All Insurance Policy Changes (Page 1188)

Continuing from page 1187. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

Medium impact
Provider Bulletin 01-08-2025 Reminder Community Based Adult Services and Long-Term Care Facilities Critical Incidents Reporting LA
Molina Healthcare·Effective Jan 8, 2025
Molina Healthcare of California reminds Community-Based Adult Services (CBAS) and Long-Term Care facilities of their obligation to report Critical Incidents within 24-48 hours, triggered by the recent state of emergency in Los Angeles and Ventura counties. Providers must complete CDA 4009 forms and submit them to CBAS@molinahealthcare.com for incidents including epidemic outbreaks, fires, deaths from unnatural causes, suspected abuse, and other unusual occurrences threatening patient safety.
Medium impact
Provider Bulletin 01-08-2025 Doula Guidance for Hospitals IM LA OC SAC SD
Molina Healthcare·Effective Jan 8, 2025
Molina Healthcare of California now covers doula services for pregnant and postpartum members on Medi-Cal and Marketplace plans. Hospitals must update maternity care policies to recognize doulas as essential support personnel (not visitors), allow unlimited access, and ensure collaboration between doulas and medical staff.
Medium impact
Provider Bulletin 01-08-2025 Informational Bulletin Regarding Emergency Declaration Palisades Fire and Windstorm Conditions LA
Molina Healthcare·Effective Jan 7, 2025
Molina Healthcare issued an emergency bulletin for providers in Los Angeles County affected by the Palisades Fire and windstorm conditions declared a state of emergency on January 7, 2025. Providers experiencing challenges providing care to Molina members should contact the designated contact center, and members needing emergency care should use the 24/7 Nurse Advice line.
Medium impact
Provider Bulletin 01 10 2025 TGI Cultural Competency Training Program and Provider Directory Requirements APL24 017 IE LA SAC SD
Molina Healthcare·Effective Mar 1, 2025
Molina Healthcare of California requires all staff and providers with direct member contact to complete transgender, gender diverse, and intersex (TGI) cultural competency training by March 1, 2025, with retraining every two years. Provider directories must also be updated to reflect TGI care proficiency by the same deadline.
Medium impact
Provider Bulletin 01-16-2025 Update on Monthly Eligibility Lists IM IE LA OC SAC SD
Molina Healthcare·Identified Jun 19, 2026
Molina Healthcare of California has identified an issue with their monthly eligibility lists (Elists) that resulted in some members being omitted from the January transmission. A corrected Elist will be provided in the next file transmission, while Availity eligibility information remains accurate.
Medium impact
Provider Bulletin 01-21-2025 End Stage Renal Disease (ESRD) Bundled Payment IE LA SAC SD
Molina Healthcare·Effective Jan 1, 2025
Effective January 1, 2025, oral-only phosphate binders for ESRD dialysis patients moved from pharmacy benefit (Part D) to medical benefit (Part B) and are now included in the ESRD bundled payment. Dialysis providers must use new HCPCS J-codes when billing for these oral phosphate binders.
Low impact
Provider Bulletin 01-29-2025 Quarter 1 Provider Training Opportunities IM IE LA OC SAC SD
Molina Healthcare·Identified Jun 19, 2026
Molina Healthcare of California announced Quarter 1 training opportunities for network providers, including Biannual Provider Regulatory Training, New Provider Orientation sessions, and EPSDT training for PCPs treating youth. Providers are encouraged to register online and contact designated representatives for assistance.
Medium impact
Provider Bulletin 02-03-2025 Minor Consent to Outpatient Mental Health Treatment or Counseling IE LA SAC SD
Molina Healthcare·Effective Jul 1, 2024
Molina Healthcare of California allows minors aged 12 or older to independently consent to outpatient mental health treatment or counseling without parental consent if the provider determines they are mature enough. This policy affects billing and consent procedures for Medi-Cal mental health services in specified California counties.
High impact
Provider Bulletin 02-12-2025 2025 Senate Bill and Assembly Bill Mandate IM IE LA OC SAC SD
Molina Healthcare·Effective Jan 1, 2025
Molina Healthcare of California has implemented 10 new legislative mandates effective January 1, 2025 and July 1, 2025. Key changes include no cost-sharing for PANDAS/PANS treatment, coverage for immediate postpartum contraception billing, elimination of prior auth for substance abuse treatment medications, and new requirements for AI/algorithm use in utilization review.
Medium impact
Provider Bulletin 02-14-2025 2025 HEDIS & Risk Adjustment Data Collection IM IE LA OC SAC SD
Molina Healthcare·Effective Feb 3, 2025
Molina Healthcare of California is beginning their annual HEDIS and Risk Adjustment medical record review starting February 3, 2025. Providers will be contacted to arrange submission of specific member medical records for quality reporting and Medicare risk adjustment purposes.
Medium impact
Provider Bulletin 02-14-2025 2025 Encounter Data Validation & Medical Record Collection IM IE LA OC SAC SD
Molina Healthcare·Effective Feb 17, 2025
Molina Healthcare of California will begin contacting providers on February 17, 2025 to collect medical records from calendar year 2023 for a state-mandated encounter data validation review. Providers must submit fully legible, signed, credentialed, and dated medical records for selected patients when requested.
Low impact
Provider Bulletin 02-17-2025 New Facility Guides Are Available SD
Molina Healthcare·Effective Feb 17, 2025
Molina Healthcare of California released updated facility resource guides for Acute Care Facilities, Long Term Acute Care Facilities (LTAC), and Skilled Nursing Facilities (SNF) in San Diego County. These guides contain essential resources and contact information for streamlined operations and patient care coordination.
Low impact
