Home Forms, Laws, and Publications  Managed Care All Plan & Policy Letters – Subject Listing 

Managed Care 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
    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

Adult Expansion

  • Extension of the Adult Expansion Risk Corridor for State Fiscal Year 2017-18
    APL 20-005 (PDF)

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

  • Dyadic Services and Family Therapy Benefit
    APL 22-029 (PDF)
  • Interim Policy for the Provision of Behavioral Health Treatment Coverage for Children Diagnosed with Autism Spectrum Disorder
    APL 14-011 (PDF)   
  • Medi-Cal Managed Care Health Plan Responsibility to Provide Services to Members with Eating Disorders
    APL 22-003 (PDF)
  • Responsibilities for Behavioral Health Treatment Coverage for Children Diagnosed with Autism Spectrum Disorder (Supersedes APL 14-011)
    APL 15-025 (PDF)   

  • Responsibilities for Behavioral Health Treatment Coverage for Members Under the Age of 21 (Supersedes APL 19-014)
    APL 23-010 (PDF)


  • Responsibilities for Behavioral Health Treatment Coverage for Members Under the Age of 21 (Supersedes APL 18-006)
    APL 19-014 (PDF)


  • Responsibilities for Behavioral Health Treatment Coverage for Members Under the Age of 21 (Supersedes APL 15-025)
    APL 18-006 (PDF)

  • Student Behavioral Health Incentive Program
    APL 23-035 (PDF)
  • Voluntary Inpatient Detoxification (Supersedes APL 14-005)
    APL 18-001 (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)
  • Requirements for Timely Payment of Claims
    APL 23-020 (PDF)
  • Treatment of Recoveries Made by the Managed Care Health Plan of Overpayments to Providers (Supersedes APL 17-003)
    APL 23-011 (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

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

CalAIM

  • California Advancing and Innovating Medi-Cal Incentive Payment Program (Supersedes APL 21-016)
    APL 23-003
  • California Advancing and Innovating Medi-Cal Incentive Payment Program APL 21-016, Attachment 1:
    Measures Reporting Template
  • Community Supports Requirements
    APL 21-017 (PDF)
  • Intermediate Care Facilities for Individuals with Developmental Disabilities — Long Term Care Benefit Standardization and Transition of Members to Managed Care
    APL 23-023 (PDF)
  • Interoperability and Patient Access Final Rule
    APL 22-026(PDF)
  • Medi-Cal Justice-Involved Reentry Initiative-Related State Guidance
    APL 23-030 (PDF)
  • Skilled Nursing Facilities — Long Term Care Benefit Standardization and Transition of Members to Managed Care (Supersedes APL 22-018)
    APL 23-004 (PDF)
  • Skilled Nursing Facilities — Long Term Care Benefit Standardization and Transition of Members to Managed Care
    APL 22-018 (PDF)
  • Subacute Care Facilities — Long Term Care Benefit Standardization and Transition of Members to Managed Care
    APL 23-027 (PDF)

Call Center

Cal MediConnect 

Capitation

Certified Nurse Midwife

  • Access Requirements for Freestanding Birth Centers and the Provision of Midwife Services (Supersedes APL 16-017)
    APL 18-022 (PDF)
  • 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 (Supersedes APL18-017)
    APL 20-016 (Revised) (PDF)
  • Blood Lead Screening of Young Children (Supersedes PL 02-01)
    APL 18-017 (PDF)
  • Blood Lead Screening of Young Children 
    PL 02-01 (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)
  • California Children’s Services Whole Child Model Program (Supersedes APL 21-005)
    APL 23-034 (PDF)
  • California Children’s Services Whole Child Model Program (Supersedes APL 18-023)
    APL 21-005 (PDF)
  • California Children’s Services Whole Child Model Program
    APL 18-011 (PDF) 
  • California Children’s Services Whole Child Model Program (Supersedes APL 18-011) APL 18-023 (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)  
  • Private Duty Nursing Case Management Responsibilities tor Medi-Cal Eligible Members Under the Age of 21
    APL 20-012 (PDF)

Clinical Laboratories Improvements Amendments of 1988

  • Ensuring Beneficiaries Receive Laboratory Services From Clinical Laboratories Improvements Amendments of 1988 (CLIA) Certified Laboratories
    APL 00-011 (PDF) 

Community Advisory Committee

Community-Based Adult Services 

  • Community-Based Adult Services Emergency Remote Services (Supersedes APL 20-007)
    APL 22-020 (PDF)

  • Policy Guidance for Community-Based Adult Services in Response to COVID-19 Public Health Emergency
    APL 20-007 (Revised) (PDF)

