22-1031 Give Advance Notice for Terminations or Practice Location Changes

Date: 11/29/22

Ensure Medi-Cal members have access to care

All physicians and other providers and delegated entities must give Health Net* sufficient advance notice of provider terminations in their network panel or of any service location changes. The required timeline is outlined in your Provider Participation Agreement (PPA) and/or Health Net policies.

Termination timeline

All termination notices will be made effective on the first of the month, approximately 60 days after the plan receives the notice, unless the stated effective date is further out. For example, a termination notice received January 10 will be effective April 1. Providers and delegated entities must ensure access for Medi-Cal members remains available during that time.

Use any of the below methods to submit prior notice

• Online: Complete the online form by going to Provider Demographic Update Form. Complete the online form with required fields and fill out, as applicable, if your information has changed.
• Call or email: Reach out to your provider relations and contracting specialist.

DHCS requirement

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

The required prior notice applies to all physicians and other providers, including, but not limited to, primary care physicians (PCPs), specialists, ancillaries, hospitals, clinics and delegated entities; no exceptions. Health Net will notify DHCS and members affected by PCP, clinic, medical group, or hospital changes. Delegated entities must also properly notify their affected members when specialists from whom they were receiving care leave the network.

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary providers, Community Supports (CS) Providers, and Enhanced Care Management (ECM) Providers.

For Medi-Cal, this information applies to Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties.