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Consumer Participation Program

Under this program, the Director may award advocacy and witness fees to a person or organization which represents the interests of consumers and has made a substantial contribution on their behalf to the adoption of a regulation, Director's order or decision affecting a significant number of consumers. If you have an individual grievance, complaint or case against a health plan, please contact the Help Center (888) 466-2219 for assistance.

Request for Finding of Eligibility to Participate and Seek Compensation:

A person who intends to seek an award should submit to the Director a Request for Finding of Eligibility to Participate and Seek Compensation, giving notice that they represent the interests of consumers and of their intent to claim compensation. The request will be verified, and may be submitted at any time independent of a proceeding in which the person seeks to participate. Please complete the Request for Finding of Eligibility to Participate and Seek Compensation Form.

Within 30 days of receipt of a completed Request for Finding of Eligibility to Participate and Seek Compensation Form, the Director will rule on the Applicant's eligibility to participate and to seek an award of fees. If the Director finds that the Applicant has met the requirements for eligibility, the Director will grant the request. A finding of eligibility to seek compensation will be valid in any proceeding in which an Applicant's involvement commences within 2 years of the finding of eligibility so long as the Applicant is still representing the interests of consumers.

Petition to Participate in a Proceeding:

The Director may identify regulatory proceedings in which he or she believes consumer participation would be helpful and anticipates that fees may be awarded. A person or organization desiring to participate in a proceeding and seek an award of fees will submit a Petition to Participate in a Proceeding. The Petition to Participate in a Proceeding will be submitted no later than the end of the public comment period or the date of the first public hearing in the proceeding in which the Applicant seeks to become involved, whichever is later. For orders or decisions, the request will be submitted within 10 working days after the order or decision becomes final.

The Director has identified the following regulatory proceedings for the Consumer Participation Program:

  • Prescription Drug Prior Authorization Form Process
  • State Medical Loss Ratio Annual Report

Please note: approval of a Petition to Participate in a Proceeding Form will not guarantee the payment of the dollar amounts requested, or any amount whatsoever.

Within 30 days of receipt of a completed Petition to Participate in a Proceeding Form, the Director will rule on whether the Petition is granted. The petition may be denied if the Director elects not to award compensation to any participants in that proceeding, or if the petition does not meet the requirements.

An amended estimate must be submitted as soon as possible when the Applicant learns that the total amount requested substantially increases. The Director may approve or disapprove the amended amount.

Procedure for Applying for an Award of Fees:

An applicant who has been found eligible for an award of compensation may submit an Application for an Award of Advocacy and Witness Fees within 60 days after issuance of a regulation, Director's order or Director's opinion. An applicant who makes a substantial contribution may be eligible for compensation.

Within 30 days after submission of the request, which will be posted on the Department's web site, the Department or any other person participating in the proceeding may file an objection to the request, which must be submitted to the Department and sent to the claiming Applicant.

Below is a list of the Applications for an Award of Advocacy and Witness Fees:

Objections to the application can be submitted by email to cpp@dmhc.ca.gov.

Below is a list of Decisions for an Award of Advocacy and Witness Fees:

Objections to the decision can be submitted by email to cpp@dmhc.ca.gov.

If you have questions regarding the Consumer Participation Program please use the Frequently Asked Questions or send an email to cpp@dmhc.ca.gov.