Managed Care All Plan & Policy Letters – Subject Listing
A – D | E – H | I – L | M – P | Q – T | U – Z
Note: Please check back periodically as new letters are added. Policy Letters are preceded by ‘PL’. Policy Letters were not issued from 2003 – 2006.
Mga Serbisyo sa Aborsyon
- Abortion Services
APL 22-022 (PDF) (Supersedes APL 15-020)
- Abortion Services
APL 15-020 (PDF) (Supersedes PL 99-08) - Abortion Services
PL 99-08 (PDF) - Mifepristone (RU-486) as a Medi-Cal Benefit
APL 01-003 (PDF)
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)
Mga Serbisyo sa Acupuncture
- Acupuncture Services
APL 16-015 (PDF)
Pagpapalawak ng Pang-adulto
- Extension of the Adult Expansion Risk Corridor for State Fiscal Year 2017-18
APL 20-005 (PDF)
Mga Advanced na Direktiba
- Advance Directive Forms
APL 05-010 (PDF – 31.0MB)
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)
Mga Serbisyo sa Matanda-Nakatatanda
- Concurrent Participation in the Medi-Cal Managed Care Program and the Multipurpose Senior Services Program
APL 99-013 (PDF)
Mga Code ng Tulong
- Six New Derivative Foster Care Aid Codes
APL 11-022 (PDF) - Aid Code 0W
APL 11-023 (PDF) - Aid Codes 06 and 46
APL 09-002 (PDF) - Aid Code 2H
APL 09-010 (PDF) - Aid Code 38
APL 98-009 (PDF) - Aid Codes 4H and 4L
APL 11-005 (PDF) - Aid Code 4T
APL 11-008 (PDF) - Aid Code 6G
APL 09-004 (PDF)
Mga susog
- 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)
Mga pagsusuri
- 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)
Pagbabangko
- Same Day Banking
APL 06-011 (PDF)
Paggamot sa Kalusugan ng Pag-uugali
- 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)
R mga responsibilidad para sa Saklaw sa Paggamot sa Kalusugan ng Pag-uugali para sa Mga Miyembrong Wala Pang Edad ng 21 (Supersedes APL 18-006)
APL 19-014 (PDF)
Mga Responsibilidad para sa Saklaw sa Paggamot sa Kalusugan ng Pag-uugali para sa Mga Miyembrong Wala pang 21 taong gulang (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)
Mga Paunawa ng Benepisyaryo
- Conlan v. Bonta; Conlan v. Shewry: Court Ordered Medi-Cal Beneficiary Reimbursement Process
APL 07-002 (PDF – 5.5MB)
Pagsingil
- 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) - Wastong Paggamit ng at Pagsingil para sa 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)
Paggamot sa Kanser sa Dibdib at Cervical
- Breast and Cervical Cancer Treatment Program
APL 01-008 (PDF)
Pagpapasuso
- Breastfeeding Promotion
PL 98-010 (PDF)
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
- Requirements for Reporting Managed Care Program Data (Supersedes APLs 14-013 (Revised) and 14-012)
APL 20-017 (PDF)
- Template ng Ulat ng Call Center APL 14-012 (PDF)
APL 14-012 Attachment: Template ng Ulat ng Call Center (MS Excel)
Cal MediConnect
- Care Plan Option Services (Supersedes DPL 13-006)
DPL 18-003 (PDF) - Care Plan Option Services
DPL 13-006 (PDF) - Complaint and Resolution Tracking
DPL 14-001 (PDF)
DPL 14-001 Attachment B alternate format (Excel) - Discharge Planning for Cal Mediconnect
DPL 16-003 (PDF) - Reporting Encounter Data Related to Provider Preventable Conditions
DPL 15-002 (PDF) - Reporting Requirements Related to Provider Preventable Conditions (Supersedes DPL 15-002)
DPL 17-002 (PDF) - Requirements for Cal MediConnect Medicare-Medicaid Plans and Qualified Agency Contract
DPL 15-004 (PDF)
Capitation
- Medi-Cal Managed Care Capitation Report
APL 09-003 (PDF) - Recovery of Capitation Paid to Health Care Plans for Deceased Beneficiaries
APL 04-002 (PDF – 4.1MB) - Same Day Banking
APL 06-011 (PDF) - Mga Kinakailangan sa Pag-uulat ng Pananagutan ng Third Party na Tort (Supersedes APLs 01-002, 11-012 At 17-021) APL 21-007 (PDF)
- Attachment A: MCP Attestation
- Attachment B: Secure File Transfer Protocol (SFTP) User Manual
- Transition to Updated HIPAA Transactions for Enrollment and Premium Payments
APL 11-014 (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 – 4.9MB)
Sertipikadong Nurse Midwife
- Access Requirements for Freestanding Birth Centers and the Provision of Midwife Services (Supersedes APL 16-017)
APL 18-022 (PDF) - Pagbibigay ng Sertipikadong Nurse Midwife at Alternatibong Serbisyo sa Pasilidad ng Birth Center (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) - Programa ng Modelong Buong Bata California Children's Services (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)
Mga Pagbabago ng Clinical Laboratories ng 1988
- Ensuring Beneficiaries Receive Laboratory Services From Clinical Laboratories Improvements Amendments of 1988 (CLIA) Certified Laboratories
APL 00-011 (PDF)
Komite sa Pagpapayo ng Komunidad
- Community Advisory Committee (CAC)
PL 99-001 (PDF)
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)
Mga Desisyon ng Korte ng Conlan
- Conlan v. Bonta; Conlan v. Shewry: Court Ordered Medi-Cal Beneficiary Reimbursement Process
APL 07-002 (PDF – 5.5MB)
Pagpapatuloy ng Pangangalaga
- Continuity of Care for Medi-Cal Beneficiaries Who Newly Enroll in Medi-Cal Managed Care from Medi-Cal Fee-For-Service, on or After January 1, 2023 (Supersedes APL 22-032)
APL 23-022 (PDF)
- Continuity of Care for Medi-Cal Members Who Transition into Medi-Cal Managed Care (Supersedes APL 15-019)
APL 18-008 (Revised) (PDF) - Continuity of Care for Medi-Cal Beneficiaries Who Transition into Medi-Cal Managed Care (Supersedes APL 14-021)
APL 15-019 (PDF) - Continuity of Care for Medi-Cal Beneficiaries who Transition from Fee-For-Service Medi-Cal into Medi-Cal Managed Care APL 13-023 (PDF) replaced by
APL 14-021 (PDF)
- Continuity of Care for New Enrollees Transitioned to Managed Care after Requesting a Medical Exemption
APL 13-013 (PDF).
