26-160 Provider Communications Posted Online and Operations Manual Updates for January 2026
Date: 02/06/26
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The tables below outline provider communications posted online and operations manual changes made in January 2026.
- 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 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, URL, and a summary of the change.
Communications posted online in January 2026
Date, number and title | Type of notice | Audience | Medi-Cal counties | Summary |
|---|---|---|---|---|
1/2/26 26-020m, Medication Trend Updates and Drug List/ | Contractual | Physicians/ PPGs
| Fresno Kings Madera | Discover changes for the formulary and any new medication safety issues to be aware of for the 1st quarter of 2026. |
1/21/26 26-064m, Essential Resources for Medi-Cal Providers | News & Announcements | Physicians/ PPGs Hospitals Ancillary ECM CS Behavioral Health | Fresno Kings Madera | Medi-Cal provider materials have been updated and are available on the New Providers Onboarding Materials page at New Providers Onboarding Materials. |
1/23/26 26-060m (PDF), Updates to Clinical Policies – December 2025 | Contractual | Physicians/ PPGs Behavioral Health
| Fresno Kings Madera | Review changes to medical policies for procedures and services for December 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. |
Medi-Cal Provider Operations Manual changes in January 2026
Effective Date | Document name (and path) | Audience | URL | Summary |
|---|---|---|---|---|
1/1/26
| Sensitive Services (under Benefits > Access to Sensitive Services) | Physicians/ Practitioners PPGs Hospitals Ancillary | Added “HIV test result disclosure” section, which clarifies how HIV test results can be disclosed for | |
1/1/26
| Reimbursement Timelines and Penalties for Late Claims | Physician/ Practitioners PPGs Hospitals Ancillary | Reimbursement Timelines and Penalties for Late Claims
| Updated timelines and information for claims reimbursement and penalties for non-adherence as of 1/1/26, based on Assembly Bill (AB) 3275. |
1/1/26 | Birth Centers | Physicians/ Practitioners PPGs Hospitals Ancillary |
| New document outlines hospital transfer policies, licensing standards and reimbursement details. Added link to this document in the “Freestanding Birth Centers” section of Nurse Midwife > Covered Services document. The changes were driven by AB 55, effective 1/1/26. |
1/1/26 | Transitional Rent (under Benefits) | Physicians/ PPGs Hospitals Ancillary |
| New document describes Transitional Rent benefit. Eligible Medi-Cal members can receive up to six months of Transitional Rent assistance to support housing stability. |
1/1/26 | Community Supports (under CalAIM) | Physicians/ PPGs Hospitals Ancillary |
| Updated document descriptions and eligibility criteria for CS services, based on regulatory and Plan changes. Changes included the addition of Transitional Rent and the removal of Community or Home Transition services. |
1/1/26 | Enteral Nutrition
| Physicians/ PPGs Hospitals Ancillary | Updated prior authorization timeline information in these documents to seven calendar days for | |
Prior Authorization | Physicians/ PPGs Hospitals
| Requesting Prior Authorization or Coordinating a PCP Referral | ||
Provider Oversight | PPGs | Authorization and Referral Timelines
| ||
1/1/26 | Glossary | Physicians/ PPGs Hospitals Ancillary |
| Updated text in the following glossary terms to reflect requirements in Department of Managed Health Care All Plan Letter (APL) 25-004, AB 118: Part 1 - Compliance with Large Group Standardized Evidence of Coverage/Disclosure Form, which pertains to use of standardized language in various health plan documents.
|
1/8/26 | Injectables (under Forms and References) | Physicians/ PPGs Hospitals Ancillary | Updated Injectable Medication HCPCS/Division of Financial Responsibility (DOFR) Crosswalk for the third quarter of 2025. |
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.
This information applies to Medi-Cal in Fresno, Kings and Madera counties.