Mandatory Notification Requirements for PPG Downstream Hospital Terminations
Provider Type
- Physicians and Practitioners
- Participating Physician Groups (PPG)
- Hospitals
- Ancillary
Participating physician groups (PPGs) must notify the Health Net when a contracted hospital terminates from their network for any reason, including but not limited to:
- Partial terminations
- Constructive terminations
- Novations
- Non‑renewals
- Contract assignments
Timely notification allows Health Net to:
- Maintain accurate provider directories.
- Meet regulatory reporting and member notification requirements.
- Ensure appropriate continuity of care protections for impacted members.
Block transfer filings
Hospital network terminations that may impact member access or continuity of care require Health Net to submit a block transfer filing to the Department of Management Healthcare (DMHC).
Note: A terminating hospital may not be removed from the network until approval of the Block Transfer Filing has been obtained from the DMHC.
Notification timing and submission
PPGs must notify their assigned Provider Engagement network specialist as soon as a hospital termination is known or anticipated, including planned non‑renewals or early terminations, at least 180 days in advance. This must include termination details and effective dates.
Required information
PPGs must submit termination‑related information using a standardized form at least 120 business days prior to the termination. The form will be provided by the PPG’s assigned Provider Engagement network specialist. Required information includes, but is not limited to:
- Hospital termination notice and effective date.
- Hospital extension notice (if applicable).
- Enrollee notification materials and distribution timing.
- COC approach and impacted members.
- Scope and impact of the termination, including affected lines of business.
Noncompliance
Failure to provide timely and complete notification may result in corrective action and may also affect the PPG’s delegation status.