APL 13-013 Attachment C MER Denial and Continuity of Care (Excel) - Continuity 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)
APL 17-007 (PDF)
- Continuity of Care
DPL 13-005 (PDF) - Continuity of Care
DPL 14-004 (PDF) (Supersedes DPL 13-005) - Continuity of Care
DPL 15-003 (PDF) (Supersedes DPL 14-004) - Continuity of Care
DPL 16-002 (PDF) Revised (Supersedes DPL 15-003) - Continuity of Care for Medi-Cal Beneficiaries Who Transition into Medi-Cal Managed Care (Supersedes APL 13-023)
APL 14-021 (PDF) - Continuity of Care for New Enrollees Transitioned to Managed Care After Requesting a Medical Exemption (Supersedes APL 13-013)
APL 15-001 (PDF)
APL 15-001 Attachment C Report Template (Excel) - Discharge Planning for Cal Mediconnect
DPL 16-003 (PDF)
- Managed Care Health Plan Transition Policy Guide
APL 23-018 (PDF)
Mga Contraceptive Device
- Contraceptive Devices
APL 06-008 (PDF)
Plano ng Pagwawasto ng Aksyon
- Corrective Action Plan (CAP) Standardized Format
PL 01-001 (PDF)
COVID 19
- COVID-19 Guidance for Medi-Cal Managed Care Health Plans
APL 22-009 (PDF)
- Medi-Cal Covid-19 Vaccination Incentive Program
APL 21-010 (Revised) (PDF), Attachment A Vaccination Incentive Program Outcome Metrics (PDF)
- Emergency Guidance for Medi-Cal Managed Care Health Plans in Response to COVID-19
All Plan Letter 20-004 (Revised) (PDF)
- Governor’s Executive Order N-55-20 in Response to COVID-19
APL 20-011 (PDF) (Revised)
- Acute Hospital Care at Home
APL 20-021 (PDF) (Revised)
COVID-19 Vaccine Administration
APL 20-022 (PDF)
Pagbibigay ng kredensyal
- Credentialing & Re-Credentialing: Time Line Change, New Primary Source Verification Requirements and Verification of Credentials of Non-Physician Practitioners
PL 02-003 (PDF) - Provider Credentialing/Re-Credentialing and Screening/Enrollment (Supersedes APL 19-004)
APL 22-013 (PDF)
APL 22-013 Frequently Asked Questions
- Provider Credentialing / Recredentialing and Screening / Enrollment (Supersedes APL 17-019)
APL 19-004 (PDF) Medi-Cal Provider Enrollment Frequently Asked Questions (PDF)
- Provider Credentialing / Recredentialing and Screening / Enrollment (Supersedes APL 16-012)
APL 17-019 (PDF) Medi-Cal Managed Care Provider Enrollment Frequently Asked Questions (FAQs) (PDF) - Provider Credentialing and Recredentialing (Supersedes PL 02-003)
APL 16-012 (PDF)
Kultura at Linggwistika
- 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
- Certification of Document and Data Submissions
APL 17-005 (PDF)
- Collecting Social Determinants of Health Data
APL 21-009 (PDF)
- Conversion of MESH to the Medi-Cal Web Site
PL 01-002 (PDF) - Data for Conversion to Fiscal Intermediary Access to Medi-Cal Eligibility Data
PL 99-006 (PDF) - Data Request CHDP (Child Health Disability Prevention) Report for FY 2007-2008 and FY 2008-2009
PL 10-013 (PDF) - Data Request Requirements for Child Health Disability Prevention Report Contained in Policy Letter 10-013
APL 15-005 (PDF) - Encounter Data Element for Medi-Cal Managed Care Health Plans, Version 2.0.
