08-25-2026 Provider Bulletin Summary IM IE LA OC SAC SD

REQUIREMENTS: Immediately review all six individual Provider Bulletins posted between August 10-21, 2026 on the MHC provider website (links provided in bulletin) for specific effective dates and implementation timelines. By the respective effective dates of each bulletin: (1) Billing team must update referral routing rules to direct ALL pediatric specialty referrals for Medi-Cal members under 18 in San Diego County to Rady Children's Specialists of San Diego, with documentation of exceptions requiring prior authorization; (2) Verify all prescribers and pharmacists are enrolled as Medi-Cal providers in the PAVE portal to receive reimbursement for Medi-Cal Rx claims; (3) Stop billing Medi-Cal members for any forms completion or information requests related to claims, appeals, or public benefits (compliance with CA Health & Safety Code Section 123114); (4) Update billing documentation and reimbursement processes for cognitive health assessments (APL 26-014), subacute care facilities (APL 26-011), intermediate care facilities for developmental disabilities (APL 26-012), and skilled nursing facilities (APL 26-010) per CalAIM requirements. Non-compliance will result in claim denials and potential regulatory violations. Contact your county-specific Provider Relations Representative (listed in bulletin) for clarification on implementation timelines and specific billing requirements for each policy.