There are many tools used by health plans, health insurers, and pharmacy benefit managers to help ensure patient safety, increase efficiency, and manage costs in the healthcare system. These are generally referred to as utilization management techniques. Learn more about some common tools in this overview.
A brief introduction to Medi-Cal Rx, the state program responsible for pharmacy benefits for Medi-Cal recipients. Learn about the history of the program, who it serves, and how it differs from commercial insurance.
This resource has been prepared by CHBRP to inform interested parties of existing state and federal health insurance benefit mandate laws that may relate to the subject or purpose of a proposed state health insurance benefit mandate or repeal bill.
Resource
Benefit mandates
Health Insurance Coverage
State and Federal Law
Health Insurance Benefit Mandates in California State and Federal Law
This explainer provides an overview of the population aged 65 and older in California, including sources of health insurance, demographic information, and how legislation and regulations may impact insurance coverage for this population
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
There are many tools used by health plans, health insurers, and pharmacy benefit managers to help ensure patient safety, increase efficiency, and manage costs in the healthcare system. These are generally referred to as utilization management techniques. Learn more about some common tools in this overview.
