Information concerning health plans that is not available on this website may also be available for review under the California Public Records Act.
California Public Records Act
As a state government agency, the Department of Managed Health Care, Office of Legal Services maintains records that are often of interest to the public. For example, information on how an entity is licensed (e.g. is the entity an HMO, PPO, EPO, etc.). All records held by the Department are public unless they are exempt from disclosure. Examples of records that the public may review include:
- Health plan license, applications and exhibits
- Block transfer filings
- Timely access data and statistics
- Rulemaking files for regulations promulgated by the Department
Legal requirements governing inspection of public records are outlined in the California Public Records Act, Government Code section 7920.000 et seq. and section 1006 of Title 28 of the California Code of Regulations.
Department of Managed Health Care's Guidelines for Accessing Public Records
How to Submit a Public Records Act (PRA) Request
It is preferred, but not required, that requests for public records be in writing. Requestors should specify as clearly as possible the records that they are seeking. It may take up to 10 days for the Department to review the PRA request and inform the requestor of the determination of disclosable records. Occasionally, the Department may need up to 14 additional days to identify potentially responsive records.
PRA requests may be submitted to the Department by any one of the following methods:
Through the Department's website at the following link: Request for Public Records
By email: PRA@dmhc.ca.gov
By mail: Department of Managed Health Care, attn: Office of Legal Services, 980 Ninth Street, Ste. 500, Sacramento, CA 95814
By fax: (916) 322-9430
How to View Public Records in Person
Requestors have the option of viewing public records in person or hiring a copy service to come to the Department and make copies. All arrangements to view or copy public records must be scheduled in advance for the convenience of all parties. To schedule an appointment please contact the Office of Legal Services at (916) 322-6727.
Information Exempt from Disclosure
Some records and documents are exempt from public disclosure. These records are deemed confidential because they contain personal, medical, or financial information about an individual, or confidential commercial information about a company or plan. Some examples of records that are NOT available for public viewing include:
- Records pertaining to pending litigation to which the Department is a party. (Gov. Code, § 7927.200.)
- Preliminary drafts, notes or agency memoranda not retained in the ordinary course of business, provided that the public interest in withholding the records clearly outweighs the public interest in disclosure. (Gov. Code, § 7927.500, subd. (a).)
- Confidential communications between an attorney and the Department. (Gov. Code, § 7927.705, and Evid. Code, § 954.)
- Personnel, medical or similar files, the disclosure of which would constitute an unwarranted invasion of personal privacy. (Gov. Code, § 7927.700)
- Corporate proprietary information, such as trade secrets or financial records (Gov. Code, § 7927.705 and Evid. Code, § 1060.)
- Peer review records (Gov. Code, § 7927.705, and Bus. & Prof. Code, § 805, subd. (g).)
The Department also has the authority to withhold requested information if it determines that the public interest in withholding a record clearly outweighs the public interest in disclosing the record. (Gov. Code, § 7922.000.)
Please note that the Department retains health plan records and reports for varying lengths of time. Rules regarding record retention are provided in the Department's regulation concerning records retention, section 1009 of Title 28 of the California Code of Regulations.
Information Practices Act Request
Individuals may have personal information they wish to review in the Department's records. Such information usually consists of:
- A complaint submitted to the Department concerning the enrollee's health plan
- The health plan's response to the enrollee's complaint
- The results of an Independent Medical Review regarding a treatment request for the enrollee
How to View and Request Personal Information
Under the Information Practices Act of 1977, the Department must strictly protect the confidentiality of any personal information in its records. Requestors must verify their identity when seeking to view their records, either through a notarized signature when requesting mailed records or by presenting official identification when examining records in person.
Attorneys or other representatives must present proof of authorization to the Department before an individual's personal records will be mailed to them. The Department will allow inspection or provide copies of responsive documents within 30 days of receipt of the request.
To inspect records in person, the requestor must schedule an appointment by phoning (916) 322-6727. At the time of the appointment, the requestor will need to show a government-issued identification card. Photocopies of the records can be made at that time for a fee of $.10 per page.
To request either method of viewing personal records, please print out, complete, and submit to the Department the form below: