Medicare AdvantagePrior AuthHigh impact
26-1056 Provider Communications Posted Online and Operations Manual Updates for August 2026
Health Net·CA · Psychiatry, Palliative Care, OB-GYN·Prior Authorization
We identified it
Sep 9, 2026
Summary
Health Net California issued a comprehensive policy update (26-1056) summarizing August 2026 operational and clinical policy changes across multiple lines of business. Key changes include: (1) Updates to prior authorization requirements for Medicare D-SNP members; (2) Clarification of services not requiring prior authorization for Medi-Cal; (3) Removal of cognitive health assessment training requirements for Medi-Cal; and (4) Updated payment guidelines for Medi-Cal Prohibited Entities following federal restrictions ending July 4, 2026.
Action Required
REQUIREMENTS: By 9/30/26, billing team and prior authorization staff must take the following actions: (1) For Medicare D-SNP claims: Review the updated 'PPGs' Responsibilities for Authorization' document (effective 8/18/26) and implement process changes to forward prior authorization requests for Exclusively Aligned Enrollment D-SNP members to Health Net for review per new regulatory references. Update authorization request forms and staff training materials. (2) For Medi-Cal claims (applicable counties: Amador, Calaveras, Inyo, Los Angeles, Molina, Mono, Sacramento, San Joaquin, Stanislaus, Tulare, Tuolumne): Review 'Services Not Requiring Prior Authorization' document (effective 8/31/26) to identify which hospice, behavioral health, maternal health, and preventive services no longer require prior auth. Update billing system rules to prevent unnecessary authorization requests. (3) For Medi-Cal billing: Update claims processing procedures to reflect current payment guidelines for Prohibited Entities (effective 8/11/26) following expiration of H.R. 1 federal restrictions. (4) For Medi-Cal billing: Remove cognitive health assessment training requirements from compliance protocols (effective 8/4/26), but maintain existing assessment, documentation, and billing requirements. (5) For all Medi-Cal staff: Implement policy that Medi-Cal members cannot be charged for form completion or information provision for public benefits claims/appeals (effective 8/21/26). Failure to comply with prior authorization forwarding requirements will result in Medicare Advantage claim denials; failure to update authorization rules may result in unnecessary claim holds or denials; failure to apply correct Prohibited Entity payment guidelines will result in payment errors.