MedicaidAdministrativeMedium impact
23-658 Hospital and Inpatient Facility Discharge Planning and Notification
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
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 comprehensive discharge information including diagnosis, medications, and follow-up needs. This policy applies to CalViva Health Medi-Cal members in Fresno, Kings, and Madera counties.
Action Required
Immediately: Hospital billing and discharge teams must establish protocols to notify member's PCP and ECM provider within 24 hours of discharge. Include all required information: member details, admission/discharge dates, attending physician, diagnosis, medications, discharge destination, and follow-up needs. Use member's CalViva Health ID card to identify PCP and provider portal to identify ECM provider. Failure to comply may impact care coordination and provider relations.