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25-1037 Provider Communications Posted Online and Operations Manual Updates for September 2025

Date: 10/07/25

Access the Provider Library for the latest operational and Plan updates and changes to better service your patients

The tables below outline provider communications posted online and operations manual changes made in September 2025.

Communications posted online: Includes the posting date, material number and title, type of notice, applicable audience and lines of business, and a summary of the communication.
Provider operations manual changes (for physicians, participating physician groups (PPGs), hospitals, and ancillary providers): Includes the effective date of the change, document name (and path to section where document is located), audience, affected lines of business and URLs, and a summary of the change.
Behavioral Health Provider Operations Manual: Includes the effective date of the change, operations manual section, topic and summary of the change.

Communications posted online in September 2025

Date, number and title	Type of notice	Audience	Lines of business¹	Summary
9/10/25 25-967m, Guidelines and Restrictions for PCP Transfers Between Health Net and Molina	News & Announcements	Physicians PPGs	Molina	Understand current processes and details for transfers between Health Net and Molina (and vice versa). Process updates : 1) ‘Retroactive’ transfers are no longer allowed; 2) Transfers are effective the first day of the following month; and 3) Members cannot transfer between Health Net and Molina while hospitalized.
9/19/25 25-1003m, Medical Policies – August 2025	Contractual	Physicians PPGs Behavioral Health providers	IFP (Ambetter HMO/PPO) Employer Group (HMO/POS, PPO) Medi-Cal (all counties) Molina	Review changes to medical policies for procedures and services for Aug. 2025. Medical policies offer guidelines for determining medical necessity for certain procedures, equipment and services, and can be accessed online at Medical Policies. As a reminder, all services must be medically necessary and member benefits. Legal and regulatory mandates take precedence over content of medical policies and must be applied first.
9/25/25 25-1007m, Maximize Savings with the Federal 340B Drug Pricing Program	News & Announcements	Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers	Medi-Cal (all counties)	Reminder! The federal 340B Drug Pricing Program requires drug manufacturers to offer significant discounts to eligible hospitals and health care providers. Also, use the UD modifier and “08” in the Basis of Cost Determination field to receive discounted pricing.
9/26/25 25-977m, Earn $75 for Early Pregnancy Confirmation	News & Announcements	Physicians	Medi-Cal (all counties)	Earn a $75 incentive for early pregnancy confirmation as part of the 2025 HEDIS^® Improvement Program. Learn more on how to qualify and required documentation to submit before the incentive ends on Dec. 31, 2025.

¹Medi-Cal (all counties) indicates that the communication applies to Medi-Cal Amador, Calaveras, Inyo, Los Angeles, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.