APL 13-006 (PDF) - Encounter Data Submission Requirements
APL 14-019 (PDF) - Encounter Data Work Group
APL 99-006 (PDF) - Errata of Policy Letter 01-01 dated October 30, 2001
PL 01-002 Rev (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 02-004 (PDF) - Implementation of a New Process Which Will Reject Encounter Data At Record Level
APL 01-005 (PDF – 6.2MB) - List of Contracted Hospitals and Bed Days
APL 09-011 (PDF) - Mandatory Signatories to the California Health and Human Services Agency Data Exchange Framework
APL 23-013 (PDF)
- Medi-Cal Managed Care Plan Ongoing Provider File Updates
APL 10-006 (PDF) - New Process for Transmitting Enrollment/Disenrollment Data
APL 05-002 (PDF – 2.1MB) - Possible Movement of FAME Files from the CA Health and Services Data Center to the Medi-Cal Website
APL 02-002 (PDF) - Quality Measures for Encounter Data
APL 14-020 (PDF)
1.
DHCS Quality Measures for Encounter Data (PDF – 3.0MB) - Reporting Encounter Data Related to Provider Preventable Conditions
APL 16-011 (PDF)
(supersedes APL 15-006) - Reporting Encounter Data Related to Provider Preventable Conditions
APL 15-006 (PDF)
(supersedes APL 13-007) - Reporting Encounter Data Related to Provider Preventable Conditions
APL 13-007 (PDF) - Reporting Encounter Data Related to Provider Preventable Conditions
DPL 15-002 (PDF) - Reporting Requirements Related To Provider Preventable Conditions (Supersedes All Plan Letter 16-011)
APL 17-009 (PDF) - Reporting Requirements Related to Provider Preventable Conditions (Supersedes Duals Plan Letter 15-002)
DPL 17-002 (PDF) - Rogers Amendment at Tertiary Hospitals APL 10-011 (PDF)
- Rogers Amendment Data Request
APL 10-002 (PDF) - Status of the Conversion to the Fiscal Intermediary Access to Medi-Cal Eligibility
APL 99-010 (PDF) - Supplemental Data Request
APL 06-009 (PDF)- APL 06-009 Attachment:
California Information Request (Excel) - APL 06-009 Attachment:
Lookup Tables (Excel)
- APL 06-009 Attachment:
- Transition of Encounter Data Submission to National Standard Transactions (ASC X12 837 5010, NCPDP 2.2 or 4.2)
APL 14-009 (PDF) - Updates to Managed Care Data Dictionary
APL 99-008 (PDF) - Utilization Data File to be Provided to Medi-Cal Managed Care Health Plans for Transitioning Low-Income Health Program Beneficiaries
APL 13-019 (PDF) - Utilization and Payment Data for Safety-Net Providers
APL 10-009 (PDF)
Dental
- Dental Services – Anesthesia Coverage
PL 00-005 (PDF – 2.1MB) - Dental Services-General Anesthesia Coverage
PL 13-002 (PDF) - Dental Services – Intravenous Moderate Sedation and Deep Sedation/General Anesthesia Coverage (Supersedes APL 15-012) APL 23-028 (PDF)
- Dental Services – Intravenous Sedation and General Anesthesia Coverage
APL 15-012 (PDF) (Supersedes Policy Letter 13-002) - Topical Fluoride Varnish
APL 07-008 (PDF)
DFMC – Delmarva Foundation for Medical Care Inc.
- Delmarva Foundation for Medical Care Inc.
APL 03-014 (PDF)
Dual-Eligible
- Coordination of Benefits: Medicare and Medi-Cal
APL 13-001 (PDF) - Koordinasyon ng mga Benepisyo: Medicare at 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) - Mga Kinakailangan sa Interdisciplinary Care Team at Individual Care Plan para sa 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)
Matibay na Kagamitang Medikal
- Criteria for Coverage of Wheelchairs and Applicable Seating and Positioning Components
APL 15-018 (PDF)
Maagang at Pana-panahong Pagsusuri sa Diagnosis at Mga Serbisyo sa Paggamot
- 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) - Mga Kinakailangan para sa Saklaw ng Maaga at Pana-panahong Pag-screen, Diagnostic, at Mga Serbisyo sa Paggamot para sa Mga Benepisyaryo ng Medi-Cal sa ilalim ng Edad ng Dalawampu't Isang APL 14-017 (PDF)
Pagiging karapat-dapat
- Addendum to Policy Letter 98-03 – Conversion to New Eligibility Report System
PL 99-005 (PDF – 3.0MB) - California Housing and Homelessness Incentive Program
APL 22-007 (PDF)
- Conlan v. Bonta; Conlan v. Shewry: Court Ordered Medi-Cal Beneficiary Reimbursement Process
APL 07-002 (PDF – 5.5MB) - Conversion to New Eligibility Reporting System
PL 98-003 (PDF) - Enhanced Care Management Requirements (Supersedes APL 21-012)
APL 23-032 (PDF)
- Enhanced Care Management Requirements
APL 21-012 (PDF), Attachment 1:
Enhanced Care Management Population of Focus Eligibility Criteria
- Mga Serbisyo sa Pangkalahatang Acute Care sa Inpatient: Pag-aangkin para sa mga Makikinabang na Saklaw ng Medi-Cal Managed Care at Medi-Cal Diagnosis na Kaugnay na Bayad sa Serbisyo ng Grupo APL 15-021 (PDF)
- Memorandum of Understanding Requirements for Medi-Cal Managed Care Plans (Supersedes APL 13-018)
