Nivano Physicians, Inc.
Effective Date: August 7, 2025
Last Updated: March 12, 2026
Version: 2.0
Purpose
This page provides required and voluntary disclosures regarding Nivano Physicians’ participation in Medicare Advantage, Part D, and Medi-Cal programs. These disclosures support transparency and compliance with federal and California state requirements.
Regulatory Framework
| Authority | Requirement |
|---|---|
| 42 C.F.R. § 411.362(b)(3)(ii)(C) | Physician ownership and financial relationship disclosures |
| Medicare Modernization Act | Creditable prescription drug coverage disclosure |
| ACA Section 6409 | Self-referral disclosure protocols |
| California Knox-Keene Health Care Service Plan Act | State managed care plan requirements |
| California Health and Safety Code §§ 1340–1399.8 | Medi-Cal member rights and plan obligations |
| DHCS All Plan Letters | Medi-Cal operational guidance |
| Senate Bill 223 | Language access in managed care |
| Senate Bill 923 (effective March 1, 2025) | Transgender-inclusive healthcare requirements |
Medicare Disclosures
Our Medicare Advantage Participation
Nivano Physicians contracts with Medicare Advantage health plans as an Independent Physician Association (IPA) to provide in-network healthcare services to Medicare beneficiaries in Northern California. Our participation includes care coordination and case management, prior authorization and utilization management, quality reporting and performance measurement, and member advocacy and appeals support.
We are required to notify Medicare beneficiaries of network terminations with a minimum of 30 days advance notice where possible, significant changes in provider availability, facility relocations, and changes to specialty care access and referral processes.
Medicare Part D — Creditable Coverage Disclosure
Notice to Medicare-Eligible Individuals: Nivano Physicians provides an annual disclosure by October 15 of each year regarding whether our prescription drug coverage is creditable — that is, whether it is at least as good as standard Medicare Part D coverage. Individuals who have creditable coverage from another source may not need to enroll in Medicare Part D immediately and can do so later without a late enrollment penalty.
We submit required creditable coverage information to CMS within 60 days of the start of each plan year, and within 30 days of any material change to coverage status.
For questions about creditable coverage and your Medicare Part D enrollment options, contact Member Services at (916) 407-2000.
Physician Ownership and Financial Relationships
We comply with the Physician Payments Sunshine Act (Open Payments Program) by maintaining transparency in financial relationships between our organization and physicians and teaching hospitals, reporting all applicable payments to CMS annually, and providing access to Open Payments database information upon request.
We disclose any ownership relationships between physicians and facilities where applicable, financial interests that may affect referral decisions, and the availability of alternative facilities for services.
Quality and Star Ratings
We make information available about contracted plan star ratings and quality performance, clinical quality measures and outcomes, member satisfaction survey results, and healthcare provider performance data. We support continuous improvement through clinical guideline implementation, patient safety initiatives, chronic disease management programs, and preventive care services.
Medi-Cal Disclosures
Our Role in Medi-Cal
Nivano Physicians operates as a delegated Medical Group contracting with Medi-Cal managed care plans. Our delegated functions include medical management and utilization review, quality assurance and improvement programs, member services and complaint resolution, and provider network management and credentialing.
Knox-Keene vs. Non-Knox-Keene Plans
We contract with both Knox-Keene licensed health plans and other plan types. These plan types differ in their regulatory oversight, available appeal rights, external review options, consumer protections, and complaint processes. Members are entitled to know which type of plan governs their coverage, as it affects the rights available to them.
California Member Rights
Medi-Cal members have the following enhanced rights under California law:
- Access to medical records within 15 days of request
- Interpreter services in threshold languages at no cost
- Culturally competent care consistent with California standards
- Enhanced privacy protections under the California Confidentiality of Medical Information Act (CMIA)
Medi-Cal Appeals Summary
Medi-Cal members have access to a two-step appeals process. First, a health plan appeal must be filed within 60 days of the adverse determination, with a 30-day resolution period. If the health plan appeal does not resolve the dispute, members may request a State Fair Hearing through the California Department of Social Services within 120 days of the plan’s decision.
For Knox-Keene licensed plans, an Independent Medical Review (IMR) is also available at no cost to members. IMR provides external physician review of medical necessity disputes and results in a binding decision. Contact the DMHC Help Center at 1-888-466-2219 or dmhc.ca.gov to request IMR.
Language Access
We provide materials and interpreter services in California’s 15 threshold languages in compliance with Senate Bill 223:
Spanish, Chinese (Mandarin/Cantonese), Vietnamese, Korean, Tagalog, Russian, Arabic, Hmong, Japanese, Thai, Punjabi, Cambodian, Laotian, Hindi, and Persian.
All language assistance services are provided at no cost to members.
SB 923 — Transgender-Inclusive Care (Effective March 1, 2025)
In compliance with Senate Bill 923, Nivano Physicians ensures that contracted providers complete transgender-inclusive healthcare training, provider directories reflect inclusive practices, non-discrimination policies explicitly cover LGBTQ+ members, and cultural competency standards address transgender and gender-diverse healthcare needs.
Financial Disclosures
We disclose any material changes in organizational ownership of 5% or more, control relationships, management agreements, and financial arrangements affecting operations. We maintain transparency regarding vendor contracts, referral relationships, joint ventures, and investment interests in healthcare entities.
We provide required financial reports to CMS and DHCS including medical loss ratios, administrative costs, quality bonus payments, risk adjustment and supplemental payments, and financial reserve and solvency measures.
External Oversight Agencies
| Agency | Contact | ||
|---|---|---|---|
| Centers for Medicare & Medicaid Services (CMS) | cms.gov | 1-800-MEDICARE (1-800-633-4227) | TTY: 1-877-486-2048 |
| California Department of Health Care Services (DHCS) | dhcs.ca.gov | (916) 445-4171 | Ombudsman: 1-888-452-8609 |
| Department of Managed Health Care (DMHC) | dmhc.ca.gov | 1-888-466-2219 | TTY: 1-877-688-9891 |
| DHCS Ombudsman Office | MMCDOmbudsmanOffice@dhcs.ca.gov | 1-888-452-8609 | |
| CA Dept. of Social Services (Fair Hearings) | cdss.ca.gov | 1-800-743-8525 | |
| Medicare Rights Center | medicarerights.org | 1-800-333-4114 |
Contact Information
Member Services — Medicare and Medi-Cal
Phone: (916) 407-2000, ext. 82512
Toll Free: (844) 889-2273
Compliance and Regulatory Affairs
Phone: (916) 407-2000
Email: compliance@nivanophysicians.com
Mail: 2554 Millcreek Dr., Suite 100, Sacramento, CA 95833
Policy Review
This document is reviewed annually, or more frequently when regulations change or CMS or DHCS issues updated guidance. The next scheduled review is August 7, 2026.
This document was last updated on March 12, 2026.