Health Plan Compliance/Medical Survey

Health Plan Compliance/Medical Survey

Behavioral Health Focused Investigations

The DMHC received approval in the 2020-21 state budget to conduct focused Behavioral Health Investigations (BHI) of all full service commercial health plans regulated by the Department to further evaluate health plan compliance with California laws and assess whether enrollees have consistent access to medically necessary behavioral health care services. Any parity issues discovered or suspected during the BHI process will be referred internally for further investigation.

A goal of the investigations is to identify and understand the challenges and barriers enrollees may still face in obtaining behavioral health care services, and to identify systemic changes that can be made to improve the delivery of care.

View list of full service commercial health plans


To view the content and scope of the Department's Behavioral Health Investigation, please review the Behavioral Health Investigation Technical Assistance Guide.

More information on the Department’s efforts around health plan compliance with federal and state behavioral health care requirements is available under Behavioral Health Plan Compliance.

Medical Surveys

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.

View Eighteen Month Survey Schedule

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

Behavioral Health Requirements Technical Assistance Guide

Language Assistance Technical Assistance Guide

Dental Technical Assistance Guides

Vision Technical Assistance Guides

Chiropractic Technical Assistance Guides