Conlan Court Decisions

Continuity of Care

Contraceptive Devices

Corrective Action Plan

 COVID-19

Credentialing

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)
  • Diversity, Equity, and Inclusion Training Program Requirements (Supersedes APL 99-005)
    APL 23-025 (PDF)
  • Health Education and Cultural and Linguistic Population Needs Assessment (Supersedes APL 17-002)
    APL 19-011 (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)
  • Population Needs Assessment and Population Health Management Strategy (Supersedes APL 19-011)
    APL 23-021 (PDF)
  • Standards for Determining Threshold Languages, Nondiscrimination Requirements, and Language Assistance Services (Supersedes APL 17-011 and Policy Letters 99-003 and 99-004)
    APL 21-004 (PDF)
  • 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)
  • State Non-Discrimination and Language Assistance Requirements
    APL 20-015 (PDF)
  • Translation of Written Informing Materials 
    PL 99-004 (PDF)

Data

Dental

DFMC – Delmarva Foundation for Medical Care Inc.

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 (Supersedes DPL 13-004) DPL 15-001 (PDF)  
  • Interdisciplinary Care Team and Individual Care Plan Requirements for Medicare-Medicaid Plans
    DPL 13-004 (PDF)  
  • Performance Improvement Project Requirements (Supersedes DPL 16-001)
    DPL 18-002 (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 (Supersedes PL 02-01)
    APL 18-017 (PDF)
  • Blood Lead Screening of Young Children 
    PL 02-01 (PDF)  
  • Requirements For Coverage of Early and Periodic Screening, Diagnostic, and Treatment Services for Medi-Cal Members Under the Age of 21 (Supersedes APL 19-010)
    APL 23-005 (PDF)
  • 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)
    APL 19-010 (PDF)
  • 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)
    APL 18-007 (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

Emergency Services (ER Care)

End of Life Option Act

Enrollments and Disenrollments

Expedited State Hearing

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

  • Adult and Youth Screening and Transition of Care Tools for Medi-Cal Mental Health Services
    APL 22-028 (PDF)
  • Alcohol and Drug Screening, Assessment, Brief Interventions and Referral to Treatment (Supersedes APL 18-014)
    APL 21-014 (PDF)
  • Alcohol Misuse: Screening and Behavioral Counseling Interventions in Primary Care (Supersedes APL 17-016)
    APL 18-014 (PDF)
  • Alcohol Misuse: Screening and Behavioral Counseling Interventions in Primary Care (Supersedes APL 14-004)
    APL 17-016 (PDF)
  • Cancer Biomarker Testing
    APL 22-010 (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)   
  • Initial Health Appointment (Supersedes APL 13-017 and Policy Letters 13-001 and 08-003)
    APL 22-030 (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)  

Indian Health

Immunization Services

Legislation

  • 2008 Chaptered Legislation Affecting, or of Interest to Medi-Cal Managed Care Plans 
    APL 09-001 (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, Notice and “Your Rights” Templates (Supersedes APL 17-006)
    APL 21-011 (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

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

Low Income Health Program

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

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

  • 2024-2025 Medi-Cal Managed Care Health Plan MEDS/834 Cutoff and Processing Scedule
    APL 25-001 (PDF)
  • 2024-2025 Medi-Cal Managed Care Health Plan MEDS/834 Cutoff and Processing Schedule
    APL 23-033 (PDF)
  • 2023-2024 Medi-Cal Managed Care Health Plan MEDS/834 Cutoff and Processing Schedule
    APL 23-002 (PDF)
  • 2022-2023 Medi-Cal Managed Care Health Plan Meds/834 Cutoff and Processing Schedule
    APL 22-001 (PDF)
  • 2021-2022 Medi-Cal Managed Care Health Plan Meds/834 Cutoff and Processing Schedule
    APL 21-001 (PDF)
  • 2020-2021 Medi-Cal Managed Care Health Plan Meds/834 Cutoff And Processing Schedule
    APL 20-001 (PDF)
  • 2019-2020 Medi-Cal Managed Care Health Plan Meds/834 Cutoff and Processing Schedule
    APL 18-021 (PDF)
  • 2018-2019 Medi-Cal Managed Care Health Plan MEDS/834 Cutoff and Processing Schedule
    APL 18-002 (PDF)
  • 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 (CalHHS) 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 Between Mental Health Plans and Medi-Cal Managed Care Health Plans (Supersedes APL 15-007)
    APL 21-013 (PDF)
  • Dispute Resolution Process for Mental Health Services
    APL 15-007 (PDF)   
  • Medi-Cal Managed Care Health Plan Responsibilities for Non-Specialty Mental Health Services (Supersedes APL 17-018)
    APL 22-006 (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)   
  • Mitigating Health Impacts of Secondary Stress Due to the COVID-19 Emergency
    APL 20-008 (PDF)
    Attachment A:
    Sources of Reference for Negative Outcomes as a Result of Secondary Health Effects
  • No Wrong Door for Mental Health Services Policy
    APL 22-005 (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

