Partnership HealthPlan of California

(revised Dec.Sept. 1830, supersedes APL 220- )

A. Department of Health Care Services (DHCS) All Plan Letter (APL) 25- -012 Governor’s Executive

calculated as .2/12.4 = 0. for a 1.61% change. A variance over the 20% threshold is shown in

https://bmcprimcare.biomedcentral.com/articles/10.1186/s12875-024- -z

BPC §4172; 22 CCR § , § , § (a-g), § ; 21 CFR §1301.72, §1301.75, §1301.76, §1302; 16 CCR §1356.3; HSC §

BPC §4172; 22 CCR § , § , § (a-g), § ; 21 CFR §1301.72, §1301.75, §1301.76, §1302; 16 CCR §1356.3; HSC §

BPC §4172; 22 CCR § , § , § (a-g), § ; 21 CFR §1301.72, §1301.75, §1301.76, §1302; 16 CCR §1356.3; HSC §

BPC §4172; 22 CCR § , § , § (a-g), § ; 21 CFR §1301.72, §1301.75, §1301.76, §1302; 16 CCR §1356.3; HSC §

BPC §4172; 22 CCR § , § , § (a-g), § ; 21 CFR §1301.72, §1301.75, §1301.76, §1302; 16 CCR §1356.3; HSC §

BPC §4172; 22 CCR § , § , § (a-g), § ; 21 CFR §1301.72, §1301.75, §1301.76, §1302; 16 CCR §1356.3; HSC §

8 CCR §5193; CA Health and Safety Code (HSC) §117600; CA Penal Code § , § ; 29 CFR §1910.1030, 8 CCR §3342  

23 Penal Code section .5

8 CCR §5193; CA Health and Safety Code (HSC) §117600; CA Penal Code § , § ; 29 CFR §1910.1030, 8 CCR §3342  

4665 Business Center Drive, Fairfield, CA | Napa/Solano Chapa-de Indian Health: Atwood Road, Auburn

HSC 117600

https://www.buttecounty.net/DocumentCenter/View/ /Butte-County-Community

3. In accordance with California Welfare and Institutions Code (WIC) sections .5 and

29 WIC .1

California Welfare and Institutions Code section .755. Tribal health programs (THPs), Rural Health

WHEREAS, Welfare and Institutions Code section .800 states that “a qualifying

H. Welfare and Institutions Codes (WIC) § .5, .03, .402 §

https://www.buttecounty.net/DocumentCenter/View/ /Butte-County-CHIP-2024

(revised Dec.Sept. 1830, supersedes APL 220- )

B. National Committee for Quality Assurance (NCQA) Guidelines (Effective July 1, ) UM 2 Clinical

A. Partnership Advantage: Effective January 1, , Partnership HealthPlan of California will operate a

This policy may also apply in part to Partnership Advantage, the HealthPlan’s Medicare product effective Jan. 1, in

8 CCR §5193; 22 CCR § ; 29 CFR §1910.1030; Federal Register 1989, §54:  

17 CCR § , § , § , § , § , § ; https://www.cdph.ca.gov/rhb or (916) 327-5106

17 CCR § , § , § , § , § , § ; https://www.cdph.ca.gov/rhb or (916) 327-5106

17 CCR § , § , § , § , § , § ; https://www.cdph.ca.gov/rhb or (916) 327-5106

17 CCR § , § , § , § , § , § ; https://www.cdph.ca.gov/rhb or (916) 327-5106

17 CCR § , § , § , § , § , § ; https://www.cdph.ca.gov/rhb or (916) 327-5106

17 CCR § , § , § , § , § , § ; https://www.cdph.ca.gov/rhb or (916) 327-5106

https://www.solanocounty.com/civicax/filebank/blobdload.aspx?blobid=

https://www.plumascounty.us/DocumentCenter/View/ /Plumas-County-CHIP

22 CCR § , § .1, § , § ; 28 CCR §1300.68; 42 CFR §438.206 (6); 42 CFR §438.224; 42 CFR §438.10 (g); HSC 124260, 1374.16; CA Penal

