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26-1056 Provider Communications Posted Online and Operations Manual Updates for August 2026

Date: 09/08/26

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 August 2026.

  • 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: 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.

Communications posted online in August 2026

Date, number and title

Type of notice

Audience

Lines of business

Summary

8/18/26

26-1012m, Updates to Medicare Clinical Policies – July 2026

Contractual

  • Physicians/
    Practitioners
  • PPGs
  • Behavioral Health
  • Medicare Advantage (HMO)

 

Review changes to medical policies for procedures and services for July 2026. Medical policies are available online:

  • Commercial, Medi-Cal
  • Medicare

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.

8/27/26

26-1033m, Updates to Clinical Policies – July 2026

Contractual

  • Physicians/
    Practitioners
  • PPGs
  • Behavioral Health
  • IFP (Ambetter HMO/PPO)
  • Employer Group
    (HMO/POS, PPO)
  • Medi-Cal (all counties)

 

 

Provider operations manual changes in August 2026

Effective Date

Document name (and path)

Audience1

Lines of business and URL

Summary

8/4/26

 

Cognitive Health Assessment  
(under Benefits) 

  • Physicians/ Practitioners
  • PPGs

Updated to align with Department of Health Care Services (DHCS) APL 26-014 by removing the cognitive health assessment training requirement. Existing assessment, documentation and billing requirements remain unchanged.

8/11/26

Payments to Medi-Cal Prohibited Entities

(under Claims and Provider Reimbursement)

All

Updated to reflect current claims payment guidelines for Medi-Cal Prohibited Entities following the end of the
H.R. 1 federal payment restriction on July 4, 2026.

8/18/26

PPGs' Responsibilities for Authorization
(under Prior Authorization)

 

 

  • PPGs

Updated to add regulatory references and clarify when certain prior authorization requests for Exclusively Aligned Enrollment Dual-Eligible Special Needs Plan
(D-SNP) members must be forwarded to Health Net for review.

8/21/26

Fees for Public Benefit Program Forms and Information Request
(under Member Rights and Responsibilities)

 

 

All

New document explains that Medi-Cal members or their authorized representatives may not be charged for completing forms or providing information needed to support a public benefits eligibility claim or appeal. Charges for copies of medical records may still apply, as allowed under California law.

8/31/26

Services Not Requiring Prior Authorization

(under Prior Authorization)

 

All

Updated to clarify services that do not require prior authorization and provide additional coverage guidance for select hospice, behavioral health, maternal health, and preventive services.

1All – The provider operations manual document applies to physicians/practitioners, PPGs, hospitals and ancillary providers, unless noted otherwise.

This information applies to Physicians and 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.



Last Updated: 09/08/2026