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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.
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.
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.
CHHS is partnering with FUSE Corps and is accepting applications for an executive-level Fellow for one year who will utilize data-driven strategies to improve client outcomes.
FUSE Corps – CHHS Agency Fellowship Summary
CHHS Agency Fellowship Summary
California Department of Managed Health Care (DMHC) Director Shelley Rouillard has approved Aetna’s acquisition of Humana.
“The Department’s primary focus in reviewing mergers is to ensure compliance with the strong consumer protections and financial solvency requirements of the Knox-Keene Act,” said Director Shelley Rouillard. “The Department’s conditions on this merger will help control health care costs, increase access to care and improve quality of care. Aetna also has committed to help improve California’s health care infrastructure, and invest in programs that will serve the vulnerable populations enrolled in these plans.”
The DMHC examines proposed health plan mergers to ensure enrollee health care rights are protected and that enrollees have continued access to appropriate health care services.
The Department of Managed Health Care (DMHC) is seeking a dynamic, creative, and consumer-oriented physician and clinical quality leader to serve as the DMHC Chief Medical Officer (CMO) as a contracted consultant. The CMO will advise the DMHC Director and the DMHC programs on clinical matters and provider network adequacy issues. The CMO will also develop the DMHC’s comprehensive health plan quality improvement program to drive continuous improvement in clinical outcomes for health plan enrollees and will coordinate with other state medical directors, as needed.
Interested candidates should submit a Statement of Qualifications (please include your hourly rate), resume or curriculum vitae, and three letters of reference to Kim.Stryke@dmhc.ca.gov by June 30, 2016. The Statement of Qualifications must respond to the following questions:
1. How does your experience and qualifications align with the responsibilities of this position?
2. How do you propose to accomplish the tasks outlined in the Scope of Work?
3. How would you approach being successful in this position?
If you have questions regarding the position or contents of this message, please contact Chris Wordlaw at Christopher.Wordlaw@dmhc.ca.gov. More...
The California Department of Managed Health Care (DMHC) announced today that it issued a $415,000 fine against Anthem Blue Cross (Anthem) for failing to identify, timely process, and resolve enrollees’ grievances. Anthem also failed to fully and timely provide information to the Department during the investigation of member complaints.
The Knox-Keene Act and DMHC’s Timely Access Regulation requires health plans to provide timely access to care within specified time-elapsed standards. The Timely Access Regulation also requires health plans to submit annual reports detailing compliance rates for each time-specific standard during the previous calendar year. The DMHC reviews the annual reports and posts a Timely Access Report with final findings concerning the submitted data, and recommendations for changes that further protect enrollees.
The Department of Managed Health Care (DMHC) invites you to a public meeting on the acquisition of Cigna by Anthem. Representatives from both plans will be present. The meeting will be held in Sacramento on March 4, 2016 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 email@example.com until 5:00 p.m. on March 11, 2016.
The Department of Managed Health Care (DMHC) has issued its 2014 annual report. In addition to serving as the annual report for 2014, the report also celebrates the many momentous anniversaries occurring this year: the 15th anniversary of the creation of the DMHC; the 40th anniversary of the Knox-Keene Health Care Service Plan Act of 1975; and, the 5th anniversary of federal health care reform. More....
The Department of Managed Health Care has announced its five-year strategic plan. The strategic plan includes a new mission statement, as well as the core values, goals, objectives and strategies for accomplishing the Department’s mission. This plan was developed with input from DMHC staff and external stakeholders. More...
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Secretary, Health & Human Services Agency
Director, Department of Managed Health Care