  • Responsibilities for Annual Cognitive Health Assessment for Eligible Members 65 Years of Age or Older
    APL 22-025(PDF)
  • Population Health Management Program Guide (Supersedes APLs 17-012 and 17-013)
    APL 22-024 (PDF)
  • 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)
  • Health Homes Program Requirements
    APL 18-012 (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

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

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

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)  
  • Preventing Isolation of and Supporting Older and Other At-Risk Individuals to Stay Home and Stay Healthy During COVID-19 Efforts
    APL 20-009 (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) 
  • Governor’s Executive Order N-01-19, Regarding Transitioning Medi-Cal Pharmacy Benefits from Managed Care to Medi-Cal RX (Supersedes APL 20-020)
    APL 22-012 (PDF)
  • Governor’s Executive Order N-01-19, Regarding Transitioning Medi-Cal Pharmacy Benefits from Managed Care to Medi-Cal Rx
    APL 20-020 (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

Primary Care Physician

  • 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)         
  • Governor’s Executive Order N-01-19, Regarding Transitioning Medi-Cal Pharmacy Benefits from Managed Care to Medi-Cal Rx
    APL 20-020 (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

Provider Participation

Quality and Performance Improvement Program

Quality Improvement Projects

  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)
  • Proposition 56 Behavioral Health Integration Incentive Program
    APL 22-021 (PDF)
  • Proposition 56 Physicians Directed Payments For Specified Services for State Fiscal Years 2017-18 & 2018-19 (Supersedes APL 18-010)
    APL 19-006 (PDF) 
  • Proposition 56 Directed Payments for Physician Services (Supersedes APL 19-015)
    APL 23-019 (PDF)
  • Proposition 56 Physicians Directed Payments For Specified Services (Supersedes APL 19-006)
    APL 19-015 (PDF)
  • Proposition 56 Directed Payment Expenditures for Specified Services for State Fiscal Year 2017-18
    APL 18-010 (PDF)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) APL 19-008 (PDF)
  • Proposition 56 Directed Payments For Private Services (Supersedes APL 19-013)
    APL 23-015 (PDF)
  • Proposition 56 Hyde Reimbursement Requirements for Specified Services
    APL 19-013 (PDF)
  • Directed Payments for Developmental Screening Services (Supersedes APL 19-016)
    APL 23-016 (PDF)
  • Proposition 56 Directed Payments for Developmental Screening Services
    APL 19-016 (PDF) 
  • Directed Payments for Adverse Childhood Experiences Screening Services (Supersedes APL 19-018)
    APL 23-017 (PDF)
  • Proposition 56 Directed Payments for Adverse Childhood Experiences Screening Services
    APL 19-018 (PDF) 
  • Public and Private Hospital Directed Payment Programs for State Fiscal Years 2017-18 and 2018-19, the Bridge Period, and Calendar Year 2021
    APL 21-018 (PDF)
  • 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)
    APL 19-008 (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

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

  • Responsibilities for Annual Cognitive Health Assessment for Eligible Members 65 Years of Age or Older
    APL 22-025(PDF)
  • Population Health Management Program Guide (Supersedes APLs 17-012 and 17-013)
    APL 22-024 (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)      
  • 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

Telehealth

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 Transgender Services (Supersedes APL 16-013)
    APL 20-018 (PDF)
  • 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

  • Utilization Review of Initial Risk Assessments for Pregnant Women 
    APL 00-012 (PDF)
  • Workers’ Compensation – Notice of Change to Workers’ Compensation Recovery Program; Reporting and Other Requirements (Supersedes APL 04-004)
    APL 17-021 (PDF)
  • Workers’ Compensation (WC)- Notice Award of New Workers’ Compensation Recovery Program (WCRP) Contractor; Reporting and Other Requirements 
    APL 04-004 (PDF – 5.9MB)
  • Federal Drug Utilization Review Requirements Designed to Reduce Opioid Related Fraud, Misuse and Abuse (Supersedes APL 19-012)
    APL 23-026 (PDF)
  • Federal Drug Utilization Review Requirements Designed to Reduce Opioid Related Fraud, Misuse and Abuse
    APL 19-012 (Revised) (PDF)

Vaccines

Year 2000