MedicaidPrior AuthMedium impact
23-1243m Medical Policies - September 2023
Health Net·CA · Endocrinology, Palliative Care, Sleep Medicine +5 more·Prior Authorization
Effective date
Sep 1, 2023
We identified it
Jun 20, 2026
Summary
CalViva Health updated multiple medical policies for September 2023, including new prior authorization criteria for Lantidra pancreatic islet therapy and palliative care eligibility, plus significant changes to transplant, sleep study, and pain management policies. Two policies were retired including ADHD guidelines and ambulatory surgery center optimization.
Action Required
Immediately: Review all updated medical policies for CalViva Health members in Fresno, Kings, and Madera counties. Update prior authorization workflows for new Lantidra therapy and revised palliative care criteria. Verify current authorization requirements for facility-based sleep studies, lung transplants, pediatric kidney transplants, radiation therapy, and pain management procedures have been updated in billing system to reflect September 2023 changes.