Medicare AdvantageCoverageMedium impact
24-734m Ensure D-SNP Members Have Timely Access to Continuity of Care
Health Net·CA·Prior Authorization
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
Health Net's D-SNP plan now requires continuity of care agreements for out-of-network Medicare providers when members have existing relationships. The plan must process requests within 5 working days and approve retroactive claims within specific timeframes when continuity requirements are met.
Action Required
Immediately: Billing team must establish process to identify D-SNP members with existing out-of-network provider relationships. Create workflow to submit continuity of care requests to Health Net D-SNP within required timeframes. Document pre-existing relationships with actual documentation (not attestations) when submitting requests. Train staff on 5-day processing timeline for standard requests and 3-day timeline for urgent cases involving risk of harm.