25-1039 Provider Communications Posted Online and Operations Manual Updates for September 2025
Date: 10/07/25
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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 communication, applicable audience, and a summary of the communication.
- Medi-Cal 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 posted | Number and title | Type of notice | Audience | Summary |
|---|---|---|---|---|
9/19/25
| 25-1004m, Medical Policies – August 2025 | Contractual | Physicians PPGs Behavioral Health providers | 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 | 25-1009m, Maximize Savings with the Federal 340B Drug Pricing Program | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | 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 | 25-978m, Earn $75 for Early Pregnancy Confirmation | News & Announcements | Physicians
| 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. |
Medi-Cal Provider Operations Manual changes in September 2025
Effective Date | Document name (and path) | Audience | Summary |
|---|---|---|---|
9/2/25
| Provider Offshore Subcontracting Attestation (under Compliance and Regulations) | Physicians PPGs Hospitals Ancillary providers | This document and related attestation forms have been removed, as attestation or acknowledgment of offshore agreements is not required for the Medi-Cal line of business. |
9/4/25
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(under Benefits) | Physicians PPGs Hospitals Ancillary providers | 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) | Physicians PPGs Hospitals Ancillary providers | 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 Hospitals Ancillary providers | Updated the following sections: |
9/5/25 | EPSDT / Medi-Cal for Kids & Teens Services (under Public Programs) | Physicians PPGs Hospitals Ancillary providers | 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 providers | 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 providers | 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 providers | 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 providers | 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;
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CCS Service Authorization Request (SAR) DDS-Administered Home and Community Based Services (HCBS) Waiver (under Public Programs) | |||
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(under Benefits > Ambulance) | |||
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(under Contacts) | |||
9/16/25 |
(under Contacts) | Physicians PPGs Hospitals Ancillary providers | Updated contact information for Case Management Department based on line of business. |
9/25/25 |
(under Benefits > Initial Health Appointment) | Physicians PPGs Hospitals Ancillary providers | 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 providers | 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.
This information applies to Medi-Cal in Imperial County.