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DMHC Regulates Health Plans and Helps Health Plan Members and Providers

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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

Public Meeting on the Acquisition of Care1st Health Plan by Blue Shield of California

Friday, May 29, 2015
The Department of Managed Health Care (DMHC) invites you to a public meeting on the acquisition of Care1st Health Plan by Blue Shield of California.  Representatives from both plans will be present.  The meeting will be held in Sacramento on June 8, 2015 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 June 12, 2015.  Additional information about the meeting can be found in the Agenda

Department of Managed Health Care Joins California Health and Human Services Open Data Portal

Tuesday, May 26, 2015

The Department of Managed Health Care (DMHC) posted initial datasets on the California Health and Human Services (CHHS) Open Data Portal. The initial data sets include enforcement actions taken by the DMHC, Independent Medical Review (IMR) decisions, and premium rates filed with the DMHC.

 

CHHS launched its Open Data Portal initiative in order to increase public access to one of the State’s most valuable assets – non-confidential health and human services data. Its goals are to spark innovation, promote research and economic opportunities, engage public participation in government, increase transparency, and inform decision-making.

 

Visit the Open Data Portal here: https://chhs.data.ca.gov/

 

Mental Health Parity and Addiction Equity Act (MHPAEA)

Thursday, July 31, 2014
The federal MHPAEA was enacted in 2008 to ensure parity between mental health and/or substance use disorders (MH/SUD) benefits and medical/surgical benefits covered by a health plan. On November 13, 2013 the federal government issued its final regulations to implement the MHPAEA. No later than January 1, 2015, full service health care service plan contracts that offer MH/SUD benefits must provide these benefits in compliance with the final regulations. The DMHC is working to ensure that health plans comply with the law. More …

Learn About...

  • DMHC
  • Rate Review
  • Consumer Assistance
  • Independent Medical Review (IMR)
  • Medical Loss Ratio

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