Members could be referred to seek medical support by reaching Health Net’s 24 hour Nurse advice line to speak with a nurse. Providers may contact the Health Net Medi-Cal Provider Services Department, Community Health Plan of Imperial Valley Provider Services Center or CalViva Health Medi-Cal Provider Services Center (for Fresno, Kings and Madera counties) with questions.

If a medical emergency occurs, members should be directed to the nearest emergency room for care or call 911. Members are encouraged to use the 911 emergency response system as appropriate. For follow up care, members should notify their primary care physician (PCP) as soon as possible after discharge from the hospital or emergency room. Emergency services are available 24 hours a day, 7 days a week.

Refer to the following Behavioral Health definition in the glossary for more information.

A medical screening exam (MSE) is an initial assessment of a member to determine whether an emergency condition exists and whether the member should be treated in the emergency department or may be safely treated at another level of care. Hospital emergency departments are required to evaluate all members seeking care. An MSE performed by a physician, nurse practitioner (NP), registered nurse (RN), or physician assistant (PA) in an emergency department does not require prior authorization regardless of the outcome.

All members are discharged from an emergency facility only on the order of a treating physician.

When an emergency department determines that a medical emergency exists, appropriate treatment must be provided until the member’s condition is stabilized. Once, stabilized, authorization for continued care must be obtained.

If the member is stabilized during the emergency room visit but requires inpatient admission, a request must be submitted to the Plan by calling the post stabilization authorization request line. Refer to the DHCS All Plan Letter 23-009 and DMHC All Plan Letter 24-012 for complete guidance. If the member is not stabilized and requires admission, the standard notification of the admission process must be followed. For additional information, refer to Notification of Hospital Admissions.

If the medical staff at the hospital emergency department determines that the condition is not an emergency, the member is responsible for arranging follow-up care with the PCP. Members are ordinarily given written instructions in the emergency department that state whether follow-up care is needed and, if so, how soon they need to be seen by their PCP. A sample instruction letter, Medi-Cal Member Instructions for Post-Emergency Care (PDF), is available for use. Emergency departments should also contact the member's PCP to arrange for follow-up care; particularly in circumstances where there are active or ongoing care needs or care coordination issues. PCPs must provide timely follow-up care to members when emergency care is deemed not necessary in an emergency department after a Medical Screening Examination (MSE) or if follow-up care is indicated after treatment in the emergency department. PCPs should see members within the time frame suggested by the hospital emergency department instructions.

Emergency departments are responsible for providing written post-emergency care instructions to all members seen in an emergency room. Refer to the Emergency Department MSE discussion above for the most current information about post-emergency care instructions and timely follow-up care.

Refer to Psychiatric emergency medical condition or Emergency for more information.

In the event of a medical emergency within the primary care facility, a physician will assess the situation and determine the optimal course of treatment in accordance with current standards of care and established facility protocols.

If a member in a primary care facility has a medical emergency requiring hospitalization, the attending physician must arrange ambulance transportation by a licensed ambulance company to the nearest emergency room.

If there is no contracting emergency transportation service and emergency transportation is needed, dial 911 or other local emergency number to obtain ambulance service. The receiving hospital calls for authorization when the member arrives.

Emergency departments must notify the member's primary care physician (PCP) whenever a member requires an emergency room visit. If an emergency care visit results in the member being admitted to the facility, the emergency department is required to notify Health Net's hospital notification department within 24 hours or the next business day. If the PPG is fully capitated for inpatient care and the notification is received by Health Net, it will be referred to the appropriate PPG for authorization. For post-stabilization authorization request from non-participating hospitals, refer to the Post-Stabilization page.

Los Angeles County only

Molina Healthcare serves as Health Net’s subcontracted health plan for Medi‑Cal members in Los Angeles County. For members assigned to Molina Healthcare, notifications related to emergency care visits that result in a hospital admission may be provided to Molina Healthcare by phone or through clinical documentation.

For members assigned to Molina