All plan letter summaries

APL 24-014
Continuity of Care for Medi-Cal Members Who Are Foster Youth and Former Foster Youth in Single Plan Counties
Enhances continuity of care protections for foster youth and former foster youth who live in a single plan county and are mandatorily transitioning from Medi-Cal Fee-for-Service (FFS) to enroll as members in Medi-Cal managed care.

APL 24-013
Managed Care Plan Child Welfare Liaison
Renames the Foster Care Liaison and revises guidance on the responsibilities attached to the role.

View APL 24-013 summary (PDF, 382 KB)

APL 24-012
Non-Specialty Mental Health Services: Member Outreach, Education, and Experience Requirements
Advises MCPs to develop and implement an annual outreach and education plan to inform members and primary care physicians about non-specialty mental health services that are covered by Medi-Cal.

APL 24-011
Intermediate Care Facilities for Individuals with Developmental Disabilities – Long Term Care Benefit Standardization and Transition of Members to Managed Care
Revises requirements for managing the long-term care of members living with developmental disabilities in intermediate care facilities.

APL 24-010
Subacute Care Facilities – Long Term Care Benefit Standardization and Transition of Members to Managed Care  
Revises requirements for managing the long-term care of members in subacute care facilities.

APL 24-009
Skilled Nursing Facilities – Long Term Care Benefit Standardization and Transition of Members to Managed Care
Revises requirements for managing the long-term care of members in skilled nursing facilities.

APL 24-008
Immunization Requirements
Clarifies guidance about the provision of immunization services to Medi-Cal members.

View APL 24-008 summary (PDF, 334 KB)

APL 24-007
Targeted Provider Rate Increases
Explains network provider payment requirements for the implementation of Medi-Cal targeted rate increases (TRI), effective for dates of service on or after January 1, 2024.

View APL 24-007 summary (PDF, 433 KB)

Read the Blue Shield Promise TRI FAQ (PDF, 646 KB)

APL 24-006
Community Health Worker Services Benefit
Revises the qualifications for becoming a Community Health Worker (CHW), the definitions of eligible populations for CHW services, and descriptions of applicable conditions for the CHW benefit.

View APL-24-006 summary (PDF, 455 KB)

APL 24-005
California Housing and Homelessness Incentive
Revises requirements MCPs must follow to qualify for payments from the Housing and Homelessness Incentive Program.

APL 24-004
Quality Improvement and Health Equity Transformation Requirements
Notifies MCPs about requirements for quality and health equity improvement.

VIew APL 24-004 summary (PDF, 285 KB)

APL 24-003
Abortion Services
Updates information on providing members with access to abortion services.

APL 24-002
Medi-Cal Managed Care Plan Responsibilities for Indian Health Care Providers and American Indian Members
Contains guidance related to healthcare options for American Indian Medi-Cal members and protections for Indian Health Care Providers.

View APL-24-002 summary (PDF, 421 KB)

APL 24-001
Street Medicine Provider: Definitions and Participation in Managed Care
Reiterates instructions for MCPs working with street medicine providers to address clinical and non-clinical needs of Medi-Cal members experiencing unsheltered homelessness. Adds information about place of service codes used for billing.

APL 23-035
Student Behavioral Health Incentive Program
Describes criteria MCPs can follow to receive payments as part of the Student Behavioral Health Incentive Program.

APL 23-034
California Children’s Services Whole Child Model Program
Updates guidance for MCPs that participate in the Whole Child Model program, including requirements for risk assessment and management, case management and care coordination, continuity of care, routine grievance and appeal processes, transplants, transportation, and payment structure.

APL 23-033
2024-2025 Medi-Cal Managed Care Health Plan MEDS/834 Cutoff and Processing Schedule
Shares the calendar for the Medi-Cal Eligibility Data System (MEDS) from December 2023 through January 2025.

APL 23-032
Enhanced Care Management Requirements
As part of the CalAIM program, revises requirements for administering the Enhanced Care Management benefit to support the needs of high-cost, high-need managed care members.