Provider operations manual changes in September 2025

Effective Date	*Document name (and path)*	Audience	Lines of business and URL	Summary
9/2/25	Provider Offshore Subcontracting Attestation (under Compliance and Regulations)	Physicians PPGs Hospitals Ancillary	HMO PPO Medi-Cal	This document and related attestation forms have been removed, as attestation or acknowledgment of offshore agreements is not required for HMO, PPO and Medi-Cal lines of business.
9/4/25	Hospice Care (under Benefits)	Physicians PPGs Hospitals Ancillary	Medi-Cal	Updated with current guidelines related to certification and requirement documentation for hospice care, as well as eligibility requirements. The updates align with policy changes and documentation requirements set forth in the DHCS All Plan Letter 25-008.
9/4/25	Participating Physician Group (PPG) Performance Management (under Provider Oversight)	PPGs	Medi-Cal	Removed ‘Delegation Oversight Committee’ reference under Performance Management subhead.
9/5/25	Health Net Quality Improvement and Health Equity Committees (under Quality Improvement > Quality Improvement Programs)	Physicians PPGs Ancillary	Medi-Cal	Updated the following sections: 1) Subcommittees > Health Equity – added ‘Monitor, review, evaluate, and improve coordination and continuity of care services to all members,’ then listed member types to include. 2) Credentialing/Peer Review Committee – added reference to include DHCS when the Peer Review Committee providers a summary of activities to the Health Net board of directors.
9/5/25	EPSDT / Medi-Cal for Kids & Teens Services (under Public Programs)	Physicians PPGs Hospitals Ancillary	Medi-Cal	Updated to reflect that the annual requirement to mail or share electronically DHCS’ Medi-Cal for Kids & Teens brochures to existing members must be completed by January 1. For new members, Medi-Cal for Kids & Teens materials will be mailed or shared electronically within seven calendar days of enrollment.
9/5/25	Member Cost-Sharing Protections (under Member Rights and Responsibilities)	Physicians PPGs Hospitals Ancillary	Medi-Cal	Updated to reflect ‘Health Net’ instead of ‘Contractor,’ and applied other grammatical changes to align with DHCS Medi-Cal contract/amendments.
9/5/25	Community-Based Adult Services (under Public Programs > Long Term Services and Supports)	Physicians PPGs Hospitals Ancillary	Medi-Cal	Updated ‘Eligibility’ section to state that Health Net must conduct CBAS-eligibility determination using DHCS-approved assessment tools within 30 calendar days from the initial inquiry request. Also updated ‘Referral Process’ section to state that a face-to-face review is not needed if the member is clinically eligible for CBAS and needs an expedited start date.
9/5/25	Access to Care and Availability Standards (under Provider Oversight > Service and Quality Requirements)	Physicians PPGs Hospitals Ancillary	Medi-Cal	Updated ‘Minor’s consent for services – Mental health services’, within Minor’s Consent for Services section, to align with AB 665.
9/9/25	California Children’s Services (under Public Programs)	Physicians PPGs Hospitals Ancillary	Medi-Cal	Updated with following changes to align with DHCS Medi-Cal contract/amendments: 1) Added reference to the ‘CCS Services Authorization Request (SAR) – new client’ where applicable; 2) Added ‘Definitions’ for CCS program and services, and other public programs; 3) Updated “Eligibility’ section of CCS-Administered HCBS Waiver document to clarify developmental disability term; 4) For Transportation, added information specific to ‘Requirements per the Medi-Cal contract’ and updated ‘Non-Medical Transportation’ section; 5) Updated Modivcare contact information.
CCS Service Authorization Request (SAR) Definitions DDS-Administered Home and Community Based Services (HCBS) Waiver (under Public Programs)	CCS Service Authorization Request (SAR) Definitions DDS-Administered Home and Community Based Services (HCBS) Waiver
Transportation (under Benefits > Ambulance)	Transportation
Modivcare (under Contacts)	Modivcare
9/16/25	Case Management Department (under Contacts)	Physicians PPGs Hospitals Ancillary	HMO, PPO, Medi-Cal	Updated contact information for Case Management Department based on line of business.
9/25/25	Participating Pharmacy (under Prescription Drug Program)	Physicians PPGs	HMO, PPO, Medicare	Updated name of provider search tool from ‘ProviderSearch’ to ‘Find a Provider.’
9/25/25	Provider Online Demographic Data Verification (under Provider Oversight > Facility and Physician Additions, Changes and Deletions)	Physicians PPGs Hospitals Ancillary	HMO, PPO, Medicare
9/25/25	Requirements (under Benefits > Initial Health Appointment)	Physicians PPGs Hospitals Ancillary	Medi-Cal	Updated to emphasize the importance of scheduling an Initial Health Appointment, noting that Health Net makes three reminder calls to newly enrolled members.
9/29/25	Community Health Worker Services (under CalAIM)	Physicians PPGs Hospitals Ancillary	Medi-Cal	Revised standing recommendations for Community Health Worker (CHW) services, per guidance from DHCS. Written recommendations are no longer required.

Effective Date

Document name (and path)

Audience

Lines of business and URL

Summary

9/2/25

Provider Offshore Subcontracting Attestation

(under Compliance and Regulations)

Physicians

PPGs

Hospitals

Ancillary

HMO

PPO

Medi-Cal

This document and related attestation forms have been removed, as attestation or acknowledgment of offshore agreements is not required for HMO, PPO and Medi-Cal lines of business.

9/4/25

Hospice Care
(under Benefits)

Physicians

PPGs

Hospitals

Ancillary

Medi-Cal

Updated with current guidelines related to certification and requirement documentation for hospice care, as well as eligibility requirements. The updates align with policy changes and documentation requirements set forth in the DHCS All Plan Letter 25-008.

9/4/25

Participating Physician Group (PPG) Performance Management
(under Provider Oversight)

PPGs

Medi-Cal

Removed ‘Delegation Oversight Committee’ reference under Performance Management subhead.

9/5/25

Health Net Quality Improvement and Health Equity Committees
(under Quality Improvement > Quality Improvement Programs)

Physicians

PPGs

Ancillary

Medi-Cal

Updated the following sections:
1) Subcommittees > Health Equity – added ‘Monitor, review, evaluate, and improve coordination and continuity of care services to all members,’ then listed member types to include.
2) Credentialing/Peer Review Committee – added reference to include DHCS when the Peer Review Committee providers a summary of activities to the Health Net board of directors.

9/5/25

EPSDT / Medi-Cal for Kids & Teens Services
(under Public Programs)

Physicians

PPGs

Hospitals

Ancillary

Medi-Cal

Updated to reflect that the annual requirement to mail or share electronically DHCS’ Medi-Cal for Kids & Teens brochures to existing members must be completed by January 1. For new members, Medi-Cal for Kids & Teens materials will be mailed or shared electronically within seven calendar days of enrollment.

