1373.65.
(a) At least 75 days before the termination date of its contract with a provider group or a general acute care hospital, the health care service plan shall submit an enrollee block transfer filing to the department that includes the written notice the plan proposes to send to affected enrollees. The plan may not send this notice to enrollees until the department has reviewed and approved its content. If the department does not respond within seven days of the date of its receipt of the filing, the notice shall be deemed approved.
(b) (1) At least 60 days before the termination date of a contract between a health care service plan and a provider group or a general acute care hospital, the plan shall send the written notice described in subdivision (a) by United States mail to enrollees who are assigned to the terminating provider group or assigned to a provider group that has admitted at least one enrollee to the terminating general acute care hospital within the past 12 calendar months of the health care service plan’s block transfer filing.
(2) In addition to sending written notice by United States mail, the health care service plan shall send the written notice to the enrollee electronically at least 60 days before the termination date of the contract via either of the following methods:
(A) Text message to the preferred or last known cell phone number of the enrollee.
(B) Email to the preferred or last known email address of the enrollee.
(3) The electronic notification pursuant to paragraph (2) applies only if the enrollee has opted in to electronic delivery as their communication preference and has included the contact information described in subparagraphs (A) and (B) of paragraph (2).
(4) A plan that is unable to comply with the timeframe described in paragraph (1) because of exigent circumstances shall apply to the department for a waiver. The plan is excused from complying with this requirement only if its waiver application is granted by the department or the department does not respond within seven days of the date of its receipt of the waiver application. If the terminating provider is a hospital and the plan assigns enrollees to a provider group with exclusive admitting privileges to the hospital, the plan shall send the written notice to each enrollee who is a member of the provider group and who resides within a 15-mile radius of the terminating hospital. If the plan operates as a preferred provider organization or assigns members to a provider group with admitting privileges to hospitals in the same geographic area as the terminated hospital, the plan shall send the written notice to all enrollees who reside within a 15-mile radius of the terminating hospital.
(c) The health care service plan shall send enrollees of a preferred provider organization the written notice required by subdivision (b) only if the terminating provider is a general acute care hospital.
(d) If an individual provider terminates the provider’s contract or employment with a provider group that contracts with a health care service plan, the plan may require that the provider group send the notice required by subdivision (b).
(e) (1) If, after sending the notice required by subdivision (b), a health care service plan reaches an agreement with a terminating provider to renew or enter into a new contract or to not terminate their contract before the termination date specified in the notice required by subdivision (b), the plan shall notify each affected enrollee of the agreement and notify enrollees that they will remain assigned to the provider to whom the enrollee was assigned prior to the notices sent by the plan as required in subdivision (b).
(2) If, after sending the notice required by subdivision (b), a health care service plan reaches an agreement with a terminated provider to renew or enter into a new contract or to not terminate their contract after the termination date specified in the notice required by subdivision (b), the plan shall notify and offer each affected enrollee the option to return to that provider.
(3) The notices in paragraphs (1) and (2) shall be provided in accordance with paragraph (4).
(4) Within five business days of reaching an agreement described in paragraph (1) or (2), the health care service plan shall submit to the department the written notice described in paragraph (1) or (2) for approval. No later than 10 business days after department approval, the plan shall send written notice by United States mail to enrollees who received the notice required by subdivision (b). In addition to sending written notice by United States mail, the health care service plan shall send written notice to the enrollee electronically no later than 10 business days after department approval via either of the following methods:
(A) Text message to the preferred or last known cell phone number of the enrollee.
(B) Email to the preferred or last known email address of the enrollee.
(5) The electronic notification pursuant to paragraph (4) applies only if the enrollee has opted in to electronic delivery as their communication preference and has included the contact information described in subparagraphs (A) and (B) of paragraph (4).
(f) A health care service plan and a provider shall include in all written, printed, or electronic communications sent to an enrollee that concern the contract termination or block transfer, the following statement in not less than 12-point type: “If you have been receiving care from a health care provider, you may have a right to keep your provider for a designated time period. Please contact your health plan’s customer service department, and if you have further questions, you are encouraged to contact the Department of Managed Health Care, which protects consumers, by telephone at its toll-free number, 1-888-466-2219, or at a TDD number for the hearing and speech impaired at 1-877-688-9891, or online at www.dmhc.ca.gov.”
(g) For purposes of this section, “provider group” means a medical group, independent practice association, or any other similar organization.
(h) The provisions of this section that were added or amended at the 2025–2026 Regular Session of the Legislature do not apply to plans for Medi-Cal managed care contracts with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) of, Chapter 8 (commencing with Section 14200) of, or Chapter 8.75 (commencing with Section 14591) of, Part 3 of Division 9 of the Welfare and Institutions Code.