MedicaidAdministrativeMedium impact
25-164 Get Ready: The Medi-Cal Subnetwork Certification Assessment Starts in April
Health Net·CA·Prior Authorization
Effective date
Apr 1, 2025
We identified it
Jun 20, 2026
Summary
Health Net/CalViva Health will conduct Medi-Cal subnetwork certification assessments for participating physician groups (PPGs) from April through September 2025 to evaluate network adequacy. PPGs must demonstrate compliance with provider-to-member ratios, time and distance standards, and timely access requirements or face corrective action plans and potential network participation issues.
Action Required
By March 19, 2025: PPGs should register for certification training webinars and review provider update 25-158m regarding access to care standards. Before April 2025: Verify all provider roster information is accurate including correct adult and pediatric provider types and patient age ranges. Ensure compliance with provider-to-member ratios, time/distance standards, and appointment access requirements. PPGs that fail to meet standards will be subject to corrective action plans and potential network participation restrictions.