Provider Bulletin 02-17-2025 New Facility Guides Are Available SAC
Molina Healthcare·Effective Feb 17, 2025
Molina Healthcare of California has released updated facility resource guides for Sacramento County providers serving Medi-Cal patients. New guides are now available for Acute Care Facilities, Long Term Acute Care Facilities (LTAC), and Skilled Nursing Facilities (SNF) with updated resources and contact information.
Low impact
Provider Bulletin 02-17-2025 New Facility Guides Are Available LA
Molina Healthcare·Effective Feb 17, 2025
Molina Healthcare of California has released updated facility resource guides for Acute Care, Long Term Acute Care (LTAC), and Skilled Nursing Facilities in Los Angeles County. These guides provide critical resources, contact information, and operational support materials for Medi-Cal providers.
Low impact
Provider Bulletin 02-17-2025 New Facility Guides Are Available IE
Molina Healthcare·Effective Feb 17, 2025
Molina Healthcare of California has released updated facility resource guides for Acute Care Facilities, Long Term Acute Care Facilities (LTAC), and Skilled Nursing Facilities (SNF) in the Riverside and San Bernardino counties. These guides provide critical resources and contact information for streamlined operations and patient care coordination.
Medium impact
Provider Bulletin 02 17 2025 Summary of the Skilled Nursing Facility Workforce and Quality Incentive Program IE LA SAC SD
Molina Healthcare·Effective Jan 1, 2023
Molina Healthcare of California has implemented the SNF Workforce and Quality Incentive Program (SNF WQIP) providing performance-based payments to eligible skilled nursing facilities for Medi-Cal patients from 2023-2026. Providers must submit clean claims for qualifying bed days and monitor CDPH citations that could disqualify facilities from payments.
Medium impact
Provider Bulletin 02-20-2025 SNF, ICF/DD and Subacute Care Facilities Billing Reminder IE LA SAC SD
Molina Healthcare·Effective Feb 20, 2025
Molina Healthcare of California issued a billing reminder for SNF, ICF/DD and subacute care facilities highlighting three common denial reasons: duplicate billing, missing authorization, and enrollment discrepancies. The bulletin provides best practices to reduce claim denials and improve processing efficiency.
High impact
Provider Bulletin 02-21-2025 Parkview Community Hospital Medical Center IE
Molina Healthcare·Effective Mar 15, 2025
Parkview Community Hospital Medical Center will be removed from Molina Healthcare of California's contracted hospital network effective March 15, 2025. Providers must redirect all new referrals and authorization requests to alternative in-network hospitals in Riverside and San Bernardino counties.
Low impact
Provider Bulletin 02-24-2025 Safeguarding Members' Protected Health Information IM IE LA OC SAC SD
Molina Healthcare·Effective Feb 24, 2025
Molina Healthcare of California issued a reminder to providers about HIPAA and PHI protection requirements. This is an advisory notification emphasizing existing privacy obligations, not introducing new billing or documentation requirements.
High impact
Provider Bulletin 02-25-2025 Changes to State License Requirements IM IE LA OC SAC SD
Molina Healthcare·Effective Jul 1, 2025
Molina Healthcare of California will begin immediately terminating contracts for practitioners whose licenses expire, effective July 1, 2025. Practitioners have a 30-day grace period to renew and notify Molina to lift termination, but after 31 days must undergo full re-credentialing to be reinstated.
Low impact
Provider Bulletin 02-25-2025 California Electronic Visit Verification (CalEVV) February Office Hours IE LA SAC SD
Molina Healthcare·Effective Feb 28, 2025
Molina Healthcare of California is announcing an informational webinar about the California Electronic Visit Verification (CalEVV) system scheduled for February 28, 2025. This is an educational opportunity for providers to ask questions about EVV registration, portal navigation, and visit data capture requirements.
Medium impact
Provider Bulletin 02 26 2025 Availity Appeals and Reconsideration Changes IM IE LA OC SAC SD
Molina Healthcare·Effective Feb 26, 2025
Molina Healthcare of California has simplified the Availity appeals and reconsideration process by reducing the dropdown menu options to just two choices: 'Claim Payment Inquiry/Reconsideration' for minor errors that don't require documentation, and 'Claim Payment Dispute/Appeal' for formal reviews requiring supporting documentation. This change affects all lines of business across seven California counties.
Medium impact
Provider Bulletin 02-27-2025 Provider Roster Submission Instructions IM IE LA OC SAC SD
Molina Healthcare·Effective Feb 5, 2025
Molina Healthcare of California has updated provider roster submission instructions for capitated Medical Groups and IPAs, introducing new monthly and quarterly submission requirements with specific templates and naming conventions. The policy clarifies submission methods: monthly rosters go to county-specific email addresses while quarterly rosters must be submitted through the D360 system.
Low impact
Provider Bulletin 03-03-2025 Informational Bulletin Regarding Emergency Declaration Fast-Track Critical Wildfire Prevention Projects Statewide LA
Molina Healthcare·Effective Mar 1, 2025
Molina Healthcare issued an informational bulletin about California's wildfire prevention emergency declaration, providing contact information for providers who need assistance serving Molina members in affected areas. This is purely informational with no changes to billing, coverage, or administrative procedures.
Low impact
Provider Bulletin 03-03-2025 Quarter 1 Provider Satisfaction Survey IM IE LA OC SAC SD
Molina Healthcare·Identified Jun 19, 2026
Molina Healthcare of California is conducting a Quarter 1 Provider Satisfaction Survey open until March 21, 2025. This is an informational bulletin requesting provider participation in a 2-minute survey to gather feedback on provider experience and identify areas for improvement.

