​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​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.

Abortion Services​

• 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)   

Acupuncture Services

•  Acupuncture Services APL 16-015 (PDF)
  

Advanced Directives

• Advance Directive Forms  APL 05-010 (PDF - 31.0MB)  

• 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

• 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)

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

• Same Day Banking  APL 06-011 (PDF) 

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 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)
• Voluntary Inpatient Detoxification (Supersedes APL 14-005) APL 18-001 (PDF)

Beneficiary Notices

• Conlan v. Bonta; Conlan v. Shewry: Court Ordered Medi-Cal Beneficiary Reimbursement Process  APL 07-002 (PDF - 5.5MB)   

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)
• Treatment of Recoveries Made by the Managed Care Health Plan of Overpayments to Providers APL 17-003 (PDF)

Breast and Cervical Cancer Treatment

• Breast and Cervical Cancer Treatment Program  APL 01-008 (PDF) 

Breastfeeding

• 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)​
  
• Interoperability and Patient Access Final Rule APL 22-026(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)​​​

Call Center

• Requirements for Reporting Managed Care Program Data (Supersedes APLs 14-013 (Revised) and 14-012) APL 20-017 (PDF)​​
  
• Call Center Report Template APL 14-012 (PDF)  
       APL 14-012 Attachment: Call Center Report Template (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)
• Third Party Tort Liability Reporting Requirements (Supersedes APLs 01-002, 11-012 And 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)    ​

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 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 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)​
  

Conlan Court Decisions

• Conlan v. Bonta; Conlan v. Shewry: Court Ordered Medi-Cal Beneficiary Reimbursement Process  APL 07-002 (PDF - 5.5MB) 
  

Continuity of Care

• 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) 
  APL 17-007 Attachment B: Monthly MER Denial Report Template (MS Excel)
• 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)
  

Contraceptive Devices

• Contraceptive Devices  APL 06-008 (PDF) 
  

Corrective Action Plan

• 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)​​
  

Credentialing

• 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 Enrollm​ent 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)​
  

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)
• 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)
• 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)
• 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)    
  1. Secure Online Reporting Portal
• 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 and 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)
  1. APL 06-009 Attachment: California Information Request (Excel)
  2. APL 06-009 Attachment: Lookup Tables (Excel)
• 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 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)    
• 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

• 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 APL 21-012 (PDF), Attachment 1: Enhanced Care Management Population of Focus Eligibility Criteria​
  
• General Acute Care Inpatient Services:  Claiming for Beneficiaries Covered by Medi-Cal Managed Care and Medi-Cal Diagnosis Related Group Fee-For-Service  APL 15-021 (PDF)  
• Memorandum of Understanding Requirements for Medi-Cal Managed Care Plans (Supersedes APL 13-018) APL 18-015 (PDF)
  • Attachment 1: Title 9 – Rehabilitative and Developmental Services, Chapter 11 – Medi-Cal Specialty Mental Health Services (PDF)
  • Attachment 2: Memorandum of Understanding Requirements for Medi-Cal Managed Care Plans and County Mental Health Plans (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)​
  

Emergency Services (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)   

Enrollments and Disenrollments

• 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)    
• Coordination of Benefits: Medicare and 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)   
  

Expedited State Hearing

• 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)
  

FAME

• Transition to Updated HIPAA Transactions for Enrollment and Premium Payments APL 11-014 (PDF)   
  

Family Planning

• Augmented Reimbursement for Family Planning Services  APL 10-003 (PDF)  
• Contraceptive Devices  APL 06-008 (PDF)
• Correction to All Plan Letter 10-003 Regarding Augmented Reimbursement for Family Planning Services APL 10-014 (PDF)   
• 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 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 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) 

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

• 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 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)
  

Foster Care

• Conversion to Electronic Filing of Financial Reports  APL 07-001 (PDF)
• Six New Derivative Foster Care Aid Codes  APL 11-022 (PDF) 
  

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

• 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)
  

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

• Diabetes Prevention Program APL 18-018 (PDF)
• Health Education  PL 02-004 (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  PL 99-002 (PDF) replaced by PL 10-012 (PDF)
• Health Education and Cultural and Linguistic Group Needs Assessment (GNA)  PL 10-012 (PDF)     
• Medi-Cal Managed Care Health Education Work Group and the “Staying Healthy” Assessment Subcommittee  APL 99-007 (PDF) 
• Non-Monetary Member Incentive Guidelines  PL 09-005 (PDF)    
• Non-Monetary Member Incentive Guidelines Addendum to Policy Letter 09-005  PL12-002 (PDF)      
      PL 12-002 Attachment: Member Incentive Program, Request for Approval Form   
      PL 12-002 Attachment: Member Incentive Program, Plan Update Form
• Readability and Suitability of Written Health Education Materials (Supersedes APL 11-018) APL 18-016 (PDF)
      Document A: Definitions and Requirements (PDF)
      Document B: Readability and Suitability Checklist for Written Health Education Materials (PDF)
• Readability and Suitability of Written Health Education Materials APL 11-018 (PDF)   
• Requirements for Use of Non-Monetary Member Incentives for Incentive Programs, Focus Groups, and Member Surveys (Supersedes Policy Letters 09-005 and 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)   
  

 HIV Counseling and Testing 

• 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)  
  

Indian Health

• 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)
• Indian Health Services APL 09-009 (PDF) 
  
• 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​​