APL 23-031
Medi-Cal Managed Care Plan Implementation of Primary Care Provider Assignment for the Age 26-49 Adult Expansion Transition
Advises MCPs on maintaining the assignment of primary care providers for adults aged 26 to 49 who are transitioning into receiving full-scope Medi-Cal benefits.

 View APL 23-031 summary (PDF, 348 KB)

APL 23-030
Medi-Cal Justice-Involved Reentry Initiative-Related State Guidance
Introduces the “Policy and Operational Guide for Planning and Implementing CalAIM Justice-Involved Reentry Initiative,” which codifies requirements for the new Medi-Cal program that aims to stabilize an individual’s health conditions and establish community supports for them during the 90 days prior to their release from a correctional facility.

 View APL 23-030 summary (PDF, 257 KB)

APL 23-029
Memorandum of Understanding Requirements for Medi-Cal Managed Care Plans and Third-Party Entities
Clarifies the intent of the Memorandum of Understanding (MOU) that MCPs and third-party entities are required to be entered into under the Medi-Cal Managed Care Contract with DHCS. Also specifies the responsibilities of MCPs under those MOUs and provides several MOU templates.

APL 23-028
Dental Services – Intravenous Moderate Sedation and Deep Sedation/General Anesthesia Coverage
Informs MCPs about responsibilities for covering certain types of sedation and anesthesia in conjunction with dental services when medically necessary.

 View APL 23-028 summary (PDF, 307 KB)

APL 23-027
Subacute Care Facilities – Long Term Care Benefit Standardization and Transition of Members to Managed Care
Establishes long-term care for people in subacute care facilities as a benefit covered by managed care plans.

 View APL 23-027 summary (PDF, 430 KB)

APL 23-026
Federal Drug Utilization Review Requirements Designed to Reduce Opioid Related Fraud, Misuse and Abuse
Reminds MCPs about federal drug utilization review requirements stated in the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act of 2018.

 View APL 23-026 summary (PDF, 273 KB)

APL 23-025
Diversity, Equity, and Inclusion Training Program Requirements
Provides guidance for diversity, equity, and inclusion training programs for MCP staff and network providers.

 View APL 23-025 summary (PDF, 382 KB)

APL 23-024
Doula Services
Shares recommendations for doula services for prenatal, perinatal, and postnatal members.

 View APL 23-024 summary (PDF, 451 KB)

APL 23-023
Intermediate Care Facilities for Individuals with Developmental Disabilities – Long Term Care Benefit Standardization and Transition of Members to Managed Care
Establishes long-term care for people with developmental disabilities as a benefit covered by managed care plans.

 View APL 23-023 summary (PDF, 391 KB)

APL 23-022
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
Updates guidance on providing continuity of care for Medi-Cal members transitioning from fee-for-service plans to managed care.

 View APL 23-022 summary (PDF, 384 KB)

APL 23-021
Population Needs Assessment and Population Health Management Strategy
Announces modifications to the Population Needs Assessment and Population Health Management strategy requirements for MCPs.

 View APL 23-021 summary (PDF, 243 KB)

APL 23-020
Requirements for Timely Payment of Claims
Reviews MCP obligation to pay claims in a timely manner.

APL 23-019
Proposition 56 Directed Payments for Physician Services
Revises guidance for directed payments for specified physician services, using funds received from the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56).

 Learn more about Proposition 56 payments

APL 23-018
Managed Care Health Plan Transition Policy Guide
Introduces a new policy guide for supporting members transitioning between different MCPs.

 View APL 23-018 summary (PDF, 323 KB)

APL 23-017
Directed Payments for Adverse Childhood Experiences Screening Services
Revises guidance for directed payments for Adverse Childhood Experiences Screening services, using funds received from the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56).

 Learn more about Proposition 56 payments

APL 23-016
Directed Payments for Developmental Screening Services
Revises guidance for directed payments for standardized developmental screening services for children, using funds received from the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56).