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Archive by year

2023 2024 2025 2026

Provider Bulletin 01-08-2025 Reminder Community Based Adult Services and Long-Term Care Facilities Critical Incidents Reporting LA

Provider Bulletin 01-08-2025 Doula Guidance for Hospitals IM LA OC SAC SD

Provider Bulletin 01-08-2025 Informational Bulletin Regarding Emergency Declaration Palisades Fire and Windstorm Conditions LA

Provider Bulletin 01 10 2025 TGI Cultural Competency Training Program and Provider Directory Requirements APL24 017 IE LA SAC SD

Provider Bulletin 01-16-2025 Update on Monthly Eligibility Lists IM IE LA OC SAC SD

Provider Bulletin 01-21-2025 End Stage Renal Disease (ESRD) Bundled Payment IE LA SAC SD

Provider Bulletin 01-29-2025 Quarter 1 Provider Training Opportunities IM IE LA OC SAC SD

Provider Bulletin 02-03-2025 Minor Consent to Outpatient Mental Health Treatment or Counseling IE LA SAC SD

Provider Bulletin 02-12-2025 2025 Senate Bill and Assembly Bill Mandate IM IE LA OC SAC SD

Provider Bulletin 02-14-2025 2025 HEDIS & Risk Adjustment Data Collection IM IE LA OC SAC SD

Provider Bulletin 02-14-2025 2025 Encounter Data Validation & Medical Record Collection IM IE LA OC SAC SD

Provider Bulletin 02-17-2025 New Facility Guides Are Available SD

Provider Bulletin 02-17-2025 New Facility Guides Are Available SAC

Provider Bulletin 02-17-2025 New Facility Guides Are Available LA

Provider Bulletin 02-17-2025 New Facility Guides Are Available IE

Provider Bulletin 02 17 2025 Summary of the Skilled Nursing Facility Workforce and Quality Incentive Program IE LA SAC SD

Provider Bulletin 02-20-2025 SNF, ICF/DD and Subacute Care Facilities Billing Reminder IE LA SAC SD

Provider Bulletin 02-21-2025 Parkview Community Hospital Medical Center IE

Provider Bulletin 02-24-2025 Safeguarding Members' Protected Health Information IM IE LA OC SAC SD

Provider Bulletin 02-25-2025 Changes to State License Requirements IM IE LA OC SAC SD

Provider Bulletin 02-25-2025 California Electronic Visit Verification (CalEVV) February Office Hours IE LA SAC SD

Provider Bulletin 02 26 2025 Availity Appeals and Reconsideration Changes IM IE LA OC SAC SD

Provider Bulletin 02-27-2025 Provider Roster Submission Instructions IM IE LA OC SAC SD

Provider Bulletin 03-03-2025 Informational Bulletin Regarding Emergency Declaration Fast-Track Critical Wildfire Prevention Projects Statewide LA

Provider Bulletin 03-03-2025 Quarter 1 Provider Satisfaction Survey IM IE LA OC SAC SD