State Considers Plan To Replace Some HMO Surveys Conducted by Department of Managed Health Care

State officials are considering a plan to replace some surveys of HMOs operating in the state conducted by the Department of Managed Health Care with surveys by the National Committee for Quality Assurance, a not-for-profit health care industry accreditation group, the Los Angeles Times reports.

DMHC currently surveys HMOs to determine whether they comply with state requirements, and NCQA also surveys HMOs as part of its accreditation process. Duplicate information includes surveys that require health plans to check the credentials of all contracted physicians.

Under a proposal discussed at a public hearing June 8, DMHC said the state also would use NCQA surveys to determine whether HMOs are in compliance with regulatory requirements. State regulators would "retain all authority and discretion to enforce health plan compliance, including follow-up surveys ... and taking any necessary enforcement action," according to a DMHC notice for the hearing.

Those who oppose the plan, including the California Medical Association and Health Access California, say that outsourcing parts of DMHC's surveys and audits would undermine the state's role as a watchdog, could put a barrier between consumers and those who investigate their complaints and could hinder the state's ability to issue fines or take over insurers if problems are found. Opponents also say that NCQA could have a conflict of interest because about 60% of NCQA's revenue is from insurers and doctor groups.

Supporters say that transferring responsibility would reduce duplication and could allow the department to redirect funds to improve programs for mental health and access to health care for people with disabilities. DMHC spokesperson Lynne Randolph said that the state is in the preliminary stages of considering the change and that regulators have not set a timetable for a decision.

Randolph said, "We just wanted to get people's views, then take them back and see if we want to proceed. We are really undecided at this point" (Vrana, Los Angeles Times, 6/17).