Embattled California agency steps up oversight of states managed care plans
California Managed Care
July 31, 1997
To beef up oversight of California health plans, Keith Bishop, Commissioner of the Department of Corporations (DOC), expects to nearly double his budget for supervision of the plans in the next fiscal year.
The additional $6.5 million, approved by a Senate-Assembly conference committee, will be used in part to monitor compliance with a 1996 law that requires plans to notify enrollees of their right to complain to the DOC and of an "800" number they can use to do so. Since January, there have been 80 fines for violations, totaling about $900,000, he said. Usage of the hot lines has gone up dramatically since then. Mr. Bishop says the hot line received 7,303 calls in February and 8,654 calls in June, up from 3,817 calls in January.
The department also wants to increase the number of routine and non-routine quality-of-care surveys and financial examinations it conducts.
Monitoring the financial viability of health plans often gets overlooked, says Mr. Bishop, who notes that his department sometimes gets "inklings of problems" when it learns that a health plan has been slow to pay providers.
While the DOC has the authority to investigate, it has not had the resources to follow up on such cases. The increased budget will allow the department to "identify problems before they become complaints," he says. The DOC also plans to speed up the processing of licensing applications from the industry, he says.
The DOC has been the target of sharp criticism from some legislators and advocacy groups who charge that the department has not been aggressive enough in protecting patients’ rights. Several bills introduced this session propose moving HMO regulation out of the DOC, which has been responsible for managed care oversight since the adoption of the Knox-Keene Health Care Service Plan Act in 1975.
Mr. Bishop says the legislature has delayed action on the bills until next year by which time a 30-member Managed Health Care Improvement Task Force, chaired by Stanford University Professor Alain Enthoven,will have reported on its findings.
Mr. Bishop declined to address the proposals directly, except to note that the DOC has been "very proactive and aggressive" since he assumed the commissioner’s post more than a year ago. "We’ve brought more actions and obtained more money than all the previous commissioners put together," he says.
Contact the commissioner’s office at 213-736-3704.
Embattled California agency steps up oversight of states managed care plans
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