L&HCaliforniaeasy
A California consumer enrolls in an HMO product offered by a 'health care service plan'. Which California regulator has primary jurisdiction over that HMO?
AThe California Department of Insurance (CDI), under the Insurance Code's disability-insurance provisions
BThe California Department of Business Oversight, as the successor agency for licensed health entities
The California Department of Managed Health Care (DMHC) under the Knox-Keene Act
DThe federal Centers for Medicare & Medicaid Services (CMS), under national managed-care standards
Why this is the answer
California uniquely splits health-care regulation between two departments. The Department of Managed Health Care (DMHC) regulates 'health care service plans' under the Knox-Keene Act (Health & Safety Code §§ 1340-1399.864), which covers HMOs and most managed-care products. The Department of Insurance (CDI) regulates 'disability insurance' — PPOs, indemnity health, disability income, long-term care, Medicare Supplement — under the Insurance Code. The Department of Business Oversight (now DFPI) regulates banks and securities, not health plans. CMS is federal.
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