Medicare AdvantageAdministrativeMedium impact
24-028 Provider Communications Posted Online and Operations Manual Updates for December 2024
Health Net·CA·Prior Authorization
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
Health Net published December 2024 provider communications covering multiple regulatory changes including expanded psychiatric emergency coverage, medication-assisted treatment drugs without prior authorization, new TB and maternal mental health screening requirements, and updated post-stabilization care authorization processes. Most changes are effective January 1, 2025.
Action Required
By January 1, 2025: Review all December 2024 Health Net communications at the Provider Library. Key actions: (1) Update billing processes to remove prior authorization requirements for FDA-approved substance use treatment drugs in four designated categories for commercial plans, (2) Implement new TB screening protocols for members 18+ with risk factors per AB 2132, (3) Add mandatory mental health screenings during pregnancy and within 6 weeks postpartum, (4) Update post-stabilization care authorization processes to align with single point of contact requirements per APL 24-012. Access full details at Health Net Medical Policies online.