MedicaidPrior AuthMedium impact
24-1348m Medical Policies - November 2024
Health Net·CA · Oncology, Sleep Medicine, Cardiology +2 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
Centene/Health Net updated three medical policies for November 2024, including changes to Electric Tumor Treatment Fields criteria (lowered Karnofsky Performance Status requirement), sleep study criteria modifications, and updated stereotactic body radiation therapy coverage. One policy for transcatheter closure of patent foramen ovale was retired.
Action Required
Immediately: Review updated prior authorization criteria for Electric Tumor Treatment Fields (now requires Karnofsky Performance Status ≥70 instead of ≥60), facility-based sleep studies (added hypertension as qualifying diagnosis, removed Epworth Sleepiness Scale requirement), and stereotactic body radiation therapy (expanded spinal tumor coverage). Stop processing prior authorizations for transcatheter closure of patent foramen ovale as this policy is retired. Update prior authorization checklists and staff training materials accordingly.