 Learn more about Proposition 56 payments

APL 23-015
Proposition 56 Directed Payments for Private Services
Revises guidance for directed payments for specified state-funded medical pregnancy termination services, using funds received from the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56).

 Learn more about Proposition 56 payments

APL 23-014
Proposition 56 Value-Based Payment Program Directed Payments
Revises guidance for value-based directed payments of funds received from the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56).

 Learn more about Proposition 56 payments

APL 23-013
Mandatory Signatories to the California Health and Human Services Agency Data Exchange Framework
Reminds MCPs to sign the California Health and Human Services Agency Data Exchange Framework Data Sharing Agreement.

APL 23-012
Enforcement Actions: Administrative and Monetary Sanctions
Clarifies the administrative and monetary actions DHCS may take to enforce compliance with MCP contractual provisions and applicable state and federal laws.

APL 23-011
Treatment of Recoveries Made by the Managed Care Health Plan of Overpayments to Providers
Explains federal and state legal requirements for MCPs’ treatment of recovered overpayments to providers.

 View APL 23-011 summary (PDF, 268 KB)

APL 23-010
Responsibilities for Behavioral Health Treatment Coverage for Members Under the Age of 21
Discusses the MCPs’ responsibility for medically necessary behavioral health treatment services for members under 21 across all environments, including on-site at school or during virtual school sessions.

 View APL 23-010 summary (PDF, 400 KB)

APL 23-009
Authorizations for Post-Stabilization Care Services
Informs MCPs about their responsibility to authorize post-stabilization care services.

 View APL 23-009 summary (PDF, 262 KB)

APL 23-008
Proposition 56 Directed Payments for Family Planning Services
Revises guidance for directed payments funded by the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56) for the provision of specified family planning services.

 Learn more about Proposition 56 payments

APL 23-007
Telehealth services policy
Describes revisions to DHCS telehealth services policy, including which covered services may be delivered by telehealth and how those services should be documented.

 View APL 23-007 summary (PDF, 433 KB)

APL 23-006

Delegation and subcontractor network certification
Updates guidance on the delegation and monitoring of subcontractors.

 View APL 23-006 summary (PDF, 350 KB)

APL 23-005
Requirements for coverage of early and periodic screening, diagnostic, and treatment services for Medi-Cal members under the age of 21
Clarifies and reinforces state and federal requirements for services for members under the age of 21.

 View APL 23-005 summary (PDF, 399 KB)

 View “Medi-Cal for Kids & Teens” provider training

APL 23-004
Skilled nursing facilities – long term care benefit standardization and transition of members to managed care
Revises requirements for managing the long-term care of members in skilled nursing facilities.

 View APL 23-004 summary (PDF, 359 KB)

 Contact LTSS Liaisons (PDF, 157 KB)

APL 23-003
California Advancing and Innovating Medi-Cal Incentive Payment Program
Provides the most recent guidance on implementing the CalAIM Incentive Payment Program.

APL 23-002
2023-2024 Medi-Cal managed care health MEDS/834 cutoff and processing schedule
Shares the calendar for the Medi-Cal Eligibility Data System (MEDS) through January 2024.

APL 23-001
Network certification requirements
Informs managed care providers about the annual network certification requirements for the contract year.

APL 22-032
Continuity of care for Medi-Cal beneficiaries who newly enroll in Medi-Cal managed care from Medi-Cal fee-for-service, and for Medi-Cal members who transition into a new Medi-Cal managed care health plan on or after January 1, 2023
Facilitates continuity of care for Medi-Cal fee-for-service members who have been mandatorily transitioned to managed care health plans.

 View APL 22-032 summary (PDF, 365 KB)

APL 22-031
Doula services
Shares recommendations for doula services for prenatal, perinatal, and postnatal members.

 View APL 22-031 summary (PDF, 444 KB)

^{APL 22-030}
Initial health appointment
Replaces the initial health assessment process as part of the population health management program.

