Updated Regulations for Medicaid

July 2017

In April 2016, the Centers for Medicare and Medicaid Services (CMS) released the final regulations (Final Rule) to strengthen the Medicaid managed care requirements.

The Final Rule: 

  • Standardizes key rules in Medicaid with those of other health insurance coverage programs 
  • Modernizes how states purchase managed care for beneficiaries
  • Strengthens the consumer experience and key consumer protections

It is the first major update to Medicaid and CHIP managed care regulations in more than a decade. As a result, the Department of Health Care Services (DHCS) issued a Medi-Cal Managed Care contract amendment to contracted health plans to implement changes to key program and benefit provisions, including updated and new reporting requirements. 

Further, DHCS released several All Plan Letters (APLs) to contracted health plans to convey information or provide interpretation of changes mandated by the Final Rule. APLs are the means by which DHCS conveys information or provides interpretation of changes in policy or procedure at the Federal or State levels, and provides instruction to contracted health plans on how to implement changes. Some of these APLs impact how L.A. Care Health Plan works with you to care for our members. In the future, we will meet with our Participating Provider Groups, Specialty Health Plans and vendors to communicate how these policies impact your service delivery to L.A. Care Medi-Cal members.

L.A. Care remains committed to ensuring you are an informed partner in providing quality care to our Medi-Cal members.