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Site Map > About DMHC > General Information > Consumer Participation Program

Consumer Participation Program

Under this program, the Director may award advocacy and witness fees to a person or organization which represents the interests of consumers and has made a substantial contribution on their behalf to the adoption of a regulation, Director's order or decision affecting a significant number of consumers. If you have an individual grievance, complaint or case against a health plan, please contact the Help Center (888) 466-2219 for assistance.

Request for Finding of Eligibility to Participate and Seek Compensation:

A person who intends to seek an award should submit to the Director a Request for Finding of Eligibility to Participate and Seek Compensation, giving notice that they represent the interests of consumers and of their intent to claim compensation. The request will be verified, and may be submitted at any time independent of a proceeding in which the person seeks to participate. Please complete the Request for Finding of Eligibility to Participate and Seek Compensation Form.

Within 30 days of receipt of a completed Request for Finding of Eligibility to Participate and Seek Compensation Form, the Director will rule on the Applicant's eligibility to participate and to seek an award of fees. If the Director finds that the Applicant has met the requirements for eligibility, the Director will grant the request. A finding of eligibility to seek compensation will be valid in any proceeding in which an Applicant's involvement commences within 2 years of the finding of eligibility so long as the Applicant is still representing the interests of consumers.

Petition to Participate in a Proceeding:

The Director may identify regulatory proceedings in which he or she believes consumer participation would be helpful and anticipates that fees may be awarded. A person or organization desiring to participate in a proceeding and seek an award of fees will submit a Petition to Participate in a Proceeding. The Petition to Participate in a Proceeding will be submitted no later than the end of the public comment period or the date of the first public hearing in the proceeding in which the Applicant seeks to become involved, whichever is later. For orders or decisions, the request will be submitted within 10 working days after the order or decision becomes final.

The Director has identified the following regulatory proceedings for the Consumer Participation Program:

• Timely Access to Non-Emergency Health Care Services
• Discount Health Plans

The Director has also determined that the following guidance letters issued by the DMHC are eligible for the Consumer Participation Program:

• CPP Participation and Awards for Work on Guidance for AB 2244 and SB 1163
  
• 9 - K: Implementation of AB 2244
  
  • Guidance posted on May 24, 2011.
  • Comments regarding the draft letter may be submitted to the contact person noted in the draft letter.
  • Award of Fees Application due by June 22, 2011.
• 8 - K: Premium