 View APL 22-030 summary (PDF, 302 KB)

APL 22-029
Dyadic care services and family therapy benefit
Describes behavioral health services that can be delivered to a dyad — a child and their parent(s) or caregiver(s) — and to family.

 View APL 22-029 summary (PDF, 312 KB)

APL 22-028
Adult and youth screening and transition of care tools for Medi-Cal mental health services
Introduces standardized adult and youth screening tools to guide referrals to mental health services.

 View APL 22-028 summary (PDF, 322 KB)

APL 22-027
Cost avoidance and post-payment recovery for other health coverage
Updates requirements with regards to cost avoidance measures and post-payment recovery for members who have access to health coverage other than Medi-Cal.

 View APL 22-027 summary (PDF, 283 KB)

APL 22-026
Interoperability and patient access final rule
Notifies all MCPs of the final Centers for Medicare and Medicaid Services interoperability and patient access requirements, which include a patient access application programming interface (API) and a provider directory API.

APL 22-025
Responsibilities for annual cognitive health assessment for eligible members 65 years of age or older
Requires an annual cognitive health assessment for members who are 65 years of age or older and who do not have Medicare coverage.

 View APL 22-025 summary (PDF, 417 KB)

APL 22-024
Population Health Management Policy Guide
Introduces the Population Health Management Policy Guide, which was provided to support MCPs in creating their own population health management programs.

 View APL 22-024 summary (PDF, 226 KB)

APL 22-023
Street medicine provider: Definitions and participation in managed care
Shares ways to use street medicine providers to address clinical and non-clinical needs of Medi-Cal members experiencing unsheltered homelessness.

 View APL 22-023 summary (PDF, 302 KB)

APL 22-022
Abortion services
Summarizes Medi-Cal requirements related to abortion services.

 View APL 22-022 summary (PDF, 267 KB)

APL 22-021
Proposition 56 behavioral health integration incentive program
Describes reporting and invoicing requirements for the Behavioral Health Integration Incentive Program funded by Proposition 56 tax income.

 Learn more about Proposition 56 payments

APL 22-020
Community-based adult services emergency remote services
Describes how remote services may be administered when a public or personal emergency prevents people from receiving services at a community-based adult services center.

 View APL 22-020 summary (PDF, 269 KB)

APL 22-019
Proposition 56 value-based payment program directed payments
Revises guidance for value-based directed payments of funds received from the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56).

 Learn more about Proposition 56 payments

APL 22-018
Skilled nursing facilities – long term care benefit standardization and transition of members to managed care
Explains how MCPs will administer the long-term care benefit to members in skilled nursing facilities after benefit standardization takes place in 2023 as part of the CalAIM initiative.

 View APL 22-018 summary (PDF, 278 KB)

APL 22-017
Primary care provider site reviews: Facility site review and medical record review
Updates the requirements for conducting and reporting primary care provider site reviews, including reviews of facilities and medical records.

 View APL 22-017 summary (PDF, 412 KB)

 2024 Facilities Site Review Standards (PDF, 1.6 MB)

 2024 Medical Records Review Standards (PDF, 1.4 MB)

APL 22-016
Community health worker services benefit
Outlines the qualifications for becoming a Community Health Worker (CHW), defines eligible populations for CHW services, and describes conditions where the CHW benefit is applicable.

 View APL 22-016 summary (PDF, 379 KB)

APL 22-015
Enforcement actions: Administrative and monetary sanctions
Clarifies the administrative and monetary actions DHCS may take to enforce compliance with MCP contractual provisions and applicable state and federal laws.

APL 22-014
Electronic Visit Verification implementation requirements
Provides MCPs with directions for implementing Electronic Visit Verification, a federally mandated telephone and computer-based application that electronically verifies in-home service visits.

