This issue brief discusses the medical necessity determination process, which may involve multiple clinicians, for enrollees in health plans and health policies regulated by the Department of Managed Health Care (DMHC) or the California Department of Insurance (CDI).
Issue Brief
Health Insurance Coverage
Medical Necessity Determination Process for Covered Benefits
This issue brief discusses laws and regulations that prohibit out-of-network (OON) providers from issuing surprise bills to enrollees in plans or policies regulated by DMHC or CDI.
Issue Brief
Balance Billing Prohibitions and the No Surprises Act
This explainer provides an overview of claims data, including how the data is collected, what information may be available within the datasets, and how the data are used to inform CHBRP's analyses.
Explainer
An Overview of Claims Data and How CHBRP Estimates Utilization and Unit Cost
This policy snapshot summarizes the state of the evidence on telehealth, and focuses on the following common types of telehealth modalities and services: live video, telephone, and eConsult.
This issue brief discusses cost sharing laws and limits that are applicable to outpatient prescription drug benefits regulated by the Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI). This brief also discusses pharmacy benefits, cost sharing, and the laws that are relevant to them.
This issue brief includes background information on genetic biomarker testing for Californians with advanced cancer, and, where possible, the presence and the impact of prior authorization on such testing.
