MedicaidPrior AuthMedium impact
22-105 Temporary Changes to Prior Authorization Requirements Due to COVID-19 Surge
Health Net·CA · Emergency Medicine, Critical Care·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net/CalViva Health has temporarily waived prior authorization requirements for hospitals experiencing COVID-19 surge conditions in Fresno, Kings, and Madera counties. The waiver applies to patient transfers/discharges to various care levels, routine DME for discharge, and eliminates daily concurrent review requirements for ICU patients.
Action Required
Immediately: Billing teams at hospitals in Fresno, Kings, and Madera counties should verify if their facility meets surge criteria (less than 10% ICU capacity or 15% inpatient capacity, staffing shortages, or use of alternative spaces). If qualifying, stop requesting prior authorization for patient transfers to acute rehab, home health, long-term acute care, SNF, and swing beds. Also skip prior auth for routine DME items like manual wheelchairs, oxygen supplies, CPAP devices, semi-electric beds, walkers, and wound care supplies for patient discharge. Continue to notify Hospital Notification Unit of admissions via fax 800-676-7969 or phone 800-995-7890.