MedicaidPrior AuthMedium impact
24-1349m Medical Policies - November 2024
Health Net·CA · Oncology, Sleep Medicine, Radiology +1 more·Prior Authorization
Effective date
Nov 1, 2024
We identified it
Jun 20, 2026
Summary
CalViva Health updated three medical policies for November 2024, including changes to prior authorization criteria for electric tumor treatment fields (lowering Karnofsky Performance Status requirement from ≥60 to ≥70), facility-based sleep studies for obstructive sleep apnea (adding hypertension as qualifying diagnosis and removing moderate-to-high risk verbiage), and stereotactic body radiation therapy (expanding spinal tumor criteria). One policy for transcatheter closure of patent foramen ovale was retired.
Action Required
Immediately: Review updated prior authorization criteria for electric tumor treatment fields, facility-based sleep studies, and stereotactic body radiation therapy. Update prior authorization workflows to reflect new Karnofsky Performance Status requirements (≥70) for tumor treatments and expanded qualifying conditions for sleep studies including hypertension diagnosis. Stop submitting prior authorizations for transcatheter closure of patent foramen ovale as this policy has been retired. Contact CalViva Health at 888-893-1569 with questions.