Medicare AdvantageAdministrativeLow impact
24-474 Follow CMS Requirements for the Plan and PPGs to Notify Members of Provider Terminations
Health Net·CA·Provider News
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
CMS has updated requirements for Wellcare By Health Net to notify members when providers leave the network, effective January 1, 2024. The policy establishes specific timeframes for notifications: 45 days for PCPs and behavioral health providers, 30 days for specialists and other providers, with different responsibilities for the Plan versus PPGs.
Action Required
Immediately: Ensure timely notification to Health Net when leaving the network. Support member transitions by helping them find new providers and ensuring continuity of care. For PPGs terminating PCPs, provide Health Net with the new PCP name plus two alternative PCPs. For specialist terminations in Medicare HMO plans, complete and mail the CMS-approved Medicare termination notification template to affected members at least 30 days before termination.