Conditions of PCP Panel Closures by Health Net
- Participating Physician Groups (PPG)
Health Net established the member assignment threshold for an individual primary care physician (PCP) to a maximum of 2,000 members in compliance with standards established by the California Department of Managed Health Care (DMHC) and California Department of Health Care Services (DHCS). An individual PCP may employ up to four physician extenders. Members assigned to a PCP and his or her extenders may not exceed 4,000 members combined. Each extender has a maximum capacity of 1,000 members.
Health Net ensures compliance by continuously monitoring our network for capacity limits and the full-time-equivalent member-to-physician ratios as follows:
- PCPs - 2,000:1
- Physician extenders - 1,000:1
Health Net may close participating PCPs' panels to new Health Net members when PCPs without physician extenders have more than 2,000 Health Net members assigned to them.
Health Net reviews the following to determine the appropriateness of the panel size, and contacts the participating physician group (PPG) or PCP to assess the PCP's status.
- PCP status: active, prior patients or full capacity
- Physician extenders (allows for an additional 1,000 members per PCP, up to four extenders)
- PCP practice located in rural area with few PCPs
Health Net sends notification to PCPs advising of panel closures once they exceed the maximum capacity. Health Net monitors access and availability and reopen the panel to additional member assignments when the number of members assigned to the PCP's panel falls within acceptable standards.