CCA is updating some of our Medical Necessity Guidelines (MNGs) to better support providers and ensure clarity in coverage and authorization requirements. These updates apply to both Senior Care Options (SCO) and One Care plans.
Summary of Changes
| MNG Title | Plan | Effective Date | Prior Authorization | Status |
| Acupuncture Services | SCO & One Care | Jan 1, 2026 | Yes | Revised |
| Chiropractic Services | SCO & One Care | Jan 1, 2026 | Yes | Revised |
| Day Habilitation | SCO & One Care | Jan 1, 2026 | Yes | Revised |
| Home and Community Based Services (HCBS) for Members who Meet Home Care Program Criteria | SCO | Jan 1, 2026 | Yes | New |
| Air Conditioner | SCO & One Care | Jan 1, 2026 | N/A | Retired |
| Massage Therapy | SCO & One Care | Jan 1, 2026 | N/A | Retired |
Highlights of Revisions
- Acupuncture Services: Updated criteria for when visits require prior authorization.
- Chiropractic Services: Updated criteria for when visits require prior authorization.
- Day Habilitation: Minor wording updates; no material changes.
- Home and Community Based Services (HCBS) for Members who Meet Home Care Program Criteria (New): defines the scope, eligibility, and regulatory framework for Home and Community Based Services (HCBS) for SCO members who meet home care program criteria.
HCBS benefits for members who meet home care program criteria include:
- Adult Companion
- Alzheimer’s/Dementia Coaching
- Assistive Technology – Electronic Comfort Animals
- Assistive Technology for Telehealth
- Chore
- Complex Care Training and Oversight (unskilled)
- Enhanced Technology/Cellular Personal Emergency Response System (ET/CPERS)
- Environmental Accessibility Adaptation (home modifications)
- Evidence Based Education Programs
- Goal Engagement Program
- Grocery Shopping and Delivery
- Home-Based Wandering Response Systems
- Home Delivered Meals
- Home Delivery of Pre-packaged Medication
- Home Health Aide
- Home Safety/Independence Evaluations (formerly Occupational Therapy)
- Homemaker
- Laundry
- Medication Dispensing System
- Orientation and Mobility Services
- Peer Support
- Personal Care (cueing and monitoring)
- Respite (caregiver relief)
- Supportive Day Program
- Supportive Home Care Aide
- Transitional Assistance
- Virtual Communication and Monitoring (VCAM)
Accessing Guidelines Online
Visit the CCA Medical Necessity Guidelines webpage to view current and upcoming policies.