26-034 Provider Communications Posted Online and Operations Manual Updates for December 2025
Date: 01/15/26
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 December 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 and practitioners, 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: As of January 15, 2026, the Behavioral Health Provider Operations Manual is now part of the digital online provider operations manual (no longer a PDF). Find all behavioral health changes at Behavioral Health Changes to the Provider Operations Manual (PDF). Information includes the section, subsection, line of business and URL.
Communications posted online in December 2025
Date, number and title | Type of notice | Audience | Lines of business1 | Summary |
|---|---|---|---|---|
12/5/25 25-1146m, Support Member Needs With New CBAS and LTC Forms | News & Announcements | Physicians PPGs Hospitals Ancillary ECM CS Behavioral Health |
| The Community-Based Adult Services (CBAS) Treatment Request and Long-Term Care (LTC) Authorization Notification forms are now easier to use. Updates to the CBAS form make it simpler to request face-to-face assessments, and the LTC form has removed old terms to help prevent confusion and speed up requests. |
12/18/25 25-1357m, Medical Policies – November 2025 | Contractual | Physicians PPGs Behavioral Health |
| Review changes to medical policies for procedures and services for November 2025. Medical policies are available online at Medical policies, and offer guidelines for determining medical necessity for certain procedures, equipment and services. 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. |
12/19/25 25-1293m (PDF), Act Now: Keep Your Provider Demographic Information Accessible to Members | Regulatory | Physicians PPGs Hospitals Ancillary ECM CS Behavioral Health |
| Reminder: Discover how to keep your demographic information current to avoid removal from the provider directory.
|
12/19/25 25-1294m (PDF), Act Now: Keep Your Provider Demographic Information Accessible to Members |
| |||
12/22/25 25-1364m, Assembly Bill 55 Expands Access to Birth Centers and Modernizes Medi-Cal Reimbursement | Regulatory | Physicians PPGs Hospitals Ancillary |
| New rules under Assembly Bill 55, starting January 1, 2026, make it easier for patients to access birth centers. The bill also updates Medi-Cal standards and sets new guidelines for care and hospital transfers. |
12/22/25 25-1367m, New HIV Test Result Disclosure Rules for Medi-Cal Providers | Regulatory | Physicians PPGs Hospitals Ancillary ECM CS Behavioral Health |
| New rules under Senate Bill (SB) 278, starting January 1, 2026, explain when and how Medi-Cal providers can share HIV test results. These rules allow more sharing for care coordination and quality improvement, sometimes without written authorization. |
12/22/25 25-1388m, 2026 CalAIM Program Updates: What Medi-Cal Providers Need to Know | Regulatory | Physicians PPGs Hospitals Ancillary ECM CS Behavioral Health |
| Several updates have been made to CS programs under CalAIM resulting in new or updated authorization guides and authorization forms, effective January 1, 2026. Review this notice to ensure compliance with new and/or updated processes and requirements. |
12/26/25 25-1405m, Upcoming Medi-Cal Eligibility and Benefits Changes: What Providers Need to Know | Regulatory | Physicians PPGs Hospitals Ancillary ECM CS Behavioral Health |
| Starting January 1, 2026, Medi-Cal eligibility and benefit changes will roll out over the next several years. Find out more details about these changes, impacted individuals, and what you and your staff should do to help protect patient coverage. |
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 December 2025
Effective Date | Document name (and path) | Audience | Lines of business and URL | Summary |
|---|---|---|---|---|
12/2/25
| Health Net Injectable Medication HCPCS/DOFR Crosswalk (PDF) (under Benefits > Injectables > Therapeutic Injections and Other Injectable Substances) | Physicians/ PPGs Hospitals Ancillary | Updated the Injectable Medication HCPCS/DOFR Crosswalk for the second quarter of 2025. | |
12/5/25
| Community-Based Adult Services Forms and References | Physicians/ PPGs Hospital Ancillary |
| The CBAS Treatment Request and LTC Authorization Notification forms have been added and/or updated to make service requests easier and reduce delays. |
12/10/25 | Facility Site Review (under Quality Improvement) | Physicians/ PPGs Hospital Ancillary | Replaced several facility site criteria policy and procedures documents. The Facility Site & Medical Record Review Preparation List was also updated, with separate versions for Northern and Southern California. | |
12/12/25 | Offshore Subcontracting Attestation: Participating Provider (PDF) | Physicians/ PPGs Hospital Ancillary | Updated attestation for which is required for providers to disclose any offshore subcontracting and confirm that safeguards are in place to protect patient information. | |
12/17/25 | Access to Care and Availability Standards (under Provider Oversight > Service and Quality Requirements) | Physicians/ PPGs Hospital Ancillary | Removed all deferral information from HMO and PPO manuals. The deferral information applies only to Medi-Cal. Additional minor editorial changes applied to ensure copy consistency. | |
12/23/25 | Health Net Transplant Performance Centers (PDF) (under Forms and References) | Physicians/ PPGs Hospital Ancillary |
| Transplant Performance Centers List updated by removing the lines for adult and pediatric pancreas transplants from Sharp Healthcare System and adding a note to Ronald Reagan UCLA Medical Center stating “LOAs will only be granted if the member is an existing Continuity of Care patient.” |
This information applies to Physicians, practitioners, 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.