Health care service plans: provider contract termination: notice.

Hospital termination notice scope narrowed: instead of notifying all enrollees assigned to the terminated provider group or hospital, notice is now limited to enrollees assigned to a provider group that admitted at least one enrollee to the terminating general acute care hospital within the past 12 calendar months of the block transfer filing.

Follow-up notice recipients narrowed from all 'affected enrollees' to only 'enrollees who received the notice required by subdivision (b),' limiting the group that gets the post-agreement communication.

New subdivision (h) exempts Medi-Cal managed care plans from all provisions added or amended during the 2025-2026 Regular Session, specifically those contracting with the State Department of Health Care Services under Chapters 7, 8, and 8.75 of Part 3 of Division 9 of the Welfare and Institutions Code.

Post-termination agreement notices split into two scenarios: if the plan reaches an agreement before the termination date stated in the original notice, it must simply notify enrollees they will remain assigned to the provider; if the agreement is reached after that date, it must notify and offer each affected enrollee the option to return to the provider.

Required font size for the consumer rights statement in all communications about contract termination or block transfer increased from not less than 8-point type to 12-point type, making the disclosure more prominent and readable.

Follow-up notice timeline changed from a flat 60 days after reaching an agreement to a two-step process: plan must submit the notice to the department for approval within 5 business days of reaching the agreement, then send it to enrollees no later than 10 business days after department approval.

Terminology changed from 'terminated' to 'terminating' in multiple provisions (subdivisions b(1), b(4), c, and e(1)), broadening coverage to situations where termination has been announced but has not yet taken effect.

Section 1373.655 is deleted entirely. This section would have required health plans to automatically reinstate an enrollee to their previously assigned primary care provider or provider group if a provider network transition was materially delayed, terminated, rescinded, or otherwise failed within 120 days of the reassignment. It also included provisions for continuity of care or out-of-network care at in-network cost sharing if the prior provider was no longer contracted.

Electronic notifications (text message or email) for both the initial contract termination notice and the post-agreement notice are now conditional: they apply only if the enrollee has opted in to electronic delivery as their communication preference and has provided the relevant contact information. Previously, plans were required to send these notices to all enrollees with a preferred or last known phone number or email address.

The bill now amends existing Section 1373.65 of the Health and Safety Code in addition to adding new Section 1373.655, significantly broadening its reach into existing provider termination notice rules.

For preferred provider organizations (PPOs), the termination notice requirement applies only when the terminated provider is a general acute care hospital, not for other provider types.

The previous Section 1, which was a legislative intent statement about requiring clear notice to consumers, has been removed and replaced with the substantive amendment to Section 1373.65.

Plans must submit an enrollee block transfer filing to DMHC at least 75 days before contract termination, including the proposed written notice. The plan cannot send notice until DMHC reviews and approves it (deemed approved if no response within 7 days).

In addition to US mail, plans must now send termination notices electronically via text message or email at least 60 days before contract termination.

If a plan reaches an agreement with a terminated provider after sending the initial notice, it must send written notice by both US mail and electronic means (text or email) to affected enrollees within 60 days of reaching the agreement.

All written, printed, or electronic communications to enrollees concerning contract termination or block transfer must include a specific statement in at least 8-point type informing enrollees of continuity of care rights and providing DMHC contact information (phone, TDD, and website).

When the terminated provider is a hospital, plans must send notice to all enrollees residing within a 15-mile radius who are members of the replacement provider group with exclusive admitting privileges, or to all PPO enrollees in the same geographic area.

Added definition of 'provider group' as a medical group, independent practice association, or any other similar organization.

Fiscal committee designation changed from 'no' to 'yes' and state-mandated local program changed from 'no' to 'yes', indicating the bill now imposes costs on local agencies that may require reimbursement analysis.

New Section 1373.655 requires automatic reinstatement of an enrollee to their previously assigned primary care provider or provider group if a provider network transition is materially delayed, terminated, rescinded, or otherwise fails within 120 days of reassignment and the provider remains contracted with the plan.

Automatic reinstatement must occur without requiring a request from the enrollee, a continuity of care determination under Section 1373.96, or a grievance or appeal filed by the enrollee.

The plan must provide written notice to the enrollee within five business days of reinstatement confirming reassignment, informing them of their right to select a different provider, and providing contact information for scheduling assistance.

If the previously assigned provider is no longer contracted with the plan after a failed transition, the plan must either offer continuity of care under Section 1373.96 or arrange out-of-network care at in-network cost sharing until a compliant reassignment can be made.

Defines 'provider network transition' as a merger, acquisition, affiliation, or contractual arrangement that results in reassignment of enrollees to a different primary care provider, provider group, or health facility under Section 1373.65.

The bill changed from a non-operative statement of legislative intent into binding statutory requirements with criminal penalty implications (willful violations are crimes), triggering a state-mandated local program designation and fiscal committee review.

Added Section 2 stating no reimbursement is required under Article XIII B of the California Constitution because costs arise only from creating or changing a crime, per Government Code Section 17556.