California law requires the Department of Managed Health Care (DMHC) to conduct a medical survey of each licensed full service and specialty health plan at least once every three years. The DMHC may also perform an investigative medical survey whenever the DMHC’s Director determines a survey is necessary. These surveys are an evaluation of a plan's compliance in the following areas:
- Quality Assurance
- Grievances and Appeals (enrollee complaints)
- Access and Availability
- Utilization Management (referrals and authorizations)
- Overall plan performance in meeting enrollees' health care needs
The DMHC will be conducting an on-site survey of Magellan in 2019 and will be using the information offered by CAMFT members to inform its survey process.
Once the survey has been completed, the DMHC issues a Final Report that is available to the public. The DMHC has the right to perform a Follow-Up Survey within 18 months of the Final Report for any uncorrected deficiencies. For more information about the DMHC’s survey process visit http://dmhc.ca.gov/LicensingReporting/HealthPlanComplianceMedicalSurvey.aspx.