 View APL 22-014 summary (PDF, 335 KB)

 Read the DHCS announcement (PDF, 917 KB)

APL 22-013
Provider credentialing/re-credentialing and screening/enrollment
Addresses MCP responsibilities for screening and enrolling providers in the Medi-Cal Program, along with obligations for credentialing and re-credentialing providers.

 View APL 22-013 summary (PDF, 344 KB)

APL 22-012
Governor’s Executive Order N-01-19, regarding transitioning Medi-Cal pharmacy benefits from managed care to Medi-Cal Rx
Clarifies changes to the administration of Medi-Cal pharmacy benefits following the executive order that transitioned responsibility for pharmacy benefits from MCPs to Medi-Cal Rx.

APL 22-011
Proposition 56 directed payments for family planning services
Designates family planning services, with dates of service on or after July 1, 2019, to receive directed payments funded by the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56).

 Learn more about Proposition 56 payments

APL 22-010
Cancer biomarker testing
Requires MCPs to cover medically necessary cancer biomarker testing for patients with advanced or metastatic stage 3 or 4 cancer and prohibits requiring prior authorization for these tests.

 View APL 22-010 summary (PDF, 233 KB)

APL 22-009
COVID-19 guidance for Medi-Cal managed care health plans
Shares information about the latest changes to federal and state requirements for COVID-19 testing, treatment, and prevention.

 View COVID-19 APL updates

APL 22-008
Non-emergency medical and non-medical transportation services and related travel expenses
Updates requirements MCPs must follow when managing non-emergency medical and non-medical transportation services for Medi-Cal members. 

 View APL 22-008 summary (PDF, 391 KB)

APL 22-007
California Housing and Homelessness Incentive Program
Outlines requirements MCPs must follow to qualify for payments from the Housing and Homelessness Incentive Program.

 View APL 22-007 summary (PDF, 309 KB)

APL 22-006
Medi-Cal managed care health plan responsibilities for non-specialty mental health services
Explains MCPs’ responsibilities for providing non-specialty mental health services, along with the regulatory requirements for the Medicaid Mental Health Parity Final Rule and how MCPs should refer to and coordinate with County Mental Health Plans to provide services.

 View APL 22-006 summary (PDF, 349 KB)

APL 22-005
No wrong door for mental health services policy
Ensures that members receive timely mental health services without delay regardless of the delivery system where they seek care and that members can maintain treatment relationships with trusted providers without interruption.

 View APL 22-005 summary (PDF, 253 KB)

APL 22-004
Strategic approaches for use by managed care plans to maximize continuity of coverage as normal eligibility and enrollment operations resume
In preparation for the end of the COVID-19 public health emergency, describes strategies for helping eligible members retain Medi-Cal coverage or transition to Covered California health care plans.

 View COVID-19 APL updates

APL 22-003
Medi-Cal managed care health plan responsibility to provide services to members with eating disorders
Clarifies the responsibility of MCPs to coordinate and provide medically necessary services for members who are diagnosed with eating disorders and are currently receiving Specialty Mental Health Services from a county Mental Health Plan.

 View APL 22-003 summary (PDF, 78 KB)

APL 22-002
Alternative format selection for members with visual impairments
Requires MCPs to track and report when written materials in alternative formats (Braille, large print, audio, etc.) are requested by members with visual impairments.

 View APL 22-002 summary (PDF, 99 KB)

 APL 22-002 Provider Training Guide (PDF, 198 KB)

APL 21-018
Public and private hospital directed payment programs for state fiscal years 2017-18 and 2018-19, the bridge period, and calendar year 2021
Instructs MCPs on the payment process for hospitals in various statewide payment programs.

 View APL 21-018 summary (PDF, 113 KB)

APL 21-017
Community Supports requirements
Explains requirements for the Community Supports program (formerly called In Lieu of Services or ILOS), which apply to both Medi-Cal and Cal MediConnect providers.

