MedicaidPrior AuthMedium impact
23-1251 New Medi-Cal Benefit: Intermediate Care Facility for the Developmentally Disabled (ICF/DD)
Health Net·CA·Prior Authorization
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
Starting January 1, 2024, Medi-Cal beneficiaries residing in ICF/DD homes must enroll in managed care plans, with the Plan now responsible for authorizing and covering all medically necessary services including professional, ancillary, and transportation services. Prior authorization will be required using Form HS 231 for ICF/DD home services, though existing TARs will be honored for up to two years.
Action Required
Immediately: Billing team must verify managed care plan enrollment for all Medi-Cal patients residing in ICF/DD homes in Fresno, Kings, and Madera counties. Update prior authorization workflows to obtain Form HS 231 certification from Regional Centers before providing ICF/DD services. Contact CalViva Health Provider Services at 888-893-1569 for benefit coordination questions. Existing Treatment Authorization Requests (TARs) remain valid for their duration and up to two years for new services.