Medicare AdvantageAdministrativeMedium impact
25-1180 Provider Communications Posted Online and Operations Manual Updates for October 2025
Health Net·CA · Psychiatry·Prior Authorization
Effective date
Oct 20, 2025
We identified it
Jun 20, 2026
Summary
Health Net California published their October 2025 provider communications summary, including updates to prior authorization procedures for injectable medications, autism spectrum disorder coverage changes effective January 1, 2026, and new non-benefit codes billing guidance. Multiple operational manual sections were updated with new forms and documentation requirements.
Action Required
By January 1, 2026: Update billing workflows to reflect that autism spectrum disorder patients with previous pervasive developmental disorder or autism diagnoses no longer require rediagnosis for continued behavioral health treatment coverage. Review updated prior authorization procedures for injectable medications in Medi-Cal, HMO, and Medicare plans. Update hospice care documentation processes to ensure required documentation is submitted within 5 calendar days of hospice election.