CommercialPrior AuthHigh impact
26-355m Updates to Clinical Policies – February 2026
Health Net·CA·Prior Authorization
Effective date
Feb 1, 2026
We identified it
Jun 20, 2026
Summary
Centene/Health Net updated multiple clinical policies effective February 2026, including changes to prior authorization criteria for several transplant procedures, home birth requirements, and extensive updates to genetic testing policies across multiple medical specialties.
Action Required
By February 1, 2026: Billing and clinical teams must review and update prior authorization workflows for allogeneic hematopoietic cell therapy (now includes severe aplastic anemia for Omisirge), assisted reproductive technologies (benefit changes for commercial plans), home birth services (new criteria structure), hypoglossal nerve stimulation (updated criteria options), transplant procedures (multiple criteria updates), and all genetic testing services (extensive policy updates across 25+ specialties). Update EMR templates and prior auth checklists to reflect new medical necessity criteria. Contact Health Net Provider Services for specific coding implications as none were listed in this update.