All records held by the Department are public records unless they are exempt from disclosure.
Examples of records that the public may review include:
- License applicant information
- License application exhibits
- Independent medical review determinations
- Rulemaking files for regulations promulgated by the Department
DMHC's Guidelines for Accessibility of Records
Legal requirements governing inspection of public records maintained by the Department are provided in the California Code of Regulations, Title 28, Division 1, Chapter 1, Article 2, § 1006, and in California's Public Records Act (PRA), Government Code §§ 6250 et seq.
The Department retains health plan records and reports for varying lengths of time. Rules regarding record retention are provided in California Code of Regulations, Title 28, Division 1, Chapter 1, Article 2, § 1009.
How to Request General Information
It is preferred, but not required, that requests for general information be in writing. Requestors should specify as clearly as possible the records that they are seeking. To assist the public in making requests, the Department has developed the following form, which may be submitted online:
Request for General Information Form
It may take up to 10 days for the Department to review the PRA request and inform the requestor of the determination of disclosable records. Occasionally, the Department may need up to 14 additional days.
Requests may also be submitted by mail to:
Department of Managed Health Care
Office of Legal Services
980 9th Street, Suite 500
Sacramento, CA 95814
or submit via facsimile to (916) 322-3968.
Occasionally, individuals may have personal information they wish to review in the Department's records. Such information usually consists of:
- A complaint concerning an enrollee's health plan, as submitted to the Department
- The health plan's response to the enrollee's complaint
- The results of an Independent Medical Review regarding denial of treatment for an enrollee
The Department must strictly protect the confidentiality of any personal information in its records, such as an individual's name, address, social security number, and medical information. For that reason, people who request personal information must provide proof of identification before the Department can release the information to the individual or his or her authorized representative.
How to Request Personal Information
Requestors must verify their identity when seeking to view their records, either through a notarized signature when requesting mailed records or by presenting official identification when examining records in person. To request either method of viewing personal records, please print out, complete, and submit to the Department the form below:
Request for Personal Information Form
The Department will allow inspection or provide copies of responsive documents within 30 days of receipt of the request.
How to View Personal Records
Requestors may inspect personal records in person, or ask that photocopies of the records be mailed either directly to them or to their authorized representative.
To inspect records in person, the requestor must schedule an appointment by phoning 916-322-6727. At the time of the appointment, the requestor will need to show a government-issued identification card. Photocopies of the records can be made at that time for a fee of $.10 per page.
To have records mailed, the requestor must send the Department an original letter, not a facsimile, or a printout of a completed Request for Personal Information Form. The letter or form must be signed, and a notary public must verify the signature.
Attorneys or other representatives must present proof of authorization to the Department before an individual's personal records will be mailed to the representative.
Requestors have the option of viewing public records in person, having records copied by the Department at a cost of $.30 per page, or hiring a copy service to come to the Department and make copies. All arrangements to view or copy public records must be scheduled in advance for the convenience of all parties.
Information Exempt from Disclosure
Some records and documents are exempt from public disclosure. In general, these records are deemed confidential because they reveal personnel, medical or other private information about an individual, or financial, trade secret, or competitive information about a company or plan. Examples of records that are NOT available for public viewing include:
- Records pertaining to pending litigation to which the Department is a party. (Gov. Code § 6254(b))
- Preliminary drafts, notes or agency memoranda not retained in the ordinary course of business, provided that the public interest in withholding the records clearly outweighs the public interest in disclosure. (Gov. Code § 6254(a))
- Personnel, medical or similar files, the disclosure of which would constitute an unwarranted invasion of personal privacy. (Gov. Code § 6254(c))
- Corporate proprietary information, such as trade secrets or financial records (Gov. Code § 6254(k), Evidence Code § 1060)
- Peer review records (Gov. Code § 6254(k), Business and Professions Code § 805(g))
- Plan payments to providers (Gov. Code § 6254(k), Health & Saf. Code § 1351(d))
- Provider solvency information (Gov. Code § 6254(k), Health & Saf. Code § 1375.4 (b)(7))
The Department has the authority to withhold requested information if it determines that the public interest in withholding a record clearly outweighs the public interest in disclosing the record. (Gov. Code § 6255(a))
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Opportunities for Public Participation