9/5/25

Member Cost-Sharing Protections

(under Member Rights and Responsibilities)

Physicians

PPGs

Hospitals

Ancillary

Medi-Cal

Updated to reflect ‘Health Net’ instead of ‘Contractor,’ and applied other grammatical changes to align with DHCS Medi-Cal contract/amendments.

9/5/25

Community-Based Adult Services

(under Public Programs > Long Term Services and Supports)

Physicians

PPGs

Hospitals

Ancillary

Medi-Cal

Updated ‘Eligibility’ section to state that
Health Net must conduct CBAS-eligibility determination using DHCS-approved assessment tools within 30 calendar days from the initial inquiry request. Also updated ‘Referral Process’ section to state that a face-to-face review is not needed if the member is clinically eligible for CBAS and needs an expedited start date.

9/5/25

Access to Care and Availability Standards

(under Provider Oversight > Service and Quality Requirements)

Physicians

PPGs

Hospitals

Ancillary

Medi-Cal

Updated ‘Minor’s consent for services – Mental health services’, within Minor’s Consent for Services section, to align with AB 665.

9/9/25

California Children’s Services

(under Public Programs)

Physicians

PPGs

Hospitals

Ancillary

Medi-Cal

Updated with following changes to align with DHCS Medi-Cal contract/amendments: 1) Added reference to the ‘CCS Services Authorization Request (SAR) – new client’ where applicable; 2) Added ‘Definitions’ for CCS program and services, and other public programs; 3) Updated “Eligibility’ section of CCS-Administered HCBS Waiver document to clarify developmental disability term; 4) For Transportation, added information specific to ‘Requirements per the Medi-Cal contract’ and updated ‘Non-Medical Transportation’ section; 5) Updated Modivcare contact information.

CCS Service Authorization Request (SAR)

Definitions

DDS-Administered Home and Community Based Services (HCBS) Waiver

(under Public Programs)

CCS Service Authorization Request (SAR)

Definitions

DDS-Administered Home and Community Based Services (HCBS) Waiver

Transportation

(under Benefits > Ambulance)

Transportation

Modivcare

(under Contacts)

Modivcare

9/16/25

Case Management Department

(under Contacts)

Physicians

PPGs

Hospitals

Ancillary

HMO, PPO, Medi-Cal

Updated contact information for Case Management Department based on line of business.

9/25/25

Participating Pharmacy
(under Prescription Drug Program)

Physicians

PPGs

HMO, PPO, Medicare

Updated name of provider search tool from ‘ProviderSearch’ to ‘Find a Provider.’

9/25/25

Provider Online Demographic Data Verification

(under Provider Oversight > Facility and Physician Additions, Changes and Deletions)

Physicians

PPGs

Hospitals

Ancillary

HMO, PPO, Medicare

9/25/25

Requirements
(under Benefits > Initial Health Appointment)

Physicians

PPGs

Hospitals

Ancillary

Medi-Cal

Updated to emphasize the importance of scheduling an Initial Health Appointment, noting that Health Net makes three reminder calls to newly enrolled members.

9/29/25

Community Health Worker Services

(under CalAIM)

Physicians

PPGs

Hospitals

Ancillary

Medi-Cal

Revised standing recommendations for Community Health Worker (CHW) services, per guidance from DHCS. Written recommendations are no longer required.

Behavioral Health Provider Operations Manual changes in September 2025

Effective Date	Section	Topic	Summary
9/9/25	Section 6.4	Transportation for Medi-Cal Members	Updated sections with following changes to align with DHCS Medi-Cal contract/amendments: 1) Added information specific to ‘Requirements per the Medi-Cal contract’ and updated ‘Non-Medical Transportation’ information in Transportation for Medi-Cal Members topic; 2) Added reference and link to definitions for CCS program and services, and other public programs.
9/9/25	Section 10.4	Requests for Authorization for Post-Stabilization Care
9/25/25	Section 6	Provider Searches	Updated name of provider search tool from ‘ProviderSearch’ to ‘Find a Provider.’

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, Community Supports (CS) Providers, Enhanced Care Management (ECM) Providers, and Behavioral Health Providers.

For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, Molina, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.

Last Updated: 10/06/2025

25-1037 Provider Communications Posted Online and Operations Manual Updates for September 2025

Access the Provider Library for the latest operational and Plan updates and changes to better service your patients

1 Medi-Cal (all counties) indicates that the communication applies to Medi-Cal Amador, Calaveras, Inyo, Los Angeles, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.

¹Medi-Cal (all counties) indicates that the communication applies to Medi-Cal Amador, Calaveras, Inyo, Los Angeles, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.