MedicaidAdministrativeHigh impact
25-800 Stay Compliant With Contracts, Laws and Regulations
Health Net·CA·Provider News
Effective date
Apr 25, 2025
We identified it
Jun 20, 2026
Summary
DHCS has issued new enforcement guidance requiring Medi-Cal managed care plans and their delegated providers to maintain strict compliance with all contractual provisions, state/federal laws, and quality metrics. Non-compliance will result in corrective action plans (CAPs), monetary sanctions, or contract termination.
Action Required
Immediately: Review all current compliance processes to ensure adherence to state/federal regulations, network adequacy requirements, data quality standards, and timely grievance processing. Billing team must maintain accurate documentation for all Medi-Cal claims and ensure timely processing to avoid triggering CAP requirements. Monitor performance metrics closely as delegation may be revoked for unresolved deficiencies.