Resources A - H

California Department of Managed Health Care (DMHC)

Learn about health care in California, types of health plans (HMO, PPO, EPO, POS, low or no income, etc.), coverages (group vs individual), consumer rights, etc.

California Code of Regulations (CCR) Title 28 Managed Health Care

Learn about regulations that apply to all Managed Health Care entities in California.

California Code of Regulations (CCR) Title 28 Managed Health Care  

Timely Access to Non-Emergency Health Care Services 

Learn about standards for timely access to care, such as specialist care, urgent care, primary care that apply to health plans in California.

California Code of Regulations (CCR) Title 28 Managed Health Care Scope of Basic Health Care Service 

Learn about basic health care services that all managed care organizations in California must provide.

Center for Medicaid and CHIP Services (CMCS) 

Learn about the CMCS, the Federal agency that oversees all national program policies and operations related to Medicaid, the Children's Health Insurance Program (CHIP), and the Basic Health Program (BHP). These critical health coverage programs serve millions of families, children, pregnant women, adults without children, and also seniors and people living with disabilities. 

Federal Poverty Level (FPL) 

View the 2021 FPL used to determine eligibility to government programs.

Industry Collaboration Efforts (ICE) 

ICE is a voluntary 501(c)3 organization that includes participation by and advice from accrediting and regulatory agencies. The goal of ICE work products is to offer ICE participating organizations standardized tools and best practices toward optimizing efficiencies to implement health industry requirements. ICE heeds feedback from accrediting and regulatory agency partners regarding ICE work products; however, ICE does not obtain official regulatory approval for its work products. As such, ICE work products are not to be considered exempt from any approval process required by regulatory agencies.  

InterQual®

An evidence-based clinical decision support solution to help payers, providers, and government agencies make clinically appropriate medical utilization decisions. 

MCG

A clinical support software with evidence-based care guidelines that help providers and health plans to drive effective care.

Medicaid  

Learn more about the Federal Medicaid program. 

Medi-Cal Resources 

Go to this page of the website to access useful Medi-Cal webpages, such as authorization and limitation guidelines for DME, orthotics, and prosthetics.  

National Committee for Quality Assurance (NCQA)  

Learn about NCQA and their accreditation programs for various healthcare entities.