 View APL 21-017 summary (PDF, 99 KB)

APL 21-016
California Advancing and Innovating Medi-Cal incentive payment program
Provides guidance on the incentive payments linked to the Enhanced Care Management (ECM) and Community Supports (In Lieu of Services [ILOS]) programs that are part of the California Advancing and Innovating Medi-Cal (Cal-AIM) initiative. The incentive program is expected to be in effect from January 1, 2022 to June 30, 2024.

 View APL 21-016 summary (PDF, 89 KB)

APL 21-015
Benefit standardization and mandatory managed care enrollment provisions of the California Advancing and Innovating Medi-Cal initiative
Standardizes managed care and fee-for-service (FFS) enrollment statewide, as part of the California Advancing and Innovating Medi-Cal (Cal-AIM) initiative. Beneficiaries in certain voluntary or excluded aid codes that are currently enrolled in Medi-Cal FFS plans will be required to enroll in a Medi-Cal managed care plan. In addition, all MCPs will be required to cover major organ transplants and institutional long-term care. Specialty mental health services will be carved out and instead covered by county health plans.

 View APL 21-015 summary (PDF, 124 KB)

APL 21-014
Alcohol and drug screening, assessment, brief interventions and referral to treatment
Explains updated requirements for administering alcohol and drug abuse screening, assessment, brief interventions, and treatment referrals to members ages eleven and older, including pregnant women.

 View APL 21-014 summary (PDF, 91 KB)

 See alcohol and drug screening tools list (PDF, 232 KB)

APL 21-013
Dispute resolution process between mental health plans and Medi-Cal managed care health plans
Describes how MCPs should submit a service delivery dispute to DHCS when the dispute cannot be resolved at the local level with a Mental Health Plan.

 View APL 21-013 summary (PDF, 90 KB)

APL 21-012
Enhanced Care Management requirements
As part of the CalAIM program, outlines requirements for administering the Enhanced Care Management benefit to support the needs of high-cost, high-need managed care members.

 View APL 21-012 summary (PDF, 109 KB)

APL 21-011
Grievance and appeals requirements, notice and “Your Rights” templates
Updates guidance regarding federal and state grievance and appeals requirements and includes templates for member notifications and the attachments that are sent with them.

 View APL 21-011 summary (PDF, 91 KB)

APL 21-010
Medi-Cal COVID-19 Vaccination Incentive Program
Offers incentives for MCPs to develop and implement a Vaccination Response Plan to encourage Medi-Cal members to be vaccinated against the COVID-19 virus.

 View COVID-19 APL updates

APL 21-009
Collecting social determinants of health data
Designates codes from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) list to be prioritized in the collection of social determinants of health data and encourages MCPs to use them to help support population health management.

 View APL 21-009 summary (PDF, 90 KB)

APL 21-008
Tribal Federally Qualified Health Center providers
Explains reimbursement requirements for Tribal Federally Qualified Health Centers, a new clinic provider type that Centers for Medicare and Medicaid Services allows to participate in Medi-Cal.

 View APL 21-008 summary (PDF, 91 KB)

APL 21-007
Third party tort liability reporting requirements
Updates the process MCPs must follow when submitting information and copies of paid invoices or claims for covered services related to third party liability torts to DHCS.

 View APL 21-007 summary (PDF, 91 KB)

APL 21-006
Network certification requirements
Informs managed care providers about the annual network certification requirements for the contract year.

 View APL 21-006 summary (PDF, 88 KB)

APL 21-005
California Children’s Services Whole Child Model program
Provides guidance to MCPs that participate in the Whole Child Model program, including requirements for continuity of care, oversight of network adequacy standards, quality performance of providers, and routine grievance and appeal processes.

APL 21-004
Standards for determining threshold languages, nondiscrimination requirements, and language assistance services
Identifies in which languages MCPs must provide written translated member information, based on established thresholds and concentrations of language speakers, and sets standards for nondiscrimination requirements and language assistance services.

 View APL 21-004 summary (PDF, 87 KB)

APL 21-003
Medi-Cal network provider and subcontractor terminations Outlines required procedures that must be followed when a provider or subcontractor’s contract is terminated, including notification, reporting, transition planning and continuity of care requirements.

