Medical and Non-Medical Transportation Services

06/29/2017

Revised​:

09/08/2020

​APL 17-011​Standards for Determining Threshold Languages and Requirements for Section 1557 of the Affordable Care Act (Supersedes APL 14-008)​06/30/2017
​APL 17-012

​Care Coordination Requirements for Managed Long - Term Services and Supports

(Supersedes APL 14-010)

​07/11/2017
​APL 17-013​Requirements for Health Risk Assessment of Medi-Cal Seniors and Persons with Disabilities (Supersedes PL 14-005)​07/11/2017
​APL 17-014​Quality and Performance Improvement Requirements (Supersedes APL 16-018)​09/11/2017
​APL 17-015​Palliative Care and Medi-Cal Managed Care​10/19/2017
​APL 17-016​Alcohol Misuse: Screening and Behavioral Counseling Interventions in Primary Care (Supersedes APL 14-004)​10/27/2017
​APL 17-017​Long Term Care Coordination and Disenrollment (Supersedes APL 03-003)​​10/27/2017
​APL 17-018​Medi-Cal Managed Care Health Plan Responsibilities for Outpatient Mental Health Services (Supersedes APL 13-021)​​​10/27/2017
​APL 17-019

​Provider Credentialing / Recredentialing and Screening / Enrollment (Supersedes APL 16-012)

​11/14/2017
​APL 17-020

​American Indian Health Programs

​12/15/2017

Revised: 09/30/2021​​

​APL 17-021​Workers’ Compensation – Notice of Change to Workers’ Compensation Recovery Program; Reporting and Other Requirements (Supersedes APL 04-004)​12/26/2017

2016​ - All Plan Letters​

Letter Number Title (Subject) of LetterDate of Issue
Medi-Cal Provider and Subcontract Suspensions, Terminations, and Decertifications (Supersedes APL 06-007) 
01/08/2016
​APL 16-002   ​2016-2017 Medi-Cal Managed Care Health Plan MEDS/834 Cutoff and Processing Schedule​01/19/2016
​APL 16-003​Family Planning Services Policy for Contraceptive Supplies

​02/05/2016

Revised:
12/23/2016
​APL 16-004     ​Medi-Cal Managed Care Health Plans Carved-Out Drugs (Supersedes APL 03-004)​02/19/2016
​APL 16-005

​Requirements for Use of Non-Monetary Member Incentives for Incentive Programs, Focus Groups, and Member Surveys (Supersedes Policy Letters 09-005 and 12-002)

​02/25/2016

Revised:
11/23/2016
​APL 16-006  ​End of Life Option Act​06/08/2016
​APL 16-007    ​Designated Public Hospitals: Billing for Beneficiaries with California Children's Services Eligible Conditions and/or Medi-Cal Managed Care (Supersedes APL 15-011)​07/18/2016
​APL 16-008    ​Diagnosis Related Groups: Billing for Beneficiaries with California Children's Services Eligible Conditions and/or Medi-Cal Managed Care (Supersedes APL 13-012)​07/18/2016
​APL 16-009 ​Adult Immunizations as a Pharmacy Benefit 

​08/31/2016

Revised: 12/23/2016

APL 16-010​Medi-Cal Managed Care Health Plan Pharmaceutical Formulary Comparability Requirement​09/06/2016
APL 16-011​Reporting Requirements Related to Provider Preventable Conditions (Supersedes APL 15-006)​09/20/2016
​APL 16-012​Provider Credentialing and Recredentialing (Supersedes PL 02-003)​09/27/2016
​APL 16-013)​Ensuring Access to Medi-Cal Services for Transgender Beneficiaries (Supersedes APL 13-011)
 
​10/06/2016
​APL 16-014​Comprehensive Tobacco Prevention and Cessation Services for Medi-Cal Beneficiaries (Supersedes PL 14-006)​11/30/2016
​APL 16-015​Acupuncture Services​12/01/2016
​APL 16-016​Rate Changes for Emergency and Post-Stabilization Services Provided by Out-of-Network “Border” Hospitals Under the Diagnosis Related Group Payment Methodology​12/07/2016
​APL 16-017​Provision of Certified Nurse Midwife and Alternative Birth Center Facility Services (Supersedes APL 15-017)​12/09/2016
​APL 16-018​Quality and Performance Improvement Requirements (Supersedes APL 15-024)​12/22/2016
​APL 16-019   ​Managed Care Provider Data Reporting Requirements (Supersedes APL 14-006)  ​12/28/2016

