California Legislature—2015–16 Regular Session

House ResolutionNo. 26


Introduced by Assembly Member Low

June 24, 2015


House Resolution No. 26—Relative to the Department of Managed Health Care.

P1    1WHEREAS, The Department of Managed Health Care was
2created by Assembly Bill 78 (Chapter 525 of the Statutes of 1999),
3and began operations on January 1, 2000; and

4WHEREAS, 2015 marks the 15th anniversary of the creation
5of the Department of Managed Health Care, which was created to
6protect the rights of health care service plan enrollees, to educate
7consumers about their rights and responsibilities, to ensure the
8financial stability of the managed health care system, and to assist
9Californians in navigating the changing health care landscape; and

10WHEREAS, With currently over 27 million enrollees in plans
11under the department’s jurisdiction, the Department of Managed
12Health Care is the only state-level department in the United States
13focused on regulating health maintenance organizations; and

14WHEREAS, The Department of Managed Health Care enforces
15California’s landmark Knox-Keene Health Care Service Plan Act
16of 1975 (the Knox-Keene Act); and

17WHEREAS, The strong patient protections contained in the
18Knox-Keene Act and enforced by the Department of Managed
19Health Care include the following:

20(a) Patients have the right to treatment or services that are
21medically necessary, and to receive an independent medical review
22by the Department of Managed Health Care if a treatment or service
23is denied by a health care service plan.

P2    1(b) Patients have the right to receive communications related
2to services in their primary languages.

3(c) Patients have the right to timely access to care, which
4includes limits on how long a patient must wait to get a health care
5appointment.

6(d) Patients have the right to request continuity of care, for both
7medicines and doctors.

8(e) Patients have the right to an expeditious process to obtain
9exceptions from step therapy, and to continued access to their
10prescribed medications when changing plans.

11(f) Patients have the right to know why their plan denies a
12service or treatment.

13(g) Patients have the right to view a health plan’s drug formulary
14before signing up for the plan.

15(h) Patients have the right to receive treatment for certain mental
16health conditions.

17(i) A health plan must respond within 30 days when a patient
18files a complaint.

19(j) Patients have the right to receive hospice care at the end of
20life; and

21WHEREAS, The Department of Managed Health Care operates
22and maintains the DMHC Help Center, where patients get
23assistance with obtaining services from their health plan; now,
24therefore, be it

25Resolved by the Assembly of the State of California, That the
26Assembly commends the Department of Managed Health Care for
2715 years of operation on behalf of California’s patients; and be it
28further

29Resolved, that the Assembly encourages all Californians to learn
30about their legal right to timely access to high quality health care;
31and be it further

32Resolved, That the Chief Clerk of the Assembly transmit copies
33of this resolution to the author for appropriate distribution.



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