Health care service plans: provider contract termination: notice

Enrollees will receive faster, additional notice of provider-network disruptions and any later agreement that keeps or restores their provider relationship.

What the law does ​

• Requires health plans to send termination notices by mail and, for enrollees who opted in and supplied contact information, by text message or email at least 60 days before a provider-group or hospital contract ends.
• Requires plans to submit notices about a later contract agreement to the Department of Managed Health Care within five business days for approval.
• Requires plans, within 10 business days after approval, to notify affected enrollees by mail and opt-in text or email when they will remain assigned to a provider or may choose to return to one.
• Continues to require notices to explain that an enrollee may have a right to keep receiving care from their provider for a designated period and provide Department of Managed Health Care contact information.
• Excludes Medi-Cal managed care contracts with the State Department of Health Care Services.

Who it affects ​

• Health care service plans.
• Enrollees assigned to affected provider groups or general acute care hospitals, including enrollees who opt in to electronic delivery.
• Provider groups and general acute care hospitals ending, renewing, or replacing contracts with health plans.

Context ​

The Department of Managed Health Care must approve the required notices, subject to specified automatic-approval timeframes.