 View APL 21-003 summary (PDF, 81 KB)

 APL 21-003 Job Aid for Member Notification of Specialist Terminations (PDF, 47 KB)

 IPA Specialist Terminations Report Template (Excel, 14 KB)

APL 21-002
Cost avoidance and post-payment recovery for other health coverage
Because state law requires that Medi-Cal be the payer of last resort, this APL provides requirements with regards to cost avoidance measures and post-payment recovery for members who have access to health coverage other than Medi-Cal.

 View APL 21-002 summary (PDF, 110 KB)

APL 20-022
COVID-19 vaccine administration
Outlines how COVID-19 vaccines will be delivered at no cost to all Medi-Cal beneficiaries and administered by DHCS and managed care plans. Includes instructions for Medi-Cal providers to bill DHCS directly for administrative-only costs, for fee-for-service reimbursement. The vaccine is provided by the government at no cost.

 View COVID-19 APL updates

APL 20-021
Acute hospital care at home
Explains requirements for the Acute Hospital Care at Home program. Hospitals that apply for and receive waiver approval from Centers for Medicare and Medicaid Services (CMS) may provide approved acute care inpatient services to eligible members at home.

 View COVID-19 APL updates

APL 20-020
Governor’s executive order N-01-19, regarding transitioning Medi-Cal pharmacy benefits from managed care to Medi-Cal Rx
Provides guidance on the planned transition of Medi-Cal pharmacy benefits management to a state-run program called Medi-Cal Rx.

Although the APL states the program will launch on January 1, 2021, DHCS has since announced that Medi-Cal Rx will begin implementation on April 1, 2021.

APL 20-019
Retracted by DHCS

APL 20-018
Ensuring access to transgender services​
Reminds managed care plans of their obligations to provide transgender services to members, including services deemed “medically necessary to treat gender dysphoria” or which “meets the statutory criteria of reconstructive surgery.”

 View APL 20-018 summary (PDF, 89 KB)

APL 20-017
Requirements for reporting managed care program data​
Requires managed care plans to report monthly program data to DHCS using standardized JavaScript Object Notation (JSON) reporting formats.

APL 20-016
Blood lead screening of young children
Managed care plans must ensure that their network providers who perform periodic health assessments on children between the ages of six months and six years (i.e., 72 months) comply with federal and state laws and industry guidelines related to blood lead anticipatory guidance and screening.

 View APL 20-016 summary (PDF, 126 KB)

 Read filter paper update (PDF, 232 KB)

APL 20-015
State non-discrimination and language assistance requirements
Regardless of changes in federal law, California state law requires that managed care plans (MCPs) must not unlawfully discriminate, exclude people, or treat them differently because of sex, race, color, religion, ancestry, national origin, ethnic group identification, age, mental disability, physical disability, medical condition, genetic information, marital status, gender, gender identity, or sexual orientation.

In addition, MCPs must continue to provide notice of their nondiscrimination policies and grievance procedures in English, and must continue to provide taglines notifying members of the availability of free language assistance services in English and in the top 16 languages spoken by individuals in California with limited English proficiency.

APL 20-014
Proposition 56 value-based payment program directed payments
Provides guidance on payment amounts and processes for applying funds from the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56) to value-based directed payments. These payments are to be made for specified services in the domains of prenatal and postpartum care, early childhood prevention, chronic disease management, and behavioral health care.

 Learn more about Proposition 56 payments

APL 20-013
Proposition 56 directed payment program directed payments
Specified family planning services, with dates of service on or after July 1, 2019, are designated to receive directed payments funded by the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56)

 Learn more about Proposition 56 payments

APL 20-012
Private duty nursing case management responsibilities for Medi-Cal eligible members under the age of 21
Clarifies that managed care plans (MCPs) must provide case management services to Medi-Cal members under the age of 21 who are receiving private duty nursing care, even for carved out services that the MCP does not cover.