2015​ - All Plan Letters

Letter Number Title (Subject) of LetterDate of Issue
Continuity of Care for New Enrollees Transitioned to Managed Care After Requesting a Medical Exemption
Superseded by APL 17-007
01/14/2015
​APL 15-002     ​Multipurpose Senior Services Program Complaint, Grievance, Appeal, and State Hearing Responsibilities in Coordinated Care Initiative Counties​01/22/2015
​APL 15-003   ​Podiatric and Chiropractic Services at Federally Qualified Health Centers and Rural Health Clinics​01/26/2015
​APL 15-004   ​Medi-Cal Managed Care Health Plan Requirements for Nursing Facility Services in Coordinated Care Initiative Counties For Beneficiaries not Enrolled in Cal Mediconnect​02/12/2015
​APL 15-005  ​Data Request Requirements for Child Health Disability Prevention Report Contained in Policy Letter 10-013 (Supersedes PL 10-013)​02/12/2015
​APL 15-006  ​Reporting Requirements Related to Provider Preventable Conditions
(Supersedes APL 13-007)		​03/11/2015
​APL 15-007    ​Dispute Resolution Process for Mental Health Services​04/01/2015
​APL 15-008    ​Professional Fees for Office Visits Associated with Alcohol and Substances Use Disorder Treatment Services​04/16/2015
​APL 15-009    ​Proper Use and Billing for Makena (Supersedes APL 13-016)​04/16/2015
​APL 15-010​Affordable Care Act Section 1202 Increased Payments for Medi-Cal Primary Care Services – Revised Guidance and Contractual Requirements​05/01/2015
​APL 15-011   ​Designated Public Hospitals: Billing for Beneficiaries with California Children's Services Eligible Conditions and/or Medi-Cal Managed Care​05/11/2015
​APL 15-012   ​Dental Services - Intravenous Sedation and General Anesthesia Coverage
(Supersedes Policy Letter 13-002)
05/12/2015
                 
Revised:
8/21/2015
APL 15-013​Requirements for Medi-Cal Managed Care Health Plans and Qualified Agency Contract​05/22/2015
​APL 15-014   ​Administrative and Financial Sanctions​06/12/2015
​APL 15-015  Physical Health Care Covered Services Provided for Members Who Are Admitted to Inpatient Psychiatric Facilities​​06/12/2015
​APL 15-016  ​Hepatitis C Virus Treatment Policy Update​06/29/2015
​APL 15-017​Provision of Certified Nurse Midwife and Alternative Birth Center Facility Services​06/30/2015
​APL 15-018  ​Criteria for Coverage of Wheelchairs and Applicable Seating and Positioning Components​07/09/2015
​APL 15-019

​Continuity of Care for Medi-Cal Beneficiaries who Transition into Medi-Cal Managed Care

(Supersedes APL 14-021)

​08/26/2015
​APL 15-020    ​Abortion Services (Supersedes PL 99-08)​09/30/2015
​APL 15-021 ​General Acute Care Inpatient Services:  Claiming for Beneficiaries Covered by Medi-Cal Managed Care and Medi-Cal Diagnosis Related Group Fee-For-Service ​10/01/2015
​APL 15-022  ​Memorandum of Understanding Requirements for Medi-Cal Managed Care Health Plans and Regional Centers ​10/02/2015
​APL 15-023   ​Facility Site Review Tools for Ancillary Service and Community-Based Adult Services Providers​10/28/2015
​APL 15-024    ​Quality and Performance Improvement Requirements (Supersedes APL 14-003)

​11/16/2015

Revised:
12/10/2015
​APL 15-025    ​Responsibilities for Behavioral Health Treatment Coverage for Children Diagnosed with Autism Spectrum Disorder (Supersedes APL 14-011)​12/03/2015
​APL 15-026   ​Actions Required Following Notice of a Credible Allegation of Fraud​12/30/2015

