MedicaidPrior AuthHigh impact
26-357m Updates to Clinical Policies – February 2026
Health Net·CA · Hematology, Oncology, OB-GYN +10 more·Prior Authorization
Effective date
Feb 1, 2026
We identified it
Jun 20, 2026
Summary
CalViva Health updated multiple clinical policies effective February 2026, including changes to prior authorization criteria for various transplant procedures, assisted reproductive technologies, home birth, and extensive updates to genetic testing policies across multiple specialties.
Action Required
Before February 1, 2026: Billing team must review and update prior authorization requirements for transplant procedures (allogeneic hematopoietic progenitor cell therapy, pancreas transplant, tandem transplant), assisted reproductive technologies, home birth services, and hypoglossal nerve stimulation. Update system to reflect new criteria for severe aplastic anemia treatment with Omisirge, revised home birth requirements, and expanded genetic testing policies across 25+ specialty areas. Contact CalViva Health at 888-893-1569 for specific policy details.