 View APL 20-012 summary (PDF, 78 KB)

APL 20-011
Governor’s executive order N-55-20 in response to COVID-19
Provides DHCS with various flexibilities in support of COVID-19 mitigation efforts. Site reviews and subcontractor monitoring may be virtual, or have deadlines extended. Annual medical audits are suspended. Deadlines for Health Risk Assessments are extended.

The revision posted June 12, 2020 adds that this order also suspends all requirements outlined in APL 20-006 during the COVID-19 emergency and for an additional six months following.

The revision posted July 8, 2021 terminates the flexibilities previously extended in APL 20-011.

 View COVID-19 APL updates

APL 20-010
Retracted by DHCS

APL 20-009
Preventing isolation of and supporting older and other at-risk individuals to stay home and stay healthy during COVID-19 efforts
Reminds providers of the need to support older and other at-risk individuals who may be isolated during the state’s COVID-19 stay-at-home campaign. Lists available public resources for food, aging and adult services, isolation, wellness checks, fraud, and Alzheimer’s support and encourages providers to share them with patients who qualify.

 View COVID-19 APL updates

APL 20-008
Mitigating health impacts of secondary stress due to the COVID-19 emergency
In consideration of the negative health outcomes the stress of the COVID-19 crisis could cause, advises MCPs to support continuity and integration of medical and behavioral health services via telehealth and other adaptations; share information with providers about disaster-responsive, trauma-informed care; and ensure providers are aware of the published signs of, and assess for, stress-related morbidity, and create responsive treatment plans. Also provides links to additional resources.

 View COVID-19 APL updates

APL 20-007
Policy guidance for community-based adult services in response to COVID-19 public health emergency
Advises community-based adult services (CBAS) providers that congregate services inside centers are not allowed during the COVID-19 public health emergency. Essential services may be provided to individuals in the center or in the home, so long as they meet safety and infection control precautions. CBAS centers are granted flexibility to reduce day-center activities and to provide CBAS temporarily alternative services telephonically, via telehealth, live virtual video conferencing, or in the home. The APL also lists specific requirements for services, staffing, authorization and reimbursement, and documentation and reporting..

 View COVID-19 APL updates

 Read the summary shared with our CBAS providers (PDF, 104 KB)

APL 20-006
Site reviews: Facility site review and medical record review
Informs Medi-Cal managed care health plans about new criteria and scoring for facility site reviews and medical record reviews. These criteria must be met by July 1, 2020.

APL 20-004
Emergency guidance for Medi-Cal managed care health plans in response to COVID-19
Outlines temporary changes to federal requirements for managed care plans (MCPs), including extended timeframe for State Fair Hearings; flexibilities for provider Medi-Cal screening and enrollment; waiving prior authorization for COVID-19 services, including screening and testing; reimbursement for COVID-19 testing; provision of care in alternative settings, hospital capacity and blanket waivers; pharmacy guidance.

Providers are advised to refer to the DHCS COVID-19 response web page for the most up-to-date information.

Additional guidance added on April 27, 2020, reminds MCPs “that they must adhere to existing contractual requirements and state and federal laws requiring MCPs to ensure their members are able to access medically necessary services in a timely manner.”

The June 8, 2020 revision adds guidelines related to well child visits and member eligibility, temporarily reinstates acetaminophen and cough/cold medicines as covered benefits, and temporarily adds coverage for services provided by Associate Clinical Social Workers and Associate Marriage and Family Therapists at Federally Qualified Health Centers and Rural Health Clinics.

 View COVID-19 APL updates

APL 20-003
Network certification requirements
Informs managed care providers about the annual network certification requirements for the contract year.

APL 20-002
Non-Contract Ground Emergency Medical Transport (GEMT) payment obligations
Specifies that the GEMT Quality Assurance Fee program, legislated by the state of California, requires that a reimbursement add-on amount be paid for GEMT services provided beginning July 1, 2019.