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Health NetMedicaid · Prior Auth · Prior Authorization · CA · Psychiatry, OB-GYN, Palliative CareHigh impact

26-1059 Provider Communication Posted Online and Operations Manual Updates for August 2026

Act
by Aug 31, 2026
Effective date
Aug 31, 2026
Identified
Sep 9, 2026

Summary

This August 2026 policy update includes multiple operational changes affecting Medi-Cal providers in Fresno, Kings, and Madera counties. Key changes include: removal of cognitive health assessment training requirements (effective 8/4/26), updated claims payment guidelines for prohibited entities (effective 8/11/26), new guidance prohibiting member charges for public benefit forms (effective 8/21/26), and clarification of services not requiring prior authorization including hospice, behavioral health, maternal health, and preventive services (effective 8/31/26).

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What to do

by Aug 31, 2026 · 6 steps
01Billing team must review and implement the updated 'Services Not Requiring Prior Authorization' guidance in the Medi-Cal Provider Operations Manual.
02Update billing system rules and prior authorization workflows to reflect which hospice, behavioral health, maternal health, and preventive services no longer require prior authorization.
03By August 21, 2026: Front desk and billing staff must ensure Medi-Cal members are NOT charged for completing public benefit eligibility forms or providing supporting information (medical record copy charges may still apply per California law).
04By August 11, 2026: Billing team must update claims submission procedures to align with current payment guidelines for Medi-Cal Prohibited Entities following the end of federal H.R.
051 payment restrictions on July 4, 2026.
06By August 4, 2026: Providers and clinical staff should note that cognitive health assessment training requirements have been removed; existing assessment, documentation, and billing requirements remain unchanged.
If missed: Failure to comply with prior authorization requirements will result in claim denials; failure to comply with member charge prohibitions may result in regulatory violations.

Original notice

26-1059 Provider Communication Posted Online and Operations Manual Updates for August 2026
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
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