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Administrative Actions and Decisions

Administrative Decisions

The Office of Administrative Hearings (OAH) is a quasi-judicial tribunal that hears administrative disputes. The Department of Managed Health Care cases heard by the OAH are for contested cases, often related to the DMHC’s enforcement of the laws it regulates.

In order to ensure impartial adjudication, the DMHC maintains separation of functions throughout the OAH process. Within the DMHC, the Office of Legal Services (OLS) assists the DMHC Director with the decision-making and the Office of Enforcement is the advocate for the DMHC in the OAH Process.

The Department's actions and decisions heard before the OAH:

 

According to Cal Gov. Code section 11425.60 (2006):

Gov. Code section 11425.60. Decisions relied on as precedents; Index of precedent decisions.

(a) A decision may not be expressly relied on as precedent unless it is designated as a precedent decision by the agency.

(b) An agency may designate as a precedent decision a decision or part of a decision that contains a significant legal or policy determination of general application that is likely to recur. Designation of a decision or part of a decision as a precedent decision is not rulemaking and need not be done under Chapter 3.5 (commencing with Section 11340). An agency's designation of a decision or part of a decision, or failure to designate a decision or part of a decision, as a precedent decision is not subject to judicial review.

(c) An agency shall maintain an index of significant legal and policy determinations made in precedent decisions. The index shall be updated not less frequently than annually, unless no precedent decision has been designated since the last preceding update. The index shall be made available to the public by subscription, and its availability shall be publicized annually in the California Regulatory Notice Register.

(d) This section applies to decisions issued on or after July 1, 1997. Nothing in this section precludes an agency from designating and indexing as a precedent decision a decision issued before July 1, 1997.

Precedent Decisions

The DMHC has designated certain administrative decisions as being "precedent decisions." These administrative decisions contain significant legal or policy findings that apply beyond the facts of the particular case.

Members of the public may receive a subscription to the Index of Precedent Decisions by calling (916) 322-6727 or by sending a written request to:

Department of Managed Health Care
980 9th Street, Suite 500
Sacramento, CA 95814

The Department's Precedent Decisions as authorized by Government Code section 11425.60:

In the Matter of the Accusation Against Universal Care, Inc -- October 13, 2011

The Capella Group, Inc. dba Care Entrée -- September 26, 2006