CommercialAdministrativeMedium impact
24-978 Comply With Senate Bill 855 Network Adequacy Requirements
Health Net·CA · Psychiatry, Family Medicine, Internal Medicine·Provider News
Effective date
Apr 1, 2024
We identified it
Jun 20, 2026
Summary
Health Net California now requires behavioral health and substance use disorder providers to meet new network adequacy requirements under Senate Bill 855, including arranging out-of-network coverage when services aren't available within geographic/time standards. Providers must issue written notices to patients when arranging out-of-network behavioral health services and use nonprofit criteria to determine medical necessity for BH/SUD conditions.
Action Required
Immediately: Behavioral health providers must ensure compliance with network adequacy requirements by arranging out-of-network coverage when BH/SUD services aren't available within required geographic and time standards. Create templates for required written notices to patients when using out-of-network providers. Update medical necessity determination processes to use latest nonprofit professional association criteria for BH/SUD conditions (reference provider update 24-765). Contact Health Net Provider Engagement with compliance questions.