MedicaidAdministrativeHigh impact
25-799 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 issued new enforcement guidelines requiring all Medi-Cal managed care plans and their delegated providers to maintain strict compliance with contracts, laws, and regulations. Non-compliance will result in corrective action plans (CAPs) and potential contract termination.
Action Required
Immediately: Review all current compliance processes to ensure adherence to state and federal regulations, timely access to care, network adequacy, data quality reporting, and grievance processing. Engage with Plan's Delegation Oversight staff to identify any deficiencies before formal CAPs are imposed. Monitor the Delegation Oversight Interactive Tool regularly for compliance alerts and training opportunities.