8 CCR §3220; 22 CCR § , § , § ; 28 CCR §1300.67, §1300.80; American Academy of Family Practice (AAFP)  

22 CCR § .2, § .2; BPC §1200-1214, §1229, §1220; 42 USC 263a; Public Law 100-578; www.cms.gov; www.fda.gov

22 CCR § .2, § .2; BPC §1200-1214, §1229, §1220; 42 USC 263a; Public Law 100-578; www.cms.gov; www.fda.gov

22 CCR § , § .1, § , § ; 28 CCR §1300.68; 42 CFR §438.206 (6); 42 CFR §438.224; 42 CFR §438.10 (g); HSC 124260, 1374.16; CA Penal

Note: https://www.lep.gov; 22 CCR .5

wheelchair under Title 22 of the Code of Regulation section (h)

CCR, Title 22, Sections , and provides specific information that is to be included on the POT and the

Title 22 CCR code was updated from .1(b)(2) to .1(c) as (b)(2) currently refers to Orthodontic

A. Title 22, CCR Sections

8 CCR §3220; 22 CCR § , § , § ; 28 CCR §1300.67, §1300.80; American Academy of Family Practice (AAFP)  

8 CCR §3220, §2299-2989; 22 CCR § ; 24 CCR, §2, §3, §9; 28 CCR §1300.80; 29 CFR §1910.37, §1910.38, §1910.157, §1910.301, §1926.34

22 CCR § , § .1, § , § ; 28 CCR §1300.68; 42 CFR §438.206 (6); 42 CFR §438.224; 42 CFR §438.10 (g); HSC 124260, 1374.16; CA Penal

22 CCR § ; 28 CCR 1300.67.04

M. Partnership is responsible for emergency room professional services as described in Section of

22 CCR § , § ; CDC guideline for disinfection and sterilization; Food and Drug Administration: Reprocessing medical equipment in health care setting

22 CCR § , § .1, § , § ; 28 CCR §1300.68; 42 CFR §438.206 (6); 42 CFR §438.224; 42 CFR §438.10 (g); HSC 124260, 1374.16; CA Penal

guidelines. 22 CCR § , § , § ; §28 CCR §1300.80; CA Civil Code §56.10

https://www.nevadacountyca.gov/DocumentCenter/View/ /Nevada-County

22 CCR § (2); 28 CCR §1300.67.2.2  

22 CCR § , §

22 CCR § , §

https://www.shastacounty.gov/media/

https://www.mendocinocounty.org/home/showpublisheddocument/ /638338395

Clarified that these two codes are for “Injection procedure” for discography

Clarified that these two codes are for “Injection procedure” for discography

Added these three codes for “Insertion or revision of spinal neurostimulator”

Added these three codes for “Insertion or revision of spinal neurostimulator”

#6: 1. Case

Added these three codes for “Insertion or revision of spinal neurostimulator”

https://humboldtgov.org/DocumentCenter/View/ /2018-Community-Health

Clarified that these two codes are for “Radiological supervision and interpretation for” for

Clarified that these two codes are for “Radiological supervision and interpretation for” for

CCR, Title 22, Sections , and provides specific information that is to be included on the POT and the

CCR, Title 22, Sections , and provides specific information that is to be included on the POT and the

8 CCR §3220; 22 CCR § , § , § ; 28 CCR §1300.67, §1300.80; American Academy of Family Practice (AAFP)  

BPC §4172; 22 CCR § , § , § (a-g), § ; 21 CFR §1301.72, §1301.75, §1301.76, §1302; 16 CCR §1356.3; HSC §

BPC §4172; 22 CCR § , § , § (a-g), § ; 21 CFR §1301.72, §1301.75, §1301.76, §1302; 16 CCR §1356.3; HSC §

BPC §4024, §4076, §4170, §4171, §4173, §4174; 22 CCR § , § , § , § (a-g), § , § ; 16 CCR §1718.1; 21 CFR §211.137; 42 USC

