MedicaidAdministrativeHigh impact
25-798 Stay Compliant With Contracts, Laws and Regulations
Health Net·CA·Provider News
We identified it
Jun 20, 2026
Summary
Health Net issued new compliance expectations for Medi-Cal managed care plan delegates, outlining specific requirements to avoid corrective action plans (CAPs) including network adequacy, timely care access, and quality metrics. The policy establishes a formal oversight process where deficiencies can lead to corrective actions or contract termination.
Action Required
Immediately: Review current practice operations against the nine compliance expectations (state/federal regulation compliance, timely care access, network adequacy, CAP requirements, contractual obligations, data quality/reporting, quality metrics, healthcare service delivery, and grievance/appeals processing). Billing team should ensure all Health Net Medi-Cal processes meet these standards and establish monitoring procedures to prevent deficiencies that could trigger corrective action plans or contract termination.