Archived Documents

Amicus Curiae Brief: Centinela Freeman Emergency Medical Associates vs. Health Net of California, Inc.

Notice of Errata for Amicus Curiae Brief

2015 SLAA Report

Ten Year Report on Health Care Consumer Protections - The year 2010 marks a major milestone for consumers and the managed care industry in California -- the ten-year anniversary of the establishment of the DMHC. This report details the significant consumer protection laws and policies established by the DMHC over the past ten years.

Implementation of Department Review of Prescription Drug Benefits

DMHC/CDI Consistency in Consumer Protection (SB 1913)

DMHC issues amended Order of Approval for the Notice of Material Modification to Blue Cross of CA Knox-Keene License.  
This amended order supersedes the Order of Approval issued on July 23, 2004, concerning the same transaction.

Report to Senate Insurance Committee and Assembly Health Committee Pursuant to Health and Safety Code section 1367.03(j)

Filing Suggestions: Exhibits F, L, and M

Compliance with Section 1366.35(i): Disclosure of the Availability of HIPAA Coverage; Model Language for Use in Evidences of Coverage

Implementation of the Claim Settlement Practices and Dispute Mechanisms Regulations

Plan Disclosure of Personal Health Information to the Department of Managed Health Care

Cancellation of Enrollment

Revised Financial Reporting Forms

Signature Requirements for Reports

Unilateral Amendments to Contracts

Updated Information On The Financial Reporting Forms And Web Portal

Advisory Regarding Exempt Employee Assistance Program

Exclusion of Coverage for Certain Pharmaceuticals

Required Disclosures and Conditions of Binding Arbitration

Confidentiality of Enrollee Social Security Numbers

Restrictions on out of area maternity services

Measurement Year 2016

Survey Tools

Survey Templates

Audit Templates

2016 Annual Network Review Report Forms

2016 Annual Network Review Supplemental Information

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Measurement Year 2015

Survey Tools

Steps for submitting Timely Access Compliance Report (A-F data):

1.  Read the MY 2015 Timely Access Compliance Report Instructions

2.  Please use the MY 2015 templates by relevant provider type when reporting results for section B.3 Data Source: Appointment Availability Audit/Survey in the DMHC's web portal.

3.  Submit documents per instructions via the web portal (You may download the D. Advanced Access Form (optional) to report provider groups).

Audit Templates

Provider Appointment Manual Audit Dates

Rule 1300.67.2.2, subd (g)(2)(B) requires health plans to report a rate of compliance with several appointment wait time standards. Pursuant to SB 964 and Section 1367.03, subd (f)(3), DMHC has adopted two standardized methodologies that plans may use to report compliance with the required appointment wait time standards for Measurement Year 2015 (“MY2015”).

Plans conducting a manual audit using the DMHC MY2015 Provider Appointment Audit Methodology will perform appointment availability audits on four days during MY2015, one day in each calendar quarter of the year. After the close of each calendar quarter, DMHC will post on its website a notification of one date from the quarter for which data shall be collected. Data should be collected for each date soon after it is posted on DMHC’s website to allow plans to use the data for ongoing monitoring and to ensure that data systems are not purged before collection is accomplished.

For MY2015, the first two audit dates are:

First quarter: Wednesday, February 11, 2015

Second quarter: Tuesday, May 5, 2015

SPECIAL REMINDER: In the DMHC's web portal, please complete Steps 1 and 2 under the Submit tab and make sure you receive a confirmation email to identify your report has been successfully submitted to the DMHC. The Timely Access Compliance Report will not be submitted if Step 2 (Affirmation to Complete) is not completed. 

Measurement Year 2015 Annual Provider Network Report Templates

Timely Access Data Element Changes – At-A-Glance

Timely Access Web Portal Profile Tab Instructions - Profile Tab Instructions

Timely Access Provider Network Report Form Instructions - Network Report Form Instructions

Frequently Asked Questions - FAQs

To clearly illustrate the changes in data elements required and requested for Measurement Year 2015 (MY2015), the DMHC has summarized them in an “at a glance” table format for each Timely Access Report Form. The tables display the following:

  • The name of the Timely Access Report Form (template), e.g. PCP or Enrollment
  • The affected data element (columns) from each Report Form;
  • The action taken, e.g. whether a previously required or requested data element was removed or a new data element added, and;
  • A brief description of the new data element or a description of the previously requested/required data element that is no longer required.    

2015 Contracted Provider Network information per California Code of Regulations, title 28, section1300.67.2.2(g)(2)(G)1 & 2

In order to ensure compliance with Health and Safety Code section 1367.035 (added under Senate Bill 964), the DMHC has modified its Timely Access Provider Network report forms for the 2015 reporting year. Below please find the 2015 Timely Access report forms in a “locked” Excel format. Plans must utilize these templates to compile network data as of December 31, 2015. As a reminder, network templates are due to the Department no later than March 31, 2016.

2015 Timely Access Provider Network Report Forms

Please note that, in addition to submitting the network templates provided above, each Plan is also required to complete a “Plan Profile” in the DMHC's web portal. For assistance, see sample data for PCPs, Specialists, Mental Health, Other Contracted Providers, Hospitals and Clinics, Enrollment.  

Timely access report forms from previous measurement years are now available at the archive portion of our website. Plan data for Measurement Year 2015 must be submitted on the Excel templates provided above. The Department will not accept health plan network reports submitted on templates from prior years.  

2015 Timely Access and Network Adequacy Grievance Reporting Documents

For Measurement Year 2015, the Department has created a standardized template for which the health plans must submit data regarding network adequacy and timely access grievances as required by Health and Safety Code section 1367.035 (a)(6).

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