- Participating Physician Groups (PPG)
Health Net or its designee conducts a full-scope facility site review (FSR) for all contracting Medi-Cal primary care physician (PCP) office sites. FSRs are conducted upon initial contract and then cyclically every three years or earlier as new locations are identified (such as when a PCP moves office locations). Additionally, FSRs are completed as a response to member complaints relating to any practice facility issues, regardless of practitioner specialty.
Events that initiate an investigation to conduct a site visit include, but are not limited to:
- Physical accessibility.
- Physical appearance.
- Adequacy of waiting and examining room space.
When there is an event that initiates a site investigation, a Health Net registered nurse from State Health Programs or a designee conducts a full-scope FSR using an approved California Medi-Cal Managed Care Division of Department of Health Care Services Facility Site Review Tool, which assesses the following:
- Access and safety.
- Office management.
- Clinical services.
- Preventive services.
- Infection control.
- Medical record-keeping practices.
- Medical record documentation.
The FSR tool has multiple criteria and includes critical elements related to patient safety, access, medication administration, and infection control. Exempt pass is 90 percent and above, conditional pass is 80-89 percent and a fail is 79 percent and below. Corrective action plans (CAPs) are required for any deficiencies in the critical elements and if the facility site review score is 89 percent and below. Specific time frames for the CAP must be met.
Participating providers who refuse the FSR or do not complete the CAP within a specified time frame are referred to the Health Net credentialing committee for administrative denial or termination, which applies to Medi-Cal. Sites that have complied with the CAP requirements remain in the Health Net network.
Refer to the Facility Site Review under the Quality Improvement section for more information.