APL 18-015 (PDF) - Memorandum of Understanding Requirements for Medi-Cal Managed Care Plans
APL 13-018 (PDF) - Memorandum of Understanding Requirements for Medi-Cal Managed Care Health Plans and Regional Centers (Supersedes APL 15-022)
APL 18-009 (PDF) - Memorandum of Understanding Requirements for Medi-Cal Managed Care Health Plans and Regional Centers
APL 15-022 (PDF) - Medi-Cal Intercounty Transfers
APL 03-005 (PDF – 5.3MB) - Refugee Health Care
PL 98-007 (PDF) - Status of the Conversion to the Fiscal Intermediary Access to Medi-Cal Eligibility Data
APL 99-010 (PDF)
- Strategic Approaches for Use By Managed Care Plans to Maximize Continuity of Coverage as Normal Eligibility and Enrollment Operations Resume
APL 22-004 (PDF)
Mga Serbisyong Pang-emergency (ER Care)
- Emergency Services Medical Claim Coding and Documentation Guidelines
APL 02-005 (PDF) - Emergency Services Claims
APL 99-015 (PDF) - Non-Contracted Emergency Room Rate Schedule
APL 03-013 (PDF)
End of Life Option Act
- End of Life Option Act
APL16-006 (PDF)
Mga Enrollment at Disenrollment
- 2009-2010 Managed Care Plan MEDS/FAME/834+Supplemental Cutoff and Processing Schedule
APL 09-015 (PDF – 2MB) - 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) - Amended Regulations for Enrollment and Disenrollment for Two-Plan Model Plans
APL 00-013 (PDF) - Benefit Standardization and Mandatory Managed Care Enrollment Provisions of the California Advancing and Innovating Medi-Cal Initiative
APL 21-015 (PDF), Attachment 1:
Mandatory Managed Care Enrollment Requirements, Attachment 2:
Major Organ Transplant Requirements
- Change of Children in Percent of Poverty Aid Categories to Mandatory Enrollment for Medi-Cal Managed Care
PL 00-003 (PDF) - Coordination of Benefits: Medicare and Medi-Cal
APL 13-001 (PDF) - Koordinasyon ng mga Benepisyo: Medicare at Medi-Cal (Supersedes APL 13-001) APL 13-003 (PDF)
- Default Assignment for Beneficiaries
APL 03-001 (PDF) - Enrollment Forms in Primary Care Provider Offices and Enrollment Packet Material Distribution
PL 98-004 (PDF) - Enrollment of Medi-Cal/Medicare Dual Eligibles and Medi-Cal Beneficiaries with Commercial Health Maintenance Coverage
PL 98-005 (PDF – 9.4MB) - Health Plan Choice Reminders (Annual Renotifications)
APL 01-004 (PDF) - Implementation of New Enrollment Forms
APL 04-007 (PDF) - Implementation of New Enrollment Forms
APL 04-005 (PDF – 4.3MB) - Long Term Care Coordination and Disenrollment (Supersedes APL 03-003)
APL 17-017 (PDF) - LTC Guidelines/Policy Letters GMC/Two-Plan Letter
APL 03-003 (PDF – 4.2MB) - Maximus Warehouse Relocation
APL 00-006 (PDF) - Medi-Cal Managed Care Medical Exemptions
APL 00-002 (PDF) - New Medi-Cal Managed Care Exemption Forms
APL 99-011 (PDF – 12.9MB) - New Process for Transmitting Enrollment/Disenrollment Data
APL 05-002 (PDF – 2.1MB) - Percent of Poverty Population
APL 00-009 (PDF) - Potential Increase in New Enrollees Due to Changes in the Section 1931(b) Program
APL 00-007 (PDF) - Processing Errors Related to Denied Medical Exemption Requests Regarding Mandatory enrollment into a Medi-Cal Managed Care Plan
APL 13-002 (PDF) - Transition to Updated HIPAA Transactions for Enrollment and Premium Payments
APL 11-014 (PDF)
Pinabilis na Pagdinig ng Estado
- Implementation of Expedited State Hearings
APL 03-009 (PDF)
External Accountability Set
- Interim Procedures Until Execution of New EQRO Contract
APL 08-006 (PDF) - External Accountability Set (EAS) Performance Measure Audits
APL 02-008 (PDF) - Quality and Performance Improvement Requirements for 2007
APL 06-010 (PDF)
SIKAT
- Transition to Updated HIPAA Transactions for Enrollment and Premium Payments
APL 11-014 (PDF)
Pagpaplano ng Pamilya
- Augmented Reimbursement for Family Planning Services
APL 10-003 (PDF) –
RETIRED
- Contraceptive Devices
APL 06-008 (PDF) - Correction to
All Plan Letter 10-003 Regarding Augmented Reimbursement for Family Planning Services
APL 10-014 (PDF) –
RETIRED - Family Planning Services in Medi-Cal Managed Care
PL 98-011 (PDF – 31.9MB) - Family Planning Services Policy for Contraceptive Supplies
APL 16-003 Revised (PDF) - Family Planning Services Policy for Self-Administered Hormonal Contraceptives (Supersedes APL 16-003)
APL 18-019 (PDF) - Medi-Cal Managed Care Plan Requirements for Provision of Contraceptive Drug Services and Supplies
APL 03-010 (PDF) - Proposition 56 Directed Payments for Family Planning Services (Supersedes APL 22-011)
APL 23-008 (PDF)
- Proposition 56 Directed Payments for Family Planning Services (Supersedes APL 20-013)
APL 22-011 (PDF)
- Proposition 56 Directed Payments for Family Planning Services
APL 20-013 (PDF)