BPC §4172; 22 CCR § , § , § (a-g), § ; 21 CFR §1301.72, §1301.75, §1301.76, §1302; 16 CCR §1356.3; HSC §

BPC §4024, §4076, §4170, §4171, §4173, §4174; 22 CCR § , § , § , § (a-g), § , § ; 16 CCR §1718.1; 21 CFR §211.137; 42 USC

BPC §4172; 22 CCR § , § , § (a-g), § ; 21 CFR §1301.72, §1301.75, §1301.76, §1302; 16 CCR §1356.3; HSC §

22 CCR § ; 28 CCR §1300.80

28 CCR §1300.80; 22 CCR §

https://www.yolocounty.org/home/showpublisheddocument/ /63809651895523

176 ("Adjusted" total points possible) 190 or "adjusted" total or 176 =0. =87%

1. Adult Screening Tool for Medi-Cal Mental Health Services (DHCS 01/2023)

3. Transition of Care Tool for Medi-Cal Mental Health Services (Adult & Youth) (DHCS

2. Youth Screening Tool for Medi-Cal Mental Health Services (DHCS 01/2023)

171 ("Adjusted" total points possible) 195 or "adjusted" total or 171 =0. =92%

4665 Business Center Drive, Fairfield, CA | Napa/Solano Chapa-de Indian Health: Atwood Road, Auburn

495 Tesconi Circle, Santa Rosa, CA | Santa Rosa Huddle Open Door Community Health Center, 770 10th St., Arcata

1036 5th St. Suite E, Eureka, CA | Grizzly Creek

1000 Fortress Street, Chico, CA | Stony Creek

Redding Office – 2525 Airpark Drive, Redding, CA

2525 Airpark Drive, Redding, CA | Trinity Alps H&HS Dept.,5730 Packard Ave., Suite 100, Marysville

21) A push-rim activated power assist device ( ) for a manual wheelchair is covered if the

13) A Group 1 PWC ( - ) or a Group 2 ( - ) is covered if all of the

13) A Group 1 PWC ( - ) or a Group 2 ( - ) is covered if all of the

13) A Group 1 PWC ( - ) or a Group 2 ( - ) is covered if all of the

13) A Group 1 PWC ( - ) or a Group 2 ( - ) is covered if all of the

14) Group 2 Single Power Option PWC ( – ) is covered if all of the coverage

14) Group 2 Single Power Option PWC ( – ) is covered if all of the coverage

15) A Group 2 Multiple Power Option PWC ( - ) is covered if all of the coverage

15) A Group 2 Multiple Power Option PWC ( - ) is covered if all of the coverage

16) A Group 3 PWC with no power options ( - ) is covered if all of the coverage

16) A Group 3 PWC with no power options ( - ) is covered if all of the coverage

17) A Group 3 PWC with Single Power Option ( - ) or with Multiple Power

17) A Group 3 PWC with Single Power Option ( - ) or with Multiple Power

Options ( - ) is covered if all of the coverage criteria [1) – 3), 10) - 13)] for a

Options ( - ) is covered if all of the coverage criteria [1) – 3), 10) - 13)] for a

18) A Group 4 PWC with no power options ( - ) is covered if all of the coverage

18) A Group 4 PWC with no power options ( - ) is covered if all of the coverage

19) A Group 4 PWC with Single Power Option ( - ) or with Multiple Power

19) A Group 4 PWC with Single Power Option ( - ) or with Multiple Power

Options ( - ) is covered if all of the coverage criteria [1) – 3), 10) - 13)] for a

Options ( - ) is covered if all of the coverage criteria [1) – 3), 10) - 13)] for a

20) A Group 5 (Pediatric) PWC with Single Power Option ( ) or with Multiple Power

Options ( ) is covered if the coverage criteria [1) – 3), 10) - 13)] for a PWC are met