Health Plan Compliance/Medical Survey

California law 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 DMHC may also perform an investigative medical survey as often as deemed necessary by the DMHC's Director. The medical survey is a comprehensive evaluation of the plan's compliance with the law in the following health plan program areas:

  • Quality Assurance
  • Grievances and Appeals (enrollee complaints)
  • Access and Availability
  • Utilization Management (referrals and authorizations)
  • Overall plan performance in meeting enrollees' health care needs
When the survey is complete, the DMHC issues a Final Report that is publicly available. The DMHC may perform a Follow-Up Survey within 18 months of the Final Report for any uncorrected deficiencies. 

The schedule of upcoming routine and follow up health plan surveys is available by using the View Eighteen Month Survey Schedule link below.

Technical Assistance Guides

The DMHC utilizes detailed audit tools when conducting medical surveys of both licensed full service and specialty plans in order to ensure compliance with the Knox-Keene Act (Act), Title 28 of the California Code of Regulations and other applicable laws and regulations. This protocol document, called a Technical Assistance Guide (TAG), is used by the surveyors to measure a health plan's performance and determine compliance. The standard TAG tools are updated as necessary based on legislative and regulation changes.

Full Service Technical Assistance Guides



Behavioral Health Technical Assistance Guides



Language Assistance Technical Assistance Guide



Dental Technical Assistance Guides



Vision Technical Assistance Guides



Chiropractic Technical Assistance Guides