2014​ - All Plan Letters

Letter Number Title (Subject) of LetterDate of Issue

APL 14-001   

2014-2015 Medi-Cal Managed Care Health Plan MEDS/834 Cutoff and Processing Schedule

01/03/2014

APL 14-002  Summary of 2013 Chaptered Legislation Impacting or of Interest to Medi-Cal Managed Care Health Plans

01/13/2014

APL 14-003   Quality and Performance Improvement Program Requirements for 2014

01/14/2014

APL 14-004  Screening, Brief Intervention, and Referral to Treatment for Misuse of Alcohol

02/10/2014

APL 14-005   New Benefit - Voluntary Inpatient Detox

03/11/2014

APL 14-006   Ongoing Provider File Submission Requirements (Supersedes APL 11-020)

03/12/2014

APL 14-007   Dual-Eligible Special Needs Plans

 06/26/2014 

APL 14-008Standards for Determining Threshold Languages

07/10/2014
Revised:
8/27/2014

APL 14-009

Transition of Encounter Data Submission to National Standard Transactions

(ASC X12 837 5010, NCPDP 2.2 or 4.2)

07/30/2014

​APL 14-010   ​Care Coordination Requirements for Managed Long-Term Services and Supports  ​09/10/2014
​APL 14-011   ​Interim Policy for the Provision of Behavioral Health Treatment Coverage for Children Diagnosed with Autism Spectrum Disorder​09/15/2014
​APL 14-012 

​Call Center Report Template

​09/25/2014
​APL 14-013 

​Grievance Report Template

​09/25/2014
Revised:
11/3/2014

​APL 14-014     ​Enrollment Requirements for Dual-Eligible Special Needs Plans in Alameda and Orange Counties​10/10/2014
​APL 14-015   Primary Care Provider Assignment in Medi-Cal Managed Care for Dual-Eligible Beneficiaries​​11/24/2014
​APL 14-016   ​Summary of 2014 Chaptered Legislation Impacting or of Interest to Medi-Cal Managed Care Health Plans​11/24/2014
​APL 14-017   ​Requirements for Coverage of Early and Periodic Screening, Diagnostic, and Treatment Services for Medi-Cal Beneficiaries under the Age of Twenty One12/12/2014​​
​APL 14-018    ​2015-2016 Medi-Cal Managed Care Health Plan MEDS/834 Cutoff and Processing Schedule​12/19/2014
​APL 14-019   ​Encounter Data Submission Requirements​12/19/2014
​APL 14-020    ​Quality Measures for Encounter Data  
APL 14-020 Attachment: DHCS Quality Measures for Encounter Data 

​12/23/2014

Revised:
8/8/2018

​APL 14-021

​Continuity of Care for Medi-Cal Beneficiaries Who Transition into Medi-Cal Managed Care

(Supersedes APL 13-023)

12/​​29/2014

2013​ - All Plan Letters

Letter Number Title (Subject) of LetterDate of Issue

APL 13-001    

Coordination of Benefits: Medicare and Medi-Cal

01/03/2013

APL 13-002   Processing Errors Related to Denied Medical Exemption Requests Regarding Mandatory Enrollment into a Medi-Cal Managed Care Plan

01/23/2013

APL 13-003     Coordination of Benefits: Medicare and Medi-Cal (Supersedes APL 13-001)

02/08/2013

APL 13-004      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

02/12/2013

APL 13-005

Quality & Performance Improvement Program Requirements for 2013 (Supersedes APL 11-021)   

04/12/2013

APL 13-006   Encounter Data Element for Medi-Cal Managed Care Health Plans, Version 2.0.

05/30/2013

APL 13-007    

Reporting Encounter Data Related to Provider Preventable Conditions 

06/25/2013

APL 13-008   Contracts with Dual-Eligible Special Needs Plans    

07/12/2013

APL 13-009   Affordable Care Act (ACA) Section 1202 Final Rule on Increased Payments for Medi-Cal Primary Care Services

10/04/2013

APL 13-010 Managed Care Compliance Plan for Section 1202 of the Affordable Care Act

10/04/2013

APL 13-011    Ensuring Access to Transgender Services

08/25/2013

APL 13-012 Diagnosis Related Groups: Billing for Beneficiaries with California Children's Services Eligible Conditions and/or Medi-Cal Managed Care

