MedicaidPrior AuthMedium impact
23-1260 Transportation Benefit for Members in Long-Term Care
Health Net·CA · Family Medicine, Internal Medicine, General Practice +1 more·Prior Authorization
Effective date
Jan 1, 2023
We identified it
Jun 20, 2026
Summary
CalViva Health now requires providers to complete a Physician Certification Statement (PCS) form to authorize non-emergency medical transportation (NEMT) for long-term care members in skilled nursing facilities. Without this completed form submitted to Modivcare or the Plan's delegated entity, members will not receive necessary transportation services.
Action Required
Immediately: Providers must complete and submit PCS forms to Modivcare or CalViva Health's delegated entity to authorize NEMT for long-term care members in skilled nursing facilities. Download the PCS form from the policy link and establish workflow to ensure forms are completed for all members requiring recurring transportation (up to 12 months authorization). Failure to submit PCS forms will result in members not receiving necessary transportation to appointments.