MedicaidAdministrativeMedium impact
23-659 Hospital and Inpatient Facility Discharge Planning and Notification
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net hospitals and inpatient facilities must now notify the member's primary care physician (PCP) and Enhanced Care Management (ECM) provider within 24 hours of discharge, providing specific patient information including diagnosis, medications, and discharge planning needs. This policy applies to general acute care hospitals, long-term acute care hospitals, and skilled nursing facilities in specified California counties.
Action Required
Immediately: Hospital discharge planning staff must establish protocols to notify patient's PCP and ECM provider within 24 hours of discharge. Include all required information: member name, ID, DOB, admission/discharge dates, attending physician details, diagnosis, medications with dosages, discharge destination, and follow-up needs. Use Health Net provider portal to identify ECM providers under Eligibility > Enhanced Care Management section.