10/04/2013

APL 13-013   

Continuity of Care for New Enrollees Transitioned to Managed Care after Requesting a Medical Exemption

Superseded by APL 15-001

10/04/2013

Revised: 4/3/2014

APL 13-014     Hospice Services and Medi-Cal Managed Care

10/28/2013

APL 13-015    Marketing Requirements for Medi-Cal and Covered California

10/29/2013

APL 13-016 Proper use of and Billing for Makena

11/14/2013

APL 13-017 Staying Healthy Assessment/Individual Health Education Behavioral Assessment for Enrollees from Low-Income Health Program

11/18/2013

APL 13-018 Memorandum of Understanding Requirements for Medi-Cal Managed Care Plans

11/27/2013

APL 13-019 Utilization Data File to be Provided to Medi-Cal Managed Care Health Plans for Transitioning Low-Income Health Program Beneficiaries

11/27/2013

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

12/04/2013

APL 13-021   Medi-Cal Managed Care Plan Responsibilities for Outpatient Mental Health Services

12/13/2013

APL 13-022

Medi-Cal Managed Care Health Plan Implementation of Primary Care Provider Assignment and Reimbursement for New Adult Expansion Members

12/24/2013 Revised: 7/25/2014

APL 13-023 Continuity of Care for Medi-Cal Beneficiaries who Transition from Fee-For-Service Medi-Cal into Medi-Cal Managed Care  

12/24/2013

APL 13-024   Designating Non-Qualified Health Plan Medi-Cal Managed Care Plans as Medicaid Certified Application Counselors  

12/30/2013

2012 - All Plan Letters 

Letter Number Title (Subject) of LetterDate of Issue

APL 12-001    

Contracts with Dual-Eligible Special Needs Plans

04/18/2012

APL 12-002  

2012-13 Rates For Post-Stabilization Inpatient Services Provided By Out-Of-Network Acute Care Hospitals

07/05/2012

APL 12-003 Revised 

2012-13 Rates For Emergency-Based Inpatient Services Provided By Out-Of-Network Acute Care Hospitals

07/13/2012

APL 12-004 Revised   

2012-13 Rates For Post-Stabilization Inpatient Services Provided By Out-Of-Network Acute Care Hospitals (Supersedes APL12-002)

07/13/2012

APL 12-0052013-2014 Managed Care Plan MEDS/834 Cutoff and Processing Schedule

12/27/2012

2011 - All Plan Letters 

Letter NumberTitle (Subject) of LetterDate of Issue

APL 11-002   

Quality and Performance Improvement Program Requirements for 2011

01/31/2011

APL 11-005     

Aid Codes 4H and 4L: Identifying Foster Care Children in the California Work Opportunity and Responsibility to Kids (CalWORKS) or 1931(b) Programs

02/10/2011

APL 11-006       

Disclosure of Select Provider Contracting Program Rates 

02/10/2011

APL 11-008

Aid Code 4T: Aid Code to Identify Children in the New Federal KIN-GAP Program

03/08/2011

APL 11​-010

Competency and Sensitivity Training Required in Serving the Needs of Seniors and Persons with Disabilities - RETIRED


APL 11-012  

Reporting Responsibilities Regarding Third-Party Tort Liability

05/23/2011

APL 11-014     

Transition to Update HIPAA Transactions for Enrollment and Premium Payments      

06/10/2011

APL 11-015    

Rate Setting: Increased Percentage of Countywide Rates  

06/20/2011

APL 11-016      

2011-2012 Rates for Emergency-Based Inpatient Services Provided by Out-of-Network Acute Care Hospitals  

07/18/2011

APL 11-017    

2011-2012 Rates for Post-Stabilization Inpatient Services Provided by Out-of-Network Acute Care Hospitals

