Conditions of PCP Office Closures
Provider Type
- Physicians
- Participating Physician Groups (PPG)
- Hospitals
- Ancillary
Participating primary care physicians (PCPs) may close their practices to new members while remaining open to members of other insured or managed health care plans, provided certain conditions are met:
- The PCP must establish a certain numerical or percentage threshold beyond which they no longer accepts new members.
- The PCP may close their panel to new members once the threshold is met, provided that the number of members of the PCP exceeds the number of patients who are members of any other single insured or managed health care plan at the time the PCP wants to close their practice to plan members.
- Health Net has established a threshold in compliance with regulatory and accreditation requirements.
If a patient of the PCP, while a member of another health care plan, joins the plan, the PCP must continue to accept the member even if the PCP practice is closed to new plan members.
PCPs must provide the plan with any documentation or information reasonably requested to demonstrate to Health Net that the above conditions are being met prior to closing the practice to new members.
A PCP may close their practice to all new patients from all insurance or health plans at any time.