MedicaidAdministrativeHigh impact
07-02-2026 Private Duty Nursing CM Responsibilities for Medi-Cal Eligible Members APL 26-009
Molina Healthcare·CA · Pediatrics, Palliative Care·Medicaid
Effective date
Jul 2, 2026
We identified it
Jul 7, 2026
Summary
Molina Healthcare of California has updated case management responsibilities for Private Duty Nursing (PDN) services under Medi-Cal for members under age 21 (APL 26-009, superseding APL 20-012). The plan now requires enhanced care coordination, monitoring of service delivery, tracking of staffing gaps, and mandatory provider participation in authorization, documentation, and continuity-of-care activities. Providers must promptly report service disruptions and maintain current clinical documentation.
Action Required
By July 2, 2026: Billing and clinical teams must implement the following: (1) Update authorization request processes to ensure complete clinical documentation is submitted timely; (2) Establish internal protocol for providers furnishing PDN services to notify Molina immediately of any anticipated or actual staffing limitations or service interruptions; (3) Ensure all physician orders and care plans are current and clearly document medical necessity; (4) Designate staff to participate in Molina-requested care coordination activities and continuity-of-care meetings; (5) For providers working with CCS-covered members, establish a communication pathway to reach out to Molina proactively regarding staffing concerns. Update encounter forms and authorization templates to reflect these requirements. Verify that clinical documentation standards support ongoing assessment and authorization cycles. Failure to comply may result in authorization denials, claim rejections, and service disruptions for members.