​​​​DRG Important Information

Below you will find important information regarding DRG.

Policy Document  

• Medi-Cal DRG Project Policy Design Document September 2013 (PDF)
• DRG Year 3 HSRV Memorandum June 2015 (PDF)

DRG Monitoring

• Final First Half Year 2016 Access Monitoring Report  March 2016 (PDF)
• Second Half Year 2016 Access Monitoring Report December 2017 (PDF)
• Final First Half Year 2016 Access Monitoring Appendix March 2016 (PDF)
• Review of SFYs 2013-14 and 2014-15 Utilization and Payment July 2017 (PDF)

All Plan Letter (APL)

• APL 19-008 Rate Changed for Out-of-Network Border Hospitals under the DRG Methodology June 2019 (PDF)​
• 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)  JULY 2016 (PDF)
• APL 16-008 Billing for CCS and Managed Care (supersedes APL 13-012) JULY 2016 (PDF)
• APL 16-016 Rates Changes for Emergency and Post-Stabilization Services Provided by Out-of-Network "Border" Hospitals Under the Diagnosis Related Group Payment Methodology     December 2016 (PDF)​

Approved State Plan Amendments (SPA) 

• Approved State Plan Amendment 24-0017 (PDF)​
  
• ​Approved State Plan Amendment 23-0014 (PDF)​​​​​​
• Approved State Plan Amendment 22-0029 (PDF)​
• ​​Approved State Plan Amendment 21-0021 (PDF)​
• ​Approved State Plan Amendment 20-0019 (PDF)
• Approved State Plan Amendment 19-0025 (PDF)
• Approved State Plan Amendment 18-013 (PDF)
• Approved State Plan Amendment 17-032 (PDF)
• Approved State Plan Amendment 17-015 (PDF)
• Approved State Plan Amendment 16-011 (PDF)
  
• Approved State Plan Amendment 15-033 (PDF)
• ​Approved State Plan Amendment 15-020 (PDF)
• ​Approved State Plan Amendment 15-014 (PDF)
• ​Approved State Plan Amendment 14-014 (PDF)
• Approved State Plan Amendment 13-033 (PDF)
• ​Approved State Plan Amendment 13-004 (PDF)