- Proposition 56 Value-Based Payment Program Directed Payments (Supersedes APL 22-019)
APL 23-014 (PDF)
- Proposition 56 Value-Based Payment Program Directed Payments (Supersedes APL 20-014)
APL 22-019 (PDF)
- Proposition 56 Value-Based Payment Program Directed Payments
APL 20-014 (PDF)
- Senate Bill (SB) 94 – Family Planning Services
PL 07-018 (PDF)
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)
Mga Sentro ng Kalusugan na Kwalipikado ng Pederal at Mga Klinikang Pangkalusugan sa Rural
- Podiatric and Chiropractic Services at Federally Qualified Health Centers and Rural Health Clinics
APL 15-003 (PDF)
Pananalapi
- Administrative and Financial Sanctions (Supersedes APL 15-014)
APL 18-003 (PDF) - Administrative and Financial Sanctions
APL 15-014 (PDF) - Conversion to Electronic Filing of Financial Reports
APL 07-001 (PDF) - Enforcement Actions: Administrative and Monetary Sanctions (Supersedes APL 22-015)
APL 23-012 (PDF)
- Enforcement Actions: Administrative and Monetary Sanctions (Supersedes APL 18-003)
APL 22-015 (PDF)
- Financial Reporting Requirements
APL 10-005 (PDF) - New Financial Reporting Requirements
APL 07-009 (PDF) - Review and Analysis of Financial Status of Health Plans Proposed Request for Funding Augmentations
APL 05-008 (PDF) - Same Day Banking
APL 06-011 (PDF)
Pangangalaga sa Pag-aalaga
- Conversion to Electronic Filing of Financial Reports
APL 07-001 (PDF) - Six New Derivative Foster Care Aid Codes
APL 11-022 (PDF)
Panloloko
- 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)
Karaingan
- 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) - Grievance Report Template
APL 14-013 (PDF)
APL 14-013 Attachment:
Grievance Report Template (MS Excel) - Requirements for Reporting Managed Care Program Data (Supersedes APLs 14-013 (Revised) and 14-012)
APL 20-017 (PDF)
- Quarterly Submission of Grievance Logs
APL 03-008 (PDF) - Timeframes For Member Grievances
PL 09-006 (PDF)
Mga Pagsusuri sa Kalusugan
- 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) - Pagtatasa ng Panganib sa Pangkalusugan at Mga Kinakailangan sa Pagsasara ng Panganib para sa Cal MediConnect (pinapalitan ang 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)
Edukasyong Pangkalusugan
- Programa sa Pag-iwas sa Diabetes APL 18-018 (PDF)
- Edukasyong Pangkalusugan PL 02-004 (PDF)
- Edukasyong Pangkalusugan at Cultural and Linguistic Group Needs Assessment (Supersedes Policy Letter 10-012) APL 17-002 (PDF)
- Edukasyong Pangkalusugan at Cultural and Linguistic Group Needs Assessment PL 99-002 (PDF) pinalitan ng PL 10-012 (PDF)
- Edukasyong Pangkalusugan at Cultural and Linguistic Group Needs Assessment (GNA) PL 10-012 (PDF)
- Medi-Cal Managed Care Health Education Work Group at ang "Staying Healthy" Assessment Subcommittee APL 99-007 (PDF)
- Non-Monetary Member Incentive Guidelines PL 09-005 (PDF)
- Non-Monetary Member Incentive Guidelines Addendum sa Policy Letter 09-005 PL12-002 (PDF)
PL 12-002 Attachment: Member Incentive Programa, Request for Approval Form
PL 12-002 Attachment: Member Incentive Programa, Plan Update Form - Kakayahang mabasa at Kaangkupan ng mga Nakasulat na Materyales sa Edukasyong Pangkalusugan (Supersedes APL 11-018) APL 18-016 (PDF)
Dokumento A: Mga Depinisyon at Mga Kinakailangan (PDF)
Dokumento B: Checklist ng Kakayahang mabasa at Kaangkupan para sa Mga Materyal na Edukasyong Pangkalusugan ( PDF) - Kakayahang mabasa at Kaangkupan ng mga Nakasulat na Materyal sa Edukasyong Pangkalusugan APL 11-018 (PDF)
- Mga Kinakailangan para sa Paggamit ng mga Non-Monetary Member Incentives para sa Incentive Programa, Focus Groups, at Member Surveys (Supersedes Policy Letters 09-005 at 12-002) APL 16-005 Revised (PDF)
Hepatitis C
- Hepatitis C Virus Treatment Policy Update
APL 18-013 (PDF) (Supersedes APL 15-016) - Hepatitis C Virus Treatment Policy Update
APL 15-016 (PDF)
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)
Pagpapayo at Pagsusuri sa HIV
- HIV Counseling and Testing Policy
APL 97-008 (PDF)
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)
Kalusugan ng India
- American Indian Health Programs
APL 17-020 (Revised) (PDF)- APL 17-020 Attachment #1:
List of American Indian Health Program Providers (PDF) - APL 17-020 Attachment #2:
Rates for American Indian Health Program Providers (PDF)
- APL 17-020 Attachment #1:
- Indian Health Services
APL 09-009 (PDF)
- Medi-Cal Managed Care Plan Responsibilities for Indian Health Care Providers and American Indian Members (Supersedes APL 09-009)
APL 24-002
- Tribal Federally Qualified Health Center Providers
APL 21-008 (PDF)
- Attachment #1: Rates for Tribal Federally Qualified Health Centers
- Attachment #2:
List of Tribal Federally Qualified Health Center Providers
Mga Serbisyo sa Pagbabakuna
- Adult Immunizations as a Pharmacy Benefit
APL 16-009 (Revised) (PDF) - Immunization Requirements (Supersedes PL 96-013 and APL 07-015)
APL 18-004 (PDF) - Immunization Services in Medi-Cal Managed Care
PL 96-013 (PDF)
Batas
- 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) - Pag-uulat Sa Pamamahagi Ng Mga Pondo Alinsunod sa 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)
Mga Ahensya ng Lokal na Edukasyon
- Managed Care Relationship with Local Education Agency Providers
PL 00-006 (PDF)
Programa sa Kalusugan na Mababang Kita
- 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 Planong Pangkalusugan 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)
Kalusugang pangkaisipan
- 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)
Paunawa ng Aksyon
- Alternative Format Selection for Members with Visual Impairments
APL 22-002 (PDF)
- Timeframes For Member Grievances
PL 09-006 (PDF)
Mga Serbisyo sa Pasilidad ng Pag-aalaga
- 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)
Mga Serbisyo sa Optometry
- Reinstatement of Optometry Services
APL 10-010 (PDF)
Iba pang Saklaw ng Kalusugan
- Cost Avoidance and Post-Payment Recovery for Other Health Coverage (Supersedes APL 21-002)
APL 22-027 (PDF) - Cost Avoidance and Post-Payment Recovery for Other Health Coverage (Supersedes Policy Letter 08-011) APL 21-002 (PDF)
- Cost Avoidance and Post-Payment Recovery for Other Health Coverage
PL 08-011 (PDF)
Outreach
- Importance of Increased Outreach to New Eligibles Under the Section 1931(b) Program
APL 00-008 (PDF) - Designating Non-Qualified Health Plan Medi-Cal Managed Care Plans as Medicaid Certified Application Counselors
APL 13-024 (PDF) - 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
- Palliative Care (Supersedes APL 17-015)
APL 18-020 (PDF)
- Palliative Care at Medi-Cal Managed Care APL 17-015 (PDF)
Porsiyento ng Kahirapan
- Percent of Poverty Population
APL 00-009 (PDF)
Personal na Pinsala
- Personal Injury Inquiry Letter
APL 05-004 (PDF)
Botika
- 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)
Patakaran at Pamamaraan
- Delegation and Subcontractor Network Certification (Supersedes APL 17-004)
APL 23-006 (PDF)
- Attachment A:
Subcontractor Network Certification Instruction Manual
- Attachment B:
Subcontractor Network Exemptions Request
- Attachment C:
Network Adequacy and Access Assurances Report
- Attachment A:
- Memorandum of Understanding Requirements for Medi-Cal Managed Care Plans and Third-Party Entities
APL 23-029 (PDF)
- Policy and Procedure Revisions
APL 00-003 (PDF) - Subcontractual Relationships and Delegation
APL 17-004 (PDF)
Post Stabilization
- Authorizations for Post-Stabilization Care Services
APL 23-009 (PDF)
- Policy and Procedure Revisions
APL 08-010 (PDF) - Ang Rogers Amendment at Tertiary Hospitals APL 10-011 (PDF)
- Rogers Amendment Data Request
APL 10-002 (PDF)
Pangangalaga sa prenatal
- Breastfeeding Promotion
PL 98-010 (PDF) - Doula Services (Supersedes APL 22-031)
APL 23-024 (PDF)
- Doula Services
APL 22-031 (PDF)
- Newborn and Prenatal Genetic Screening Services
PL 98-006 (PDF – 38.2MB) - Obstetrical Care-Perinatal Services
PL 12-001 (PDF) - Obstetrical Care-Perinatal Services (supersedes PL 12-001 and PL 96-01)
PL 12-003 (PDF) - Utilization Review of Initial Risk Assessments for Pregnant Women
APL 00-012 (PDF)
Primary Care Physician
- 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)
Mga Reseta (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
- Medi-Cal Providers on Probation
APL 03-012 (PDF) - Medi-Cal Providers on Probation
APL 04-003 (PDF – 7.6MB)
Direktoryo ng Provider at Networks
- Health Plan Provider Directory Policy, Guidelines and Delivery Standards
PL 00-002 (PDF) - Medi-Cal Managed Care Health Plan Guidance on Network Provider Status
APL 19-001 (PDF)
Attachment A:
Network Provider Agreement Boilerplate Checklist (PDF) - Mga Kinakailangan sa Pag-uulat ng Data ng Managed Care Provider (Supersedes APL 14-006) APL 16-019 (PDF)
- Medi-Cal Managed Care Plan Ongoing Provider File Updates
APL 10-006 (PDF) - Medi-Cal Managed Care Plan Ongoing Provider File Submission Requirements
APL 14-006 (PDF) - Medi-Cal Managed Care Plan Patuloy na Mga Kinakailangan sa Pagsusumite ng File ng Provider APL 11-020 (PDF)
- Network Certification Requirements (Supersedes APL 21-006)
APL 23-001 (PDF)
- Attachment A: Network Adequacy Standards (PDF)
- Attachment B: Taunang Network Certification Instruction Manual (PDF)
- Attachment C: Alternative Access Standard (AAS) Request Template (.xls)
