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Network Adequacy

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In order to strengthen access to services in a managed care network, the Final Rule requires states to establish network adequacy standards in Medicaid managed care for key types of providers, while leaving states the flexibility to set the actual standards. The Final Rule requires that states:

  • Develop and implement time and distance standards for primary and specialty care (adult and pediatric), behavioral health (adult and pediatric), OB/GYN, pediatric dental, hospital, and pharmacy providers;
  • Develop and implement timely access standards for long-term services and support (LTSS) providers who travel to the beneficiary to provide services; and
  • Assess and certify the adequacy of a managed care plan’s provider network at least annually.

The Final Rule network adequacy requirements are effective in the July 1, 2018 health plan contract year.

The Network Adequacy Standards proposal outlines the approach that DHCS has undertaken to develop the standards and describes monitoring activities for ongoing compliance. 

Starting with the 2022 contract year, CMS requested DHCS submit one Annual Network Certification for Medi-Cal Managed Care Health Plans (MCPs), Medi-Cal Dental Managed Care (Dental MC) plans, county Drug Medi-Cal Organized Delivery System (DMC-ODS) plans, and county Mental Health Plans (MHPs). 

Annual Network Certification (ANC)

2024 Managed Care

2024 Behavioral Health

2024 Dental Managed Care

2023 Behavioral Health and Managed Care 

2023 Dental Managed Care

2022 Behavioral Health, Dental, and Managed Care

Managed Care Plans

Subcontractor Network Certification (SNC) to meet the 1915(b) STC A4 requirement 

Annual Network Certifications

Archived Annual Network Certification Reports

Significant Change Network Certifications

All Behavioral Health Plans (MHPs & DMC-ODS Plans)

Mental Health Plans (MHPs)

2024 Submission:

2023 Submission:

2022 Submission:

2021 Submission:

Archived Mental Health Plans Network Certification Reports

Drug Medi-Cal Organized Delivery System (DMC-ODS) Plans

2024 Submission:

2023 Submission:

2022 Submission:

2021 Submission:

Archived Drug Medi-Cal Organized Delivery System Network Certification Reports

Dental Managed Care (DMC) Plans

Submissions:

2024 DMC Summary Document
2024 Medi-Cal Methodology Overview
DMC Summary Document
Medi-Cal DMC Methodology Overview
2021 Dental Network Certification
2021 Dental Network Adequacy Cover Letter
2020 Attestation of Network Certification
2020 Annual Network Certification Report
2019 Attestation of Network Certification
2019 Annual Network Certification Report
2018 Attestation of Network Certification
2018 Annual Network Certification Report
2018 Approved Alternative Access Standards – Access
2018 Approved Alternative Access Standards – Health Net
2018 Approved Alternative Access Standards – Liberty
2018 Corrective Action Plan Closeout Letters (Timely Access) – Health Net
2018 Corrective Action Plan Closeout Letters (Timely Access) – Liberty