Facility and Physician Additions, Changes and Deletions | Facility Decertification Notification Requirement

Health Net is required to end contracts with network providers and subcontractors who have been decertified or whose participation has been revoked from the Medi-Cal and Medicare programs.

The California Department of Public Health (CDPH) is responsible for decertifying licensed long-term care (LTC) facilities. LTC facilities that receive a decertification notice from CDPH must take these steps:

1. Notify their Health Net Provider Network Management representative to begin the contract termination process.
2. Help with the transition planning for Health Net members in the LTC facility’s care.

Affected LTC facilities

These requirements apply to any of these LTC facility types:

• Skilled nursing facilities (SNFs)
• Intermediate care facilities
• Congregate living health facilities
• Nursing facilities
• Pediatric day
• Respite facilities

Health Net’s responsibilities

Upon notice from the LTC facility, Health Net:

• Ends its contract with the LTC facility within five business of the notice.
• Develops and submits a member transition plan to the DHCS.
• Suspends all payments for services provided after the effective date of the decertification notice.
• Informs all affected contracted providers and members of the decertified LTC facility.
• Coordinates care for members as required by federal and state law, and Health Net’s contract with DHCS.

Immediate closure of LTC facilities by CDPH

In these cases, CDPH handles the transition of all affected members residing in the LTC facility. Health Net tracks the transition of members and coordinates care as needed.