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Medical Surveys

California Managed Care law (Knox-Keene Health Care Service Plan Act) requires the DMHC to conduct a routine medical survey of each licensed full service and specialty health plan at least once every three years. The medical survey is a comprehensive evaluation of the plan's compliance with the law in the following health plan program areas:

  • Quality Management
  • Grievances and Appeals (member complaints)
  • Access and Availability
  • Utilization Management (referrals and authorizations)
  • Overall plan performance in meeting enrollees' health care needs

At completion of the survey, we issue a final report which is available to the public. We will perform a follow-up survey within 18 months of the final report if any deficiencies remain uncorrected.

The Department's Division of Plan Surveys may also perform an investigative medical survey as often as deemed necessary by DMHC's Director. This is to protect the interests of managed care members.

California Managed Care Law (Knox-Keene Health Care Service Plan Act) requires the DMHC to conduct a routine medical survey of each licensed full service and specialty health plan at least once every three years. In accordance the Division of Plan Surveys is posting a rotating 6 Month Survey Schedule of all routine health plan surveys.

This section allows you to search and view medical survey reports and view Medical Technical Assistance Guides.