25-1180 Provider Communications Posted Online and Operations Manual Updates for October 2025
Date: 11/07/25
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The tables below outline provider communications posted online and operations manual changes made in October 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.
Read the latest issue of the fall Provider Pulse newsletter
Check out the fall issue for details on how we are working to support you, your patients and your community. Topics in this issue include:
- California Community Health Centers Help More Families Stay Healthy with $45,000 From Health Net
- California’s Physician Pipeline Gains Steam Through Investments
- New Fact Sheet Shares Health Needs of LGBTQ+ Kids in California
- California Medicare and Medicaid Members Get Expanded Options in 2026 Plans
Download the current and past issues in the Provider Library. Then, select the applicable line of business > Provider Pulse Newsletter.
Communications posted online in October 2025
Date, number and title | Type of notice | Audience | Lines of business1 | Summary |
10/9/25 25-962m (PDF), Assist Members With Getting Care Fast | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | IFP (Ambetter HMO/PPO) Employer Group Medi-Cal (all counties) Molina | Access this flyer to help inform your patients about same-day care options available to them. |
25-963m (PDF), Assist Members With Getting Care Fast | Medicare Advantage (HMO) | |||
10/10/25 25-1022m (PDF), 2024 Provider Access Survey Results | News & Announcements | Physicians PPGs Ancillary providers | Medi-Cal (all counties)
| Learn how providers performed in the 2024 Provider Appointment Availability Survey and Provider After-Hours Access Survey. Survey results are used to monitor provider compliance with timely access and after-hours regulations and evaluate the effectiveness of the network to meet the needs of members. |
10/14/25 25-1050m, Patient Privacy Matters: Key Requirements for Providers | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | Medi-Cal (all counties) Molina | Stay current on key requirements for protecting patient privacy, including maintaining HIPAA-compliant policies, safeguarding sensitive health information and ensuring confidential communications. |
10/15/25 25-1033m (PDF), Protect Your Patients With the Flu Vaccine: Flu Season Has Arrived | News & Announcements | Physicians PPGs | IFP (Ambetter HMO/PPO) Employer Group Medi-Cal (all counties) Molina | Help reduce flu-related illness and hospital stays—find out about flu vaccine updates for 2025-2026, tips to help reassure and educate patients about the vaccine, and vaccine coverage and reimbursement. |
10/15/25 25-1036m (PDF), Protect Your Patients With the Flu Vaccine: Flu Season Has Arrived
| Medicare Advantage (HMO) | |||
10/20/25 25-1028m (PDF), Medication Trend Updates and Formulary Changes – 4th Quarter 2025 | Contractual | Physicians PPGs
| IFP (Ambetter HMO/PPO) Employer Group Medi-Cal (all counties) Molina Medicare Advantage (HMO) | Find out about drug list and formulary changes and medication safety issues for the 4th quarter of 2025.
|
10/20/25 25-1076m, Strengthening Cognitive Health in Aging Patients | News & Announcements | Physicians
| Medicare Advantage (HMO) | Access a new resource guide, Boost Cognitive Health Screenings During Medicare Annual Wellness Visits, for information about cognitive health assessments. It includes who can give an assessment, screening tools, required documents, billing codes, and more. |
10/29/25 25-1122m, Medical Policies – August 2025 | Contractual | Physicians PPGs Hospitals Ancillary providers | IFP (Ambetter HMO/PPO) Employer Group Medi-Cal (all counties) Molina | Review changes to medical policies for procedures and services for Aug./Sept. 2025. Medical policies are available online at: Medical policies offer guidelines for determining medical necessity for certain procedures, equipment and services. 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. |
10/29/25 25-1125m, Updates to Medicare Clinical Policies - September 2025 | Physicians PPGs Behavioral Health providers | Medicare Advantage (HMO) |
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.
Provider operations manual changes in October 2025
Effective Date | Document name (and path) | Audience | Lines of business and URL | Summary |
|---|---|---|---|---|
10/20/25
| Billing and Authorization Procedures for Non-Benefit Codes (under Claims and Provider reimbursement) | Physicians PPGs Hospitals Ancillary | New document to clarify DHCS’ policy on “non-benefit” codes and how it affects claims, prior authorization and dispute processes. | |
10/20/25
| Autism Spectrum Disorder | Physicians PPGs (HMO only) Ancillary | Updated ‘Rediagnosis for Continued Treatment’ section to clarify that, effective Jan. 1, 2026, a member is not required to obtain a rediagnosis if the member has previously been diagnosed with pervasive developmental disorder or autism to maintain coverage for behavioral health treatment, per Assembly Bill 951 requirements. | |
10/20/25 | Prior Authorization | Physician PPGs Hospital Ancillary | Updated to clarify the options for submitting prior authorization for injectable medications, based on line of business. | |
10/30/25 | Blood Pressure Monitor Request Form (under Forms and References) | Physicians PPGs Hospital Ancillary | Updated durable medical equipment contact information; added fields for height and weight. | |
10/31/25 | Hospice Care (under Benefits)
| Physicians PPGs Hospital Ancillary |
| Updated to clarify documentation that must be submitted within five calendar days of a hospice election. Also added reference to Hospice Services Documentation Guide, which is also available under Forms and References. |
Behavioral Health Provider Operations Manual changes in October 2025
Effective Date | Section | Topic | Summary |
|---|---|---|---|
10/20/25 | Section 13.1 | AB 951 (2026) Health Care Coverage: Behavioral Diagnoses | Added to clarify that, effective Jan. 1, 2026, a member is not required to obtain a rediagnosis if the member has previously been diagnosed with pervasive developmental disorder or autism to maintain coverage for behavioral health treatment, per Assembly Bill 951 requirements. |
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.