07/18/2011

APL 11-018    

Readability and Suitability of Written Health Education Materials

08/19/2011

APL 11-019

Extended Continuity of Care for Seniors and Persons with Disabilities  

09/21/2011

APL 11-020    

Medi-Cal Managed Care Plan Ongoing Provider File Submission Requirements

09/21/2011

APL 11-021   

Quality and Performance Improvement Program Requirements for 2012

09/21/2011

APL 11-022     Six New Derivative Foster Care Aid Codes

12/06/2011

APL 11-023     Aid Code 0W

12/06/2011

APL 11-024 

2012-2013 Managed Care Plan MEDS/FAME/5010 834 Cutoff and Processing Schedule

12/27/2011

2010 - All Plan Letters

Letter NumberTitle (Subject) of LetterDate of Issue

APL 10-001   

Quality and Performance Improvement Program Requirements for 2010

03/04/2010

APL 10-002    

Rogers Amendment Data Request

03/22/2010

APL 10-003  

Augmented Reimbursement for Family Planning Services

06/22/2010

APL 10-005    

Financial Reporting Requirements

06/22/2010

APL 10-006    

Medi-Cal Managed Care Plan Ongoing Provider File Updates

07/13/2010

APL 10-007   

2010-11 Rates for Emergency Inpatient Services Provided by Out-Of-Network Acute Care Hospitals

07/06/2010

APL 10-008   

2010-11 Rates for Post-Stabilization Inpatient Services Provided by Out-of-Network
Acute Care Hospitals

07/06/2010

APL 10-009  

Utilization and Payment Data for Safety-Net Providers

07/13/2010

APL 10-010  

Reinstatement of Optometry Services

07/15/2010

APL 10-011   

The Rogers Amendment and Tertiary Hospitals 

09/02/2010

APL 10-014  

Correction to All Plan Letter 10-003 Regarding Augmented Reimburse​ment for Family Planning Services

12/28/2010

APL 10-015  

2011-2012 Managed Care Plans MEDS/FAME/834+Supplemental Cutoff and Processing Schedule 

12/28/2010

2009 - All Plan Letters 

Letter NumberTitle (Subject) of LetterDate of Issue

APL 09-001 

2008 Chaptered Legislation Affecting, or of Interest to Medi-Cal Managed Care Plans

01/14/2009

APL 09-002  

Aid Codes 06 and 46

01/28/2009

APL 09-003

Medi-Cal Managed Care Capitation Report

01/28/2009

APL 09-004

Aid Code 6G

03/16/2009

APL 09-007

List of Contracted Hospitals and Bed Days

06/04/2009

APL 09-008

Procedures for Submitting QIP Documents and New Resources for Plans

06/09/2009

APL 09-009

Indian Health Services

06/11/2009

APL 09-010 

Aid Code 2H

06/22/2009

APL 09-011     

List of Contracted Hospitals and Bed Days

06/22/2009

APL 09-012   

2009-10 Rates For Non-Contracted Hospital Emergency Inpatient Services

06/29/2009

APL 09-013   

2009-10 Rates For Hospital Payment for Medi-Cal Post-Stabilization Services 

06/29/2009

APL 09-014

Exhibit G, Health Insurance Portability and Accountability Act (HIPAA) 

09/29/2009

APL 09-015

2010-2011 Managed Care Plan MEDS/FAME/834+Supplemental Cutoff and Processing Schedule 

12/29/2009

200​8​ - All Plan Letters

Letter NumberTitle (Subject) of LetterDate of Issue

APL 08-001

Summary of 2007 Chaptered Legislation Affecting, or of Interest to Medi-Cal Managed Care Plans

02/05/2008

APL 08-004

Managed Care Rate Reductions for FY 2008-09

05/12/2008

APL 08-005

Managed Care Rate Reductions for FY 2008-09; Technical Clarification to All Plan Letter NO. 08-004

06/18/2008

APL 08-006

Interim Procedures Until Execution of New EQRO Contract

06/30/2008

APL 08-007

Requirements for Employee Education Regarding False Claims Recovery

07/01/2008

APL 08-008

Reimbursement for Non-contracted Hospital Emergency Inpatient Services

10/02/2008

APL 08-009

Quality and Performance Improvement Requirements for 2009

10/27/2008

APL 08-010

Hospital Payment for Post Medi-Cal Post-Stabilization Services

11/10/2008

APL 08-012

2009-2010 Managed Care Plan MEDS/FAME/834+Supplemental Cutoff and Processing Schedule

12/08/2008

2007 - All Plan Letters

 Letter NumberTitle (Subject) of LetterDate of Issue

APL 07-001

Conversion to Electronic Filing of Financial Reports

05/18/2007

APL 07-002

Conlan v. Bonta: Conlan v. Shewry: Court Ordered Medi-Cal Beneficiary Reimbursement Process

