25-1287 Provider Communications Posted Online and Operations Manual Updates for November 2025
Date: 12/05/25
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 November 2025.
- Communications posted online: Includes the posting date, material number and title, type of communication, applicable audience and counties, 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 November 2025
Date, number and title | Type of notice | Audience | Medi-Cal counties | Summary |
|---|---|---|---|---|
11/5/25 25-1137m, Submit Medical Records for HEDIS® Review Starting January 2, 2026 | News & Announcements | Physicians PPGs
|
| Be prepared! The annual medical record collection for HEDIS® Measurement Year 2025 begins on January 2, 2026. Physicians and PPGs may be randomly selected to submit member medical records to support national evaluations of health care quality. |
11/7/25 25-1178m, Updated Authorization Guides: Personal Care and Homemaker Services and Day Habilitation Services | Regulatory | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers |
| The Personal Care and Homemaker Services and Day Habilitation Services authorization guides were updated to align services with the Department of Health Care Services standards. A new referral form for Day Habilitation is now available. Visit the CalAIM Resources for Providers page for the latest guides and referral forms. |
11/14/25 25-1168m, Integrating Social Determinants of Health Into Clinical Practice | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers |
| Learn more about social determinants of health (SDOH) and the importance of screening to impact patient health outcomes. Includes key details about screening, documenting, claims coding, referrals to services, and follow-up. |
11/18/25 25-1214m, Medical Policies – October 2025 | Contractual | Physicians PPGs Behavioral Health providers
|
| Review changes to medical policies for procedures and services for October 2025. Medical policies are available online at Medical policies. 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. |
11/20/25 25-1251m, Streamline Compliance With Same-Day Scheduling | News & Announcements | Physicians PPGs |
| Let us know if you offer advanced access (same-day scheduling). Refer to the Improve Patient Satisfaction With Advanced Access flyer for a description of the program and how to get help from Provider Network Management on implementing advanced access if you don't currently offer it. |
11/21/25 25-1199m (PDF), Opioid Interactions: Potentiator Drugs That Increase the Risk of Overdose | News & Announcements | Ancillary providers ECM providers CS providers Behavioral Health providers |
| Refer to this resource to learn more about medications that can dangerously amplify opioid effects, increasing the risk of overdose and death. |
11/25/25 25-1265m, Faster Access to Phone Interpretation – No New Numbers, Just a Better Experience | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers |
| You can now access phone interpretation services more quickly and efficiently by using the existing Provider Services Center number and following updated prompts—no new numbers required. |
Medi-Cal Provider Operations Manual changes in November 2025
Effective Date | Document name (and path) | Audience | Summary |
|---|---|---|---|
11/3/25
| Payments to Medi-Cal Prohibited Entities | Physicians PPGs Hospitals Ancillary | Updated to reflect new guidance on how the Plan and providers will handle claims under H.R. 1, which restricts payments to Prohibited Entities. These updates derive from the DHCS All Plan Letter 25-011, dated September 17, 2025. |
11/4/25
| WIC | Physician PPGs Hospital Ancillary | Updated with information that food vouchers can also be used for fresh produce at select farmer’s markets; added link to the WIC web page on the California Department of Public Health’s website. |
11/17/25 | Confidentiality of Medical Records (under Medical Records) | Physicians PPGs Hospitals Ancillary | Updated with information and guidance specific to the inclusion of immigration status and place of birth as medical information and protected health information. These updates derive from California Senate Bill (SB) 81, which was approved and signed into law in September 2025. |
Behavioral Health Provider Operations Manual changes in November 2025
Effective Date | Section | Topic | Summary |
|---|---|---|---|
11/3/25 | Section 12.6 | Payments to Medi-Cal Prohibited Entities | Updated to reflect new guidance on how the Plan and providers will handle claims under H.R. 1, which restricts payments to Prohibited Entities. These updates derive from the DHCS All Plan Letter 25-011, dated September 17, 2025. |
11/17/25 | Section 3.7 |
| Updated with information and guidance specific to the inclusion of immigration status and place of birth as medical information and protected health information. These updates derive from California SB 81, which was approved and signed into law in September 2025. |
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 Fresno, Kings and Madera counties.