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22-1016m Respite Services: Provide Temporary Relief for Primary Caregivers
Act
immediately
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
CalViva Health now covers respite services for caregivers of Medi-Cal members who need temporary supervision, with up to 336 hours per calendar year. Prior authorization is required for these services using specific billing codes with modifier U6.
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What to do
immediately · 4 steps
01Billing team must set up prior authorization requirements for respite service codes H0045, S5151, and S9125 when used with modifier U6.
02Update billing system to track the 336-hour annual limit per member.
03Add eligibility verification step to confirm member lives in community and has ADL dependencies.
04Access CalAIM Resources authorization guides on provider portal for specific approval criteria.
Codes mentioned
H0045S5151S9125
Original notice
22-1016m Respite Services: Provide Temporary Relief for Primary Caregivers
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
Related changes
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