01/31/2007

APL 07-003

Federal Deficit Reduction Act of 2005 (Reimbursement for Non-Contracted Emergency Services Providers)

03/16/2007

APL 07-004

Summary of 2006 Chaptered Legislation Affecting, or of Interest to, Medi-Cal Managed Care Plans

02/13/2007

APL 07-005

Implementation of NPI Update

05/18/2007

APL 07-007

Federal Deficit Reduction Act of 2005 (Employee Education About False Claims)

03/09/2007

APL 07-008

Topical Fluoride Varnish

04/18/2007

APL 07-009

New Financial Reporting Requirements

05/14/2007

APL 07-011

Update on California Department of Health Services Reorganization

06/06/2007

APL 07-012

Identification of Regional Center Consumers

08/24/2007

APL 07-013 

Quality and Performance Improvement Program Requirements for 2008

09/25/2007

APL 07-014

Hospice Services and Medi-Cal Managed Care

10/12/2007

APL 07-015

Human Papillomavirus Vaccine

10/18/2007

APL 07-017

Federal Deficit Reduction Act of 2005, Section 6036 (Citizenship Verification Requirement)

11/06/2007

APL 07-019

2008-2009 Managed Care Plan MEDS/FAME/834+Supplemental Cutoff and Processing Schedule

12/20/2007

APL 07-020

Medi-Cal Billing Restriction on the Use of Social Security Numbers

12/26/2007

2006 - All Plan Letters

Letter NumberTitle (Subject) of LetterDate of Issue

APL 06-001

HIPAA Requirements: Notice of Privacy Practices and Notification of Breaches

04/13/2006

APL 06-002

MEDICARE PART D UPDATE

06/21/2006

APL 06-003

MEDICARE PART D UPDATE

06/21/2006

APL 06-004

National Provider Identifier (NPI)

06/14/2006

APL 06-005

Protected Health Information (PHI) and Notification of Breaches

08/03/2006

APL 06-006

Update to All Plan Letter 06-04 re: Implementation of the National Provider Identifier (NPI)

09/08/2006

APL 06-007

Termination of Subcontracting Relationships

09/18/2006

APL 06-008

Contraceptive Devices

10/26/2006

APL 06-009

Supplemental Data Request                

10/23/2006

APL 06-010

Quality and Performance Improvement Requirements for 2007

11/30/2006

APL 06-011

Same Day Banking

11/01/2006

APL 06-012

2007-2008 Managed Care Plan MEDS/FAME Cutoff and Processing Schedule

12/06/2006

2005 - All plan letters

Letter NumberTitle (Subject) of LetterDate of Issue

APL 05-001

Summary of 2003 and 2004 Chaptered Legislation Impacting or of Interest to Medi-Cal Managed Care Plans

01/06/2005

APL 05-002

New Process for Transmitting Enrollment/Disenrollment Data

03/28/2005

APL 05-003

Hospice Services and Medi-Cal Managed Care

03/25/2005

APL 05-004

Personal Injury Inquiry Letter

04/11/2005

APL 05-006

HIPAA Requirements:  Plans’ Reporting Responsibilities

05/02/2005

APL 05-007

Erectile Dysfunction Treatment for Known Sex Offenders

06/13/2005

APL 05-008

Review and Analysis of Financial Status of Health Plans Proposed Request for Funding Augmentations

10/18/2005

APL 05-009

Carve out Erectile Dysfunction Drugs

11/18/2005

APL 05-010

Advance Directive Form

11/23/2005

APL 05-011

2005-2006 Managed Care Plan (MCP) MEDS/FAME Cutoff and Processing Schedule

no date

APL 05-012

Medicare Modernization Act; Medicare Part D Prescription Drug Plan

12/14/2005

APL 05-013

Medicare Modernization Act; Medicare Part D Implementation System Changes

12/29/2005

APL 05-014

Summary of 2005 Chaptered Legislation Impacting or of Interest to Medi-Cal Managed Care Plans

