MedicaidAdministrativeMedium impact
Provider Bulletin 11-21-2025 Data Sharing and Quality Rate Production for Directed Payment Initiatives and Alternative Payment Methodology Programs APL 25-015 IE LA SAC SD
Molina Healthcare·CA·Claims & Billing
We identified it
Jun 19, 2026
Summary
Molina Healthcare of California will now calculate and report quality measure performance rates on behalf of providers for Directed Payment Initiatives and Alternative Payment Methodology programs, instead of requiring providers to produce their own quality data. This affects Medi-Cal providers in specific California counties and includes a 90-day dispute resolution process.
Action Required
Immediately: Review current quality reporting processes for Medi-Cal patients. Billing and quality teams should prepare to receive performance rates and data from Molina rather than calculating internally. Establish familiarity with the 90-day dispute resolution process and contact your assigned Molina Provider Relations Representative for questions about data sharing or rate calculations.