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The DMHC Protects the Health Care Rights of More Than 25 Million Californians

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Californians have the strongest patient's rights laws in the nation. DMHC’s Help Center is available to explain your health care rights and help you understand how to use your health care benefits. The Help Center can also resolve problems you may have with your health plan.

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Ensuring prompt and fair payment of health care providers is critical to the stability of California's health care delivery system.  The DMHC’s Provider Complaint Unit can assist California physicians; hospitals and other licensed health care providers resolve disputed claim issues with payers.

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The DMHC licenses and regulates California health plans and strives to streamline the process health plans must follow to comply with the law. This section has all the information and forms plans need to ensure compliance.

What's New

Request For Proposal No. 16MC-SA011 - Health Consumer Outreach and Assistance Program

Friday, September 16, 2016

The Department of Managed Health Care (DMHC) is soliciting proposals from qualified entities to provide outreach and assistance services to insured and uninsured health care consumers in California. Services to be performed by the Contractor(s) shall include but are not limited to the following: educate consumers about health care protections including the health plan grievance procedures and the DMHC Complaint or Independent Medical Review (IMR) process, assist consumers with enrollment into health coverage, filing a health plan complaint and appeal as well as helping consumers navigate the complex health care coverage system.

Questions and Answers

DMHC Financial Solvency Standards Board (FSSB) Member Solicitation

Tuesday, September 6, 2016
The Department of Managed Health Care (DMHC) is seeking five (5) dynamic and solution-oriented healthcare professionals to serve on the DMHC Financial Solvency Standards Board (FSSB). The FSSB meets quarterly to advise the Director on matters of financial solvency that affect the delivery of health care services.  The Board reviews periodic reports related to plan operations and makes recommendations to the Director related to financial solvency requirements, standards, and regulations.  Members are appointed by the Director for a term of three years.

 

Interested candidates should submit a Letter of Interest along with a Statement of Qualifications, résumé or curriculum vitae, to Mary.Watanabe@dmhc.ca.gov by October 7, 2016. The most-qualified candidates will have training and experience in one or more of the following areas:

  • Medical and health care economics

  • Accountancy, with experience in integrated or affiliated health care delivery systems

  • Excess loss insurance underwriting in the medical, hospital, and health plan business

  • Actuarial studies in the area of health care delivery systems

  • Management and administration in integrated or affiliated health care delivery systems

  • Investment banking

  • Information technology in integrated or affiliated health care delivery systems

 

A description of the duties of FSSB board members is attached. To learn more about the FSSB and to review materials from prior Board meetings, visit the FSSB page.

                               

If you have questions regarding the positions, please contact Mary Watanabe at Mary.Watanabe@dmhc.ca.gov or (916) 324-2560.

 

Thank you for your interest in the Department of Managed Health Care.

 

More......

 

DMHC Director Rouillard Issues Statement on Provider Directory Non-Routine Survey Follow-Up Reports

Monday, August 1, 2016

California Department of Managed Health Care (DMHC) Director Shelley Rouillard issued the following statement today after the DMHC issued Non-Routine Survey Follow-Up Reports on the accuracy of provider directories for Anthem Blue Cross (Blue Cross of California) and Blue Shield of California (California Physicians' Service).

 

“Access to care often starts with the provider directory, which is why its accuracy is so important,” said Director Shelley Rouillard. “While I am disappointed the corrective actions implemented by the plans to date have not resulted in more accurate provider directories, we expect measurable improvement with the full implementation of Senate Bill 137. This legislation provides a new comprehensive framework for the regulation of provider directories and adds significant accountability for health plans and providers.”

DMHC Approves Aetna's Acquisition of Humana

Monday, June 20, 2016

California Department of Managed Health Care (DMHC) Director Shelley Rouillard has approved Aetna’s acquisition of Humana.

“The Department’s primary focus in reviewing mergers is to ensure compliance with the strong consumer protections and financial solvency requirements of the Knox-Keene Act,” said Director Shelley Rouillard. “The Department’s conditions on this merger will help control health care costs, increase access to care and improve quality of care. Aetna also has committed to help improve California’s health care infrastructure, and invest in programs that will serve the vulnerable populations enrolled in these plans.”

The DMHC examines proposed health plan mergers to ensure enrollee health care rights are protected and that enrollees have continued access to appropriate health care services.

DMHC Fines Anthem $415,000 for Grievance System Violations

Tuesday, May 3, 2016

The California Department of Managed Health Care (DMHC) announced today that it issued a $415,000 fine against Anthem Blue Cross (Anthem) for failing to identify, timely process, and resolve enrollees’ grievances.  Anthem also failed to fully and timely provide information to the Department during the investigation of member complaints.

Timely Access Report

Monday, April 25, 2016

The Knox-Keene Act and DMHC’s Timely Access Regulation requires health plans to provide timely access to care within specified time-elapsed standards. The Timely Access Regulation also requires health plans to submit annual reports detailing compliance rates for each time-specific standard during the previous calendar year. The DMHC reviews the annual reports and posts a Timely Access Report with final findings concerning the submitted data, and recommendations for changes that further protect enrollees.

DMHC Approves Centene’s Acquisition of Health Net

Tuesday, March 22, 2016
California Department of Managed Health Care (DMHC) Director Shelley Rouillard approved Centene’s acquisition of Health Net. The DMHC examines proposed health plan mergers to ensure enrollee health care rights are protected and that enrollees have continued access to appropriate health care services. The DMHC’s approval includes several conditions that will improve access and quality of care, and protect the health care rights of enrollees. More…

Public Meeting on the Acquisition of Cigna by Anthem

Thursday, February 18, 2016

The Department of Managed Health Care (DMHC) invites you to a public meeting on the acquisition of Cigna by Anthem.  Representatives from both plans will be present.  The meeting will be held in Sacramento on March 4, 2016 from 1:30 p.m. to 3:30 p.m.  The purpose of the meeting is to discuss DMHC’s jurisdiction and authority to oversee the transaction and to solicit public comment for DMHC’s consideration as it reviews the transaction.  Public comment will be limited to 3 minutes. Comments may also be submitted to publiccomments@dmhc.ca.gov until 5:00 p.m. on March 11, 2016. 

2014 Annual Report

Thursday, December 3, 2015

The Department of Managed Health Care (DMHC) has issued its 2014 annual report. In addition to serving as the annual report for 2014, the report also celebrates the many momentous anniversaries occurring this year: the 15th anniversary of the creation of the DMHC; the 40th anniversary of the Knox-Keene Health Care Service Plan Act of 1975; and, the 5th anniversary of federal health care reform.  More....

Department of Managed Health Care Strategic Plan 2015 - 2019

Tuesday, September 1, 2015

The Department of Managed Health Care has announced its five-year strategic plan. The strategic plan includes a new mission statement, as well as the core values, goals, objectives and strategies for accomplishing the Department’s mission. This plan was developed with input from DMHC staff and external stakeholders.  More...

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