November monthly overview

Network News is published once a month. See updates below.

November 1 publication

Policy and protocol updates

Medical policy updates
Medical policy updates for November 2025 for the following plans: Medicare, Medicaid, Exchanges and commercial.

Reimbursement policy updates
See the latest updates for reimbursement policies. 

Specialty Medical Injectable Drug program updates
See the latest updates to requirements for Specialty Medical Injectable Drugs for UnitedHealthcare members. 

Pharmacy and clinical updates
Access upcoming new or revised clinical programs and implementation dates for UnitedHealthcare plans.

State news

Medicare Advantage: Arizona, California prior authorization for outpatient therapies
The prior authorization requirement for outpatient PT, OT, ST, and traditional Medicare chiropractic services is expanding to specific plan members in Arizona and California on Feb. 1, 2026

District of Columbia Medicaid: Coverage criteria for skin and soft tissue substitutes
View our UnitedHealthcare Community Plan medical policy for skin and soft tissue substitutes.

Florida Medicaid: Dental payment moves to Medicaid health plans
Payment for non-emergency dental services in ambulatory surgical center and outpatient hospital settings managed by Medicaid effective Oct. 1, 2025.

Indiana Community Plan: See the latest 2025 state newsletters
Get the latest updates from UnitedHealthcare Community Plan of Indiana.

Maine: New coverage for safer pain management options
View our new guidance for opioid medication alternatives for UnitedHealthcare commercial and Individual Exchange plans.  

Massachusetts: New coverage for safer pain management options
View our new guidance for opioid medication alternatives for UnitedHealthcare commercial and Individual Exchange plans. 

Nebraska Medicaid: New respite hours request process
Starting Nov. 1, we’ll transition respite hours to applicable Department of Health and Human Services waivers and programs.

New Mexico Medicaid: New Food is Medicine benefit
Food is Medicine includes several services that provide home-delivered meals tailored to medical needs.

Texas Medicaid: Contact service coordinator for long-term skilled nursing
You’re required to contact a service coordinator for long-term skilled nursing prior authorizations.

Texas Medicaid: Transform maternal care delivery with Delfina Care
Delfina is an AI-powered maternal health platform that can help you deliver more informed, proactive and connected care.

Texas MMP: Harris County members converting to new UnitedHealthcare plans
Starting Jan. 1, 2026, Harris County MMP members transition to integrated D-SNP and STAR+PLUS plans.

Washington Medicaid: Discharge requirements for inpatient mental health stays
Review the notification requirements for discharging members from inpatient mental health stays.

Wisconsin Medicaid: Review annual quality and utilization profiles
Wisconsin PCPs can identify improvement opportunities using annual profiles

Plan and program updates

Care Cash expanding to NexusACO network Jan. 1
The UnitedHealthcare Care Cash program offers members the option to pay for their medical services with an employer-granted Mastercard® debit card.

Medicaid: Documentation updates for hip and knee total joint replacements
Additional documentation needed for total joint replacements for additional states starting Dec. 1, 2025.

New UnitedHealthcare Individual Exchange plan information for 2026
View the new UnitedHealthcare Individual Exchange Plans for 2026 with additional expansion areas.

Medicare Advantage plan news

New Medicare Advantage referral requirement in 2026
Starting Jan. 1, 2026, PCP referrals will be required for specialist visits under most UnitedHealthcare Medicare Advantage HMO/HMO-POS plans.

Telehealth benefits maintained through 2026
Telehealth services for medical and mental health will remain available to UnitedHealthcare Medicare Advantage members through 2026.

Resources for member care

Build healthier communities during Native American Heritage Month
Earn CME credits while learning how to prevent and treat alcohol abuse in Indigenous American communities.

Help for the holidays: Children’s medical grants
Promote UHCCF grants for families of children with medical needs.

Reduce risks in older adults who take multiple anticholinergic medications
Explore our quick reference guide to assess the overall anticholinergic burden in older adults.

Digital platform updates

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