MedicaidCoverageHigh impact
Provider Bulletin 02-12-2025 2025 Senate Bill and Assembly Bill Mandate IM IE LA OC SAC SD
Molina Healthcare·CA · Pediatrics, OB-GYN, Psychiatry +3 more·Provider Bulletin
Effective date
Jan 1, 2025
We identified it
Jun 19, 2026
Summary
Molina Healthcare of California has implemented 10 new legislative mandates effective January 1, 2025 and July 1, 2025. Key changes include no cost-sharing for PANDAS/PANS treatment, coverage for immediate postpartum contraception billing, elimination of prior auth for substance abuse treatment medications, and new requirements for AI/algorithm use in utilization review.
Action Required
Immediately: Update billing systems to remove cost-sharing for PANDAS/PANS treatment in pediatric patients. Enable separate billing for immediate postpartum contraception devices and services when birth occurs in hospitals/birthing centers. Remove step therapy and prior authorization requirements for naloxone, buprenorphine, and long-acting injectable naltrexone for substance use disorder treatment. By July 1, 2025: Implement coverage for emergency medical services from community paramedicine and mobile integrated health programs, and establish processes for integrated mental health/substance use disorder treatment with primary care services.