MedicaidAdministrativeMedium impact
25-1286 Provider Communications Posted Online and Operations Manual Updates for November 2025
Health Net·CA·Prior Authorization
Effective date
Nov 3, 2025
We identified it
Jun 20, 2026
Summary
This is a comprehensive update listing all provider communications and operations manual changes from November 2025, including updates to authorization guides for Personal Care and Day Habilitation Services, new guidance on prohibited entity payments, and enhanced confidentiality requirements for immigration status in medical records.
Action Required
Review all November 2025 updates: 1) Access updated Personal Care and Homemaker Services and Day Habilitation Services authorization guides on the CalAIM Resources page and use new referral forms effective 11/7/25. 2) Implement new H.R. 1 guidance for prohibited entity payment handling effective 11/3/25. 3) Update medical record confidentiality procedures to protect immigration status and place of birth as PHI per California SB 81 effective 11/17/25. 4) Prepare for HEDIS medical record requests starting January 2, 2026.