- Network Certification Requirements (Supersedes APL 20-003)
APL 21-006 (PDF)
- Attachment A: Network Adequacy Standards (PDF)
- Attachment B: Taunang Network Certification Instruction Manual (PDF)
Attachment C: Template ng Kahilingan sa Alternative Access Standard (AAS) (.xls)
- Network Certification Requirements (Supersedes APL 19-002) APL 20-003 (PDF)
Attachment A: Network Adequacy Standards (PDF)
Attachment B: Annual Network Certification Instruction Manual (PDF)
Attachment C: Alternative Access Standards Request Template (MS Excel)
- Network Certification Requirements (Supersedes APL 18-005)
APL 19-002 (PDF)
Attachment A:
Network Adequacy Standards (PDF)
Attachment B:
Annual Network Certification Checklist (PDF)
Attachment C:
Alternative Access Standards Request Template (MS Excel)
Attachment D:
Alternative Access Standard Renewal Template (MS Excel) - Network Certification Requirements
APL 18-005 (PDF) - Update to Health Plan Provider Directory Policy and Guidelines
PL 11-009 (PDF) - Providing Informing Materials to Medi-Cal Beneficiaries in an Electronic Format
APL 19-003 (PDF)
Paglahok ng Provider
- Community Health Worker Services Benefit
APL 22-016 (PDF)
- Facilities Excluded from the Medi-Cal Program
PL 98-009 (PDF) - Medi-Cal Providers on Probation
APL 03-012 (PDF) - Medi-Cal Providers on Probation
APL 04-003 (PDF – 7.6MB) - Medi-Cal Network Provider and Subcontractor Terminations (Supersedes APL 16-001)
APL 21-003 (PDF)
- Attachment A:
Exclusionary Databases and Lists - Attachment B:
Facility Decertification Member Notice Template
- Attachment A:
- Medi-Cal Provider and Subcontract Suspensions, Terminations, and Decertifications (Supersedes APL06-007)
APL 16-001 (PDF) - Street Medicine Provider: Definitions and Participation in Managed Care (Supersedes APL 22-023)
APL 24-001 (PDF)
- Street Medicine Provider: Definitions and Participation in Managed Care
APL 22-023 (PDF)
- Termination of Subcontracting Relationships
APL 06-007 (PDF)
Programa sa Pagpapabuti ng Kalidad at Pagganap
- Certification of Managed Care Plan Staff Responsible for the Conduct of Primary Care Provider site Reviews
PL 03-002 (PDF) - Certified Quality Provider Site Certificate
APL 03-007 (PDF) - Credentialing & Re-Credentialing: Time Line Change, New Primary Source Verification Requirements and Verification of Credentials of Non-Physician Practitioners
PL 02-003 (PDF) - Facility Site Review Clarification #2
APL 03-006 (PDF) - Implementation of Medi-Cal Managed Care Policy Letter 02-002
APL 02-006 (PDF) - Procedures for Submitting QIP Documents and New Resources for Plans
APL 09-008 (PDF) - Quality and Performance Improvement Program
PL 03-001 (PDF) - Quality and Performance Improvement Requirements for 2007
APL 06-010 (PDF) - Quality and Performance Improvement Requirements for 2008
APL 07-013 (PDF) - Quality and Performance Improvement Requirements for 2009
APL 08-009 (PDF) - Quality and Performance Improvement Requirements for 2010
APL 10-001 (PDF) - Quality and Performance Improvement Requirements for 2011
APL 11-002 (PDF) - Quality and Performance Improvement Requirements for 2012
APL 11-021 (PDF) - Mga Kinakailangan sa Pagpapabuti ng Kalidad at Pagganap para sa 2013 (Supersedes APL 11-021) APL 13-005 (PDF)
- Quality and Performance Improvement Requirements for 2014 (supersedes APL 13-005)
APL 14-003 (PDF) - Quality and Performance Improvement Requirements (Supersedes APL 14-003)
APL 15-024 Revised (PDF) - Quality and Performance Improvement Requirements (Supersedes APL 15-024)
APL 16-018 (PDF) - Quality and Performance Improvement Requirements (Supersedes APL 16-018)
APL 17-014 (PDF) - Quality and Performance Improvement Requirements (Supersedes APL 17-014)
APL 19-017 (PDF)
Supplement to APL 19-017: Quality and Performance Improvement Adjustments Due to COVID-19 (PDF)
- Site Review
PL 02-002 (PDF – 28.4MB) - Use of Services Measures
APL 03-015 (PDF)
Mga Proyekto sa Pagpapabuti ng Kalidad
- Quality and Performance Improvement Requirements for 2007
APL 06-010 (PDF) - Quality and Performance Improvement Requirements for 2008
APL 07-013 (PDF) - Quality and Performance Improvement Requirements for 2009
APL 08-009 (PDF) - Quality and Performance Improvement Requirements for 2010
APL 10-001 (PDF) - Quality and Performance Improvement Requirements for 2011
APL 11-002 (PDF) - Quality and Performance Improvement Requirements for 2012
APL 11-021 (PDF) - Mga Kinakailangan sa Programa sa Pagpapahusay ng Kalidad at Pagganap para sa 2013 (Supersedes APL 11-021) APL 13-005 (PDF)
- Quality and Performance Improvement Program Requirements for 2014 (supersedes APL 13-005)
APL 14-003 (PDF)
Mga rate
