Providing information to the public is an important part of the consumer protection services provided by the DMHC. Search our databases and read our reports to gain a better understanding of California’s health care delivery systems.
Premium Rate Review
- Quarterly Reports - SB 1163 requires the DMHC to report quarterly to the legislature on any unreasonable premium rate health plan filings.
- Rate Review Grant Quarterly Reports - As recipients of the federal Rate Review Grant funds, the DMHC is required to report quarterly on the progress of the grant rate review activities.
- Proposed Premium Rate Filings - Health plans that offer individual and small group coverage must file proposed rate increases with the DMHC.
Health Plan Information
Health Plan Compliance Information
- Medical Survey Reports- California managed care law (Knox-Keene Health Care Service Plan Act) requires the Department to conduct a routine medical survey of each licensed full service and specialty health plan at least once every three years.
- 6 Month Survey Schedule - The Division of Plan Surveys posts a rotating 6 Month Survey Schedule of all routine medical surveys of health plans.
- Search Enforcement Actions - Search for enforcement actions, which have been adjudicated since July 1, 2000, in the Enforcement Action Database.
- Timely Access Reports - Summary of health and mental health plan compliance with the timely access regulations.
Provider Related Information
- Quarterly Claims Settlement Practices Report
Shows providers and affiliates that did not reimburse at least 95% of claims in a timely fashion. Shown by year and quarter.
- Provider Complaint / Dispute Issues Statistics - The Department of Managed Health Care's Provider Complaint Unit tracks and trends provider complaints submitted by California providers. The posted statistical information reflects the provider complaint activity for each calendar year quarter.
Disputes and Resolutions
- Arbitration Decisions - Each health plan which uses arbitration to settle disputes with its members must file with the Department a copy of any written arbitration decision.
- Independent Medial Review and Complaint Resolutions - The Department publishes an annual report that details the number and types of complaints or grievances received during the calendar year, including Independent Medical Review (IMR) data.
- Search for Independent Medical Review cases - The IMR program was created by the California Legislature, and provides a vital service for California health plan members. In our database, you’ll find all IMR decisions since the program began on January 1, 2001.
California Public Records Act Request
The California Public Records Act (CPRA) allows the public to access any and all existing, disclosable documents maintained by the Department. The Department encourages, but does not require, requests for records to be made in writing. Written requests help the Department correctly identify the records requested. Written requests for records can be submitted through the Department’s Request for General Information Form.