12/30/2005

2004 - All Plan Letters

Letter NumberTitle (Subject) of LetterDate of Issue

APL 04-001

2004 Managed Care Plan (MCP) MEDS/FAME Cut-off and Processing Schedule

02/02/2004

APL 04-002

Recovery of Capitation Paid to Health Care Plans for Deceased Beneficiaries

04/27/2004

APL 04-003

Medi-Cal Providers on Probation

04/30/2004

APL 04-004

Workers’ Compensation (WC)- Notice Award of New Workers’ Compensation Recovery Program (WCRP) Contractor; Reporting and Other Requirements

07/13/2004

APL 04-005

Implementation of New Enrollment Forms

07/15/2004

APL 04-006

SB 59 (Stats. 1999, Chapter 539) Required Notices of Action

11/01/2004

APL 04-007

Implementation of New Enrollment Forms

10/29/2004

APL 04-008

2004-2005 Managed Care Plan (MCP) MEDS/FAME Cut-off and Processing Schedule

12/16/2004

2003 - All Plan Letters

Letter NumberTitle (Subject) of LetterDate of Issue

APL 03-001

Default Assignment of Beneficiaries

01/17/2003

APL 03-002

SB 87 Medi-Cal Contact Information Release Form

01/31/2003

APL 03-003

LTC Guidelines/Policy Letters GMC/Two Plan Letter

02/03/2003

APL 03-004

Medi-Cal Managed Care Health Plan Capitated and Non-Capitated Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) and Antipsychotic Drugs

04/07/2003

APL 03-005

Medi-Cal Intercounty Transfers

05/20/2003

APL 03-006

Facility Site Review Clarification #2

06/23/2003

APL 03-007

Certified Quality Provider Site Certificate

06/23/2003

APL 03-008

Quarterly Submission of Grievance Logs

07/07/2003

APL 03-009

Implementation of Expedited State Hearings

08/27/2003

APL 03-010

Medi-Cal Managed Care Plan Requirements for Provision of Contraceptive Drug Services and Supplies

09/12/2003

APL 03-011

Fraud Referral Procedure to Audits and Investigations (A&I)

10/22/2003

APL 03-012

Medi-Cal Providers on Probation

10/24/2003

APL 03-013

Non Contracted Emergency Room Rate Schedule

12/12/2003

APL 03-014

Delmarva Foundation for Medical Care, Inc.

12/12/2003

APL 03-015

Use of Services Measures

12/17/2003

2002 - All Plan Letters

Letter NumberTitle (Subject) of LetterDate of Issue

APL 02-001

Medi-Cal HIV/AIDS Home and Community Based Services Waiver Program

07/19/2002

APL 02-002

Possible Movement of Fame Files from the CA Health and Human Services (CalHHS) Data Center to the Medi-Cal Web Site​

03/15/2002

APL 02-003

Cultural and Linguistic Contractual Requirements: Threshold and Concentration Standard Languages Update

07/07/2002

APL 02-004

Health Plan Employer Data and Information Set (HEDIS) and Consumer Assessment of Health Plans (CAHPS) Reports Are Now Available on the DHCS Internet Site

06/11/2002

APL 02-005

Emergency Services Medical Claim Coding and Documentation Guidelines

08/07/2002

APL 02-006

Implementation of Medi-Cal Managed Care Policy Letter 02-02

09/25/2002

APL 02-007

Summary of 2002 Chaptered Legislation for Medi-Cal Managed Care Plans

11/12/2002

APL 02-008

External Accountability Set (EAS) Performance Measure Audits

11/26/2002

APL 02-009

2003 Managed Care Plan (MCP) MEDS/FAME Cut-off and Processing Schedule

12/27/2002

2001 - All Plan Letters

Letter NumberTitle (Subject) of LetterDate of Issue

APL 01-001

Summary of 2000 Chaptered Legislation Impacting or of Interest to Medi-Cal Managed Care Plans

01/16/2001

APL 01-002

Reporting and Other Requirements Regarding Workers’ Compensation Recovery

02/21/2001

APL 01-003

Mifepristone (RU-486) As a Medi-Cal Benefit

07/25/2001

APL 01-004

Health Plan Choice Reminders (Annual Renotifications)

