California Department of Managed Health Care

The Department of Managed Health Care (DMHC) is a regulatory body governing managed health care plans, sometimes referred to as Health Maintenance Organizations (HMOs) in California. The current director, Shelley Rouillard, was appointed by Governor Jerry Brown on December 2, 2013. The DMHC is part of the California Health and Human Services Agency. It was established in 2000 and is responsible for enforcing the Knox-Keene Health Care Service Plan Act of 1975, and other related laws and regulations.

Dual health insurance regulation

Not all health plans operating in California are under the jurisdiction of the DMHC; for example, some preferred provider organizations are regulated by the California Department of Insurance (DOI). Two state-based health insurance regulators is unusual in the United States, and has led to various additional work to synchronize laws.[1] This dual regulation arose due for historical reasons, and when the DMHC was created in 2000, the California legislature requested a report on merging the health insurer responsibilities with the CDI.[2] In 2001, J. Clark Kelso, who served as acting California Insurance Commissioner in 2000, produced a report outlining costs and benefits of agency consolidation.[3]

In addition, "self-insured" or ERISA plans, offered by some large employers are under the jurisdiction of the U.S. Department of Labor.

Knox-Keene licenses

The department has regulated "limited" licenses for agencies which did not engage in marketing or enrollment but lacked regulations for these until 2019.[4]

History

The agency was created in July 2000, in the wake of widespread dissatisfaction with managed care across the country and in response to concerns that the prior regulator, the California Department of Corporations, lacked medical and consumer protection expertise.[5] At the time of its creation, California was the largest market for health maintenance organizations (HMOs) in the United States.[5]

After it was created, Kaiser Permanente challenged its authority in court, but did not succeed.[6]

See also

References
  1. Kelch, Deborah Reidy (2015). "Health Insurance Oversight in California: Observations on the Post-ACA Environment" (PDF). Archived (PDF) from the original on 2019-10-12. Retrieved 2019-10-12.
  2. "Making Sense of Managed Care Regulation in California" (PDF). California HealthCare Foundation. 2001.
  3. Kelso, J. Clark (2001). "Regulatory Jurisdiction Over Health Insurance Products: The Department of Managed Health Care & The Department of Insurance" (PDF). Archived (PDF) from the original on 2015-09-09. Retrieved 2019-10-12.
  4. "Changes to California's Knox-Keene Act Potentially Impact California Health Care Providers | Blogs | Health Care Law Today | Foley & Lardner LLP". www.foley.com. Retrieved 2019-10-13.
  5. "The Department of Managed Care". Managed Care magazine. 2002-03-01. Retrieved 2019-10-13.
  6. "Department of Managed Health Care". www.allgov.com. Retrieved 2019-10-13.



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