MedicaidPrior AuthHigh impact
08-20-2026 Intermediate care facilities for individuals with developmental disabilities LTC benefit APL 26-012 IE LA SAC SD
Molina Healthcare·CA · Geriatrics, Palliative Care, Psychiatry·Provider Bulletin
Effective date
Jun 10, 2026
We identified it
Aug 22, 2026
Summary
Molina Healthcare of California has updated ICF/DD (Intermediate Care Facilities for Individuals with Developmental Disabilities) long-term care benefit requirements under Medi-Cal managed care, replacing APL 24-011 with APL 26-012. MHC is now responsible for authorization, care coordination, prior authorization, credentialing, and claims processing for ICF/DD services. Providers must submit HS 231 forms with clinical documentation for initial and reauthorization requests, and promptly notify MHC of member admissions, discharges, transfers, and care changes.
Action Required
REQUIREMENTS:
- Immediately: Billing team must update all MHC Medi-Cal authorization processes to align with APL 26-012 (superseding APL 24-011). Ensure all ICF/DD service requests include the required HS 231 form and supporting clinical documentation.
- By August 20, 2026 (effective date of this bulletin): Providers must implement procedures to notify MHC promptly of all member admissions, discharges, hospitalizations, transfers, and changes affecting care. Add checklist to provider communication workflows.
- Immediately: Billing team must verify MHC credentialing requirements are met for all ICF/DD homes in network and confirm compliance with DHCS documentation standards before processing claims.
- Ongoing: Coordinate with Regional Centers and MHC care coordination team for all transitions and continuity of care issues. Failure to follow prior authorization, documentation, and notification requirements will result in claim denials and service interruptions.