Many years ago, California established the Department of Managed Health Care, one of the first in...

Many years ago, California established the Department of Managed Health Care, one of the first in the Nation to recognize that HMOs were different from other forms of insurance. Please identify and discuss three major functions of this Department.

Expert Solution

Major functions of managed healthcare system inclufesm

The Department of Managed Health Care (DMHC) is the primary government watchdog overseeing managed health care in California. It exists within the state's Business, Transportation and Housing Agency.

1.

The department enforces the Knox-Keene Act. The act is a plethora of regulations regarding consumer protections, access to care, specific service coverage, prescription drugs, grievances, licensing of plans and reporting by health plans.

Essentially, it monitors and regulates HMOs, provides information to consumers and enforces state regulations when they are violated.

2.

The DMHC is organized into eight functional offices: Administrative Services; Enforcement; Help Center, Health Plan Oversight; Legal Services; Patient Advocate; Provider Oversight; and Technology and Innovation. Each office is led by an assistant deputy director who reports to the Director’s Office.

3. The department monitors and regulates HMOs through licensing, financial examinations and regular medical surveys of each health plan. It informs the public via an annual HMO report card, public education and awareness efforts, and its HMO Help Center.

Nightingale answered 2 years ago

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