MedicaidPrior AuthMedium impact
22-916 Long-Term Care Benefit for Medi-Cal
Health Net·CA · Geriatrics, Internal Medicine, Family Medicine·Prior Authorization
Effective date
Jan 1, 2023
We identified it
Jun 20, 2026
Summary
Effective January 1, 2023, CalViva Health/Health Net will manage long-term care services for Medi-Cal members in skilled nursing facilities, requiring providers to submit prior authorization requests through a new Long-Term Care Intake Line. Providers must use the Long-Term Care Authorization Notification Form and submit supporting documentation for all SNF admissions and services.
Action Required
Immediately for SNF services: Providers must submit completed Long-Term Care Authorization Notification Form plus supporting clinical documentation (PASRR, MDS, or approved TAR) to Long-Term Care Intake Line via fax at 855-851-4563. Contact 800-453-3033 for LTC referrals and authorization questions. Verify member eligibility monthly and include prior authorization number on all claim forms submitted to Plan Medi-Cal Claims Department.