Last week, the California Department of Managed Health Care (DMHC) celebrated its tenth anniversary. It was an occassion worth marking, as the nation’s first and only department solely focused on protecting patients and watching over insurers. Before the DMHC, HMOs and managed care insurance companies were regulated by the suspiciously-named Department of Corporations.
It was the passage of the HMO Patients’ Bill of Rights–with many bills sponsored by Health Access California–that created the new department and began a new chapter in consumer protection in the state. We were pleased to speak at the event last week, and recalled that the Department is responsible for implementing many first-in-the-nation patient’s rights, including the first to establish an Independent Medical Review program to evaluate treatment decisions, the first to change rescission practices, the first to establish guidelines for waiting times for appointments with physicians, the first to require that health plans provide language access, including interpreters and translated consumer materials at all points-of-service, and more.
These and other accomplishments are detailed in a 10th Anniversary booklet by the DMHC, now on their website. It lists these numbers of ways the Department has assisted consumers:
* More than 1 million consumers have been assisted by the Help Center.
* The DMHC has recovered more than $14 million for consumers through its Help Center and Enforcement Offices.
* The Help Center has administered nearly 12,000 Independent Medical Reviews, and slightly more than half were decided in favor of consumers, allowing them to receive care that was previously denied.
* As the result of the DMHC’s actions to end rescissions, the number of consumers who had coverage improperly rescinded or cancelled was reduced from a high of 1,552 in 2005 to only four in 2009.
* Nearly $35 million in fines and penalties have been assessed to health plans that were in violation of the law.
* The Provider Complaint Unit has received more than 29,500 provider complaints and has recovered more than $22 million in payments owed to physicians and hospitals.
* The Licensing Division has approved more than 85 new plans and products now available to the public.
* A total of 18 unlicensed discount health card companies have been ordered to cease operations or become licensed.
* The DMHC oversaw the transition of 2,313 kidney patients to transplant lists at other hospitals after the closure of a Northern California kidney transplant center in 2006. A subsequent enforcement action resulted in a $3 million contribution to Donate Life California, for outreach efforts which resulted in increased organ donations.
* The DMHC secured more than $450 million in community benefits for California consumers through the establishment of community investment programs.
Congratulations should go to both Daniel Zingale, the founding director of the Department under Governor Davis, and Cindy Ehnes, the current director under Governor Schwarzenegger, for keeping the focus on patients. Credit should also go to the Department’s staff, at a time when government service is too often maligned, for keeping their commitment in such a vital function.
Our comments at the event said that given our role in its creation, we considered the Department an accomplishment, but also a focus of our continued attention, as a needed check on the abuses of the health insurance industry. While we haven’t agreed with the Department on every decision, California consumers appreciate what the Department has done, but need it to do even more.
And under health reform, it will: the Department will have more responsibilities. The new federal health law adopts many existing California protections as the standard nationwide, but also provides a host of patient protections new to Californians. The Department will need to ensure that insurers comply with the new requirements, and transition smoothly to the newly regulated marketplace of 2014.
Under both the federal health law and new implementing state legislation, the Department will have new responsibilities–for example, one bill pending on the Governor’s desk, SB1163(Leno), would provide new authority for the Department to review rates and rate hikes. Consumer and community groups, including Health Access California, the California Pan-Ethnic Health Network, Consumers Union, Western Center on Law and Poverty, and many others, will work to increase the Department’s ability to protect patients, now under the new framework of federal health reform.
The passage of the HMO Patients’ Bill of Rights–and the creation of the DMHC–was the biggest advance in patient rights in the last decade.. until this year, with the passage of the federal health reform bill, along with the (hoped-for) signature of companion consumer protection legislation now pending on the Governor’s desk. So marking the 10 years for the DMHC is not just an opportunity to look back, but important in setting the stage to move forward.