CMS Interoperability and Prior Authorization Final Rule

2025 Prior Authorization Requirements Reports and Metrics Summaries

In accordance with the Centers for Medicare & Medicaid Services (CMS) Final Rule (CMS-0057-F), we are annually publishing our prior authorization requirements and performance metrics to promote transparency, accountability, and better support our members and providers.

The data presented in these publications reflects prior authorization requests processed during the applicable measurement year in accordance with CMS reporting specifications. Metrics are calculated using CMS defined methodologies and may not be directly comparable to alternative reports or third-party summaries.

Reports – Calendar Year (CY) 2025

Health Net Medi-Cal

• CMS Final Rule 0057-F Prior Authorization Requirements for CY2025 – Health Net (PDF)
• Prior Authorization Metrics Summary – Health Net (PDF)

CalViva Health Medi-Cal

• CMS Final Rule 0057-F Prior Authorization Requirements for CY2025 – CalViva Health (PDF)
• Prior Authorization Metrics Summary – CalViva Health (PDF)

Community Health Plan of Imperial Valley Medi-Cal

• CMS Final Rule 0057-F Prior Authorization Requirements for CY2025 – Community Health Plan of Imperial Valley (PDF)
• Prior Authorization Metrics Summary, Effective December 31, 2025 – Community Health Plan of Imperial Valley (PDF)

Wellcare By Health Net (Medicare Advantage)

• CMS Final Rule 0057-F Prior Authorization Requirements for CY2025 – Wellcare By Health Net (PDF)
• Prior Authorization Metrics Summary – H0562 – Wellcare By Health Net (PDF)
• Prior Authorization Metrics Summary – H3561 – Wellcare By Health Net (PDF)

For current lists of services that require authorization by Health Net, refer to the Prior Authorizations page.