08/21/2001

APL 01-005

Implementation of a New Process Which Will Reject Encounter Data At Record Level

11/26/2001

APL 01-006

2002 Managed Care Plan (MCP) MEDS/FAME Cut-off and Processing Schedule

12/24/2001

APL 01-007

Summary of 2001 Chaptered Legislation Impacting or of Interest to Medi-Cal Managed Care Plans

12/17/2001

APL 01-008

Breast and Cervical Cancer Treatment Program

12/17/2001

2000 - All Plan Letters

Letter NumberTitle (Subject) of LetterDate of Issue

APL 00-001

2000 Managed Care Plan (MCP) MEDS/FAME Cut-off and Processing Schedule 

02/03/2000

APL 00-002

Medi-Cal Managed Care Medical Exemptions

02/29/2000

APL 00-003

Policy and Procedure Revisions

03/07/2000

APL 00-004

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)

04/14/2000

APL 00-005

Invitation to All Plan Meeting on Year 2000 Proposed Contract Amendments

05/09/2000

APL 00-006

Maximus Warehouse Relocation

06/05/2000

APL 00-007

Potential Increase in New Enrollees Due to Changes in the Section 1931(b) Program

07/05/2000

APL 00-008

Importance of Increased Outreach to New Eligibles Under the Section 1931(b) Program

08/15/2000

APL 00-009

Percent of Poverty Population

09/15/2000

APL 00-010

Draft 2000 Medi-Cal Managed Care Contract Amendments Package 00-01

09/13/2000

APL 00-011

Ensuring Beneficiaries Receive Laboratory Services From CLIA Certified Laboratories

10/17/2000

APL 00-012

Utilization Review of Initial Risk Assessments for Pregnant Women

12/22/2000

APL 00-013

Amended Regulations for Enrollment and Disenrollment for Two-Plan Model Plans

12/28/2000

APL 00-014

2001 Managed Care Plan (MCP) MEDS/FAME Cut-off and Processing Schedule

12/29/2000

1999 - All Plan Letters

​Letter NumberTitle (Subject) of LetterDate of Issue

APL 99-001

Managed Care Plan Utilization of Therapeutic Pharmaceutical Agents-Certified Optometrists

01/21/1999

APL 99-002

1999 Managed Care Plan (MCP) MEDS/FAME Cut-off and Processing Schedule

01/21/1999

APL 99-003

Year 2000 Readiness Certification and Business Continuation Plan

01/27/1999

APL 99-004

New Laws from the 1997-98 Session of the California Legislature Affecting the Medi-Cal Program

02/17/1999

APL 99-005

Cultural Competency in Health Care - Meeting the Needs of a Culturally and Linguistically Diverse Population

04/02/1999

APL 99-006

Encounter Data Work Group

 4/28/1999

APL 99-007

Medi-Cal Managed Care Health Education Work Group and the “Staying Healthy” Assessment Subcommittee

06/01/1999

APL 99-008

Updates to Managed Care Data Dictionary

07/14/1999

APL 99-009

Draft 1999 Medi-Cal Managed Care Contract Amendments

07/26/1999

APL 99-010

Status of the Conversion to the Fiscal Intermediary Access to Medi-Cal Eligibility

08/03/1999

APL 99-011

New Medi-Cal Managed Care Exemption Forms

08/03/1999

APL 99-012

Revision to All Plan Letter 99003 Re: Year 2000 Readiness

10/08/1999

APL 99-013

Concurrent Participation in the Medi-Cal Managed Care Program and the Multipurpose Senior Services Program

10/20/1999

APL 99-014

Summary of 1999 Chaptered Legislation Impacting or of Interest to Medi-Cal Mana​​​ged Care Plans

12/01/1999

APL 99-015

Emergency Services Claims

12/06/1999

APL 99-016

Year 2000 Contingency Plan Update

12/16/1999

199​​8​ - All Plan Letters

Letter Number Title (Subject) of LetterDate of Issue

APL 98-003

1998 Managed Care Plan (MCP) MEDS/FAME Cut-off and Processing Schedule

02/20/1998

APL 98-006

California Children Services Numbered Letters 01-0298 and 09-0598

07/28/1998

APL 98-007

Recombinant Growth Hormone Injections 

03/27/1998

APL 98-009

AID Code 38

11/25/1998

 

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Last modified date: 10/19/2021 10:20 AM