- 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)- APL 06-009 Attachment:
California Information Request (Excel) - APL 06-009 Attachment:
Lookup Tables (Excel)
- APL 06-009 Attachment:
Mga Konsyumer ng Regional Center
- Identification of Regional Center Consumers
APL 7-012 (PDF)
Reimbursement
- Augmented Reimbursement for Family Planning Services
APL 10-003 (PDF) - Correction to
All Plan Letter 10-003 Regarding Augmented Reimbursement for Family Planning Services
APL 10-014 (PDF) - Conlan v. Bonta; Conlan v. Shewry: Court Ordered Medi-Cal Beneficiary Reimbursement Process
APL 07-002 (PDF – 5.5MB) - Medi-Cal Managed Care Health Plan Implementation of Primary Care Provider Assignment and Reimbursement for New Adult Expansion Members
APL 13-022 (PDF) - Reimbursement for Non-contracted Hospital Emergency Inpatient Services
APL 08-008 (PDF)
Rogers Amendment
- Ang Rogers Amendment at 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)
Nakatatanda at Mga May Kapansanan
- 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)-
-
- PL14-005 Attachment:
Reporting Instructions (PDF) - PL14-005 Attachment:
Reporting Template (MS Excel)
- PL14-005 Attachment:
-
-
Mga Serbisyo sa Sakit na Naililipat sa Sekswal
- Sexually Transmitted Disease Services in Medi-Cal Managed Care
APL 96-009 (PDF-2.2MB)
Pagsusuri ng Site
- Certified Quality Provider Site Certificate
APL 03-007 (PDF) - Facility Site Review / Physical-Accessibility Reviews
DPL 13-003 (PDF) - Facility Site Review / Physical-Accessibility Reviews
DPL 14-005 (PDF) (Supersedes DPL 13-003) - Facility Site Review Clarification #2
APL 03-006 (PDF) - Facility Site Review Tools for Ancillary Service and Community-Based Adult Services Providers
APL 15-023 (PDF) - Primary Care Provider Site Reviews: Facility Site Review and Medical Record Review (Supersedes APL 20-006)
APL 22-017 (PDF)
- Revised Facility Site Review Tool
PL 10-016 (PDF) - Revised Facility Site Review (FSR) Tool
PL 11-013 (PDF) - Revised Facility Site Review Tool (supersedes PL 11-013)
PL 12-006 (PDF) - Site Review
PL 02-002 (PDF – 28.4MB) - Site Reviews: Facility Site Review and Medical Record Review (Supersedes PLs 14-004 and 03-002, and APL 03-007)
APL 20-006 (PDF)
Attachment A:
Application for DHCS Site Review Master Trainer Certification
- Site Reviews: Facility Site Review and Medical Record Review
PL 14-004 (PDF)
Mga Pagdinig ng Estado
- Conlan v. Bonta; Conlan v. Shewry: Court Ordered Medi-Cal Beneficiary Reimbursement Process
APL 07-002 (PDF – 5.5MB) - Timeframes For Member Grievances
PL 09-006 (PDF)
Telehealth
- Electronic Visit Verification Implementation Requirements
APL 22-014 (PDF)
- Telehealth Services Policy (Supersedes APL 19-009)
APL 23-007 (PDF)
- Telehealth Services Policy
APL 19-009 (Revised) (PDF)
- Supplement to APL 19-009 (Revised): Emergency Telehealth Guidance –
COVID-19 Pandemic (PDF)
Pananagutan ng Third Party
- Reporting and Other Requirements Regarding Workers’ Compensation Recovery
APL 01-002 (PDF – 7.9MB) - Reporting Responsibilities Regarding Third-Party Tort Liability
APL 11-012 (PDF) - Third Party Tort Liability Reporting Requirements (Supersedes APLs 01-002, 11-012 And 17-021)
APL 21-007 (PDF)- Attachment A:
MCP Attestation
A T T A chment B:
Secure File Transfer Protocol (SFTP) User Manual
- Attachment A:
Tabako
- 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)
Mga Serbisyong Transgender
- 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) - Pagtiyak ng Access sa Mga Serbisyong Transgender APL 13-011 (PDF)
Transportasyon
- Non-Contract Ground Emergency Medical Transport Payment Obligations APL 20-002 (PDF)
- Non-Contract Ground Emergency Medical Transport Payment Obligations for State Fiscal Year 2018-19
APL 19-007 (PDF) - Non-Emergency Medical and Non-Medical Transportation Services and Related Travel Expenses (Supersedes APL 17-010)
APL 22-008 (PDF), Non-Emergency Medical and Non-Medical Transportation Services and Related Travel Expenses
Frequently Asked Questions
- Non-Emergency Medical and Non-Medical Transportation Services
DPL 18-001 (PDF) - Non-Emergency Medical and Non-Medical Transportation Services
APL 17-010 (Revised) (PDF)
APL 17-010 Frequently Asked Questions (PDF)
Pagsusuri sa Paggamit
- 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)
Mga bakuna
- Human Papillomavirus Vaccine
APL 07-015 (PDF) - Immunization Requirements (Supersedes PL 96-013 and APL 07-015)
APL 18-004 (PDF)
Taon 2000
- Year 2000 Contingency Plan Update
APL 99-016 (PDF) - Revision to All Plan Letter 99-003 Re: Year 2000 Readiness
APL 99-012 (PDF) - Year 2000 Readiness Certification and Business Continuation Plan
APL 99-003 (PDF)