20-809 Advance Notice Required to Terminate Providers or Change Practice Locations

Date: 10/23/20

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.

This information applies to Medi-Cal in Fresno, Kings and Madera counties.

Help your patients keep their access to care

The Department of Health Care Services (DHCS) requires Medi-Cal managed care plans (MCPs) to have a sufficient network of providers to ensure its members have timely access to care. MCPs also have prior notification requirements to members and to DHCS when there is a change in the location or availability of services in the MCP’s network, all subject to DHCS approval.   

As a reminder, all providers and delegated entities are required to give Health Net, on behalf of CalViva Health, sufficient advance notice of any substantial change in the availability or location of covered services, including but not limited to, terminations in their network panel of providers or of any service location terminations. The timeline required is outlined in your Provider Participation Agreement and/or plan policies.

Impact of termination date on access to care

All such termination notices to the plan will be made effective on the first day of the month following two (2) full months after receipt of the notice by the plan (e.g., notice received January 10, termination will be effective April 1). Providers and delegated entities must ensure access for Medi-Cal members remains available during that time. If the effective date of the substantial change or termination is 90 days or more in the future, then such planned effective date in the notice will be used for notifications to DHCS.

Per DHCS guidance, this prior notification requirement applies to all provider types, including, but not limited to, primary care physicians (PCPs), specialists, ancillaries, hospitals, clinics, and delegated entities; no exceptions. CalViva Health will notify DHCS and members affected by PCP, clinic, medical group or hospital changes. Delegated entities must ensure their affected members are properly notified when specialists they were receiving care from leave their network.

Additional information

Providers are encouraged to access the provider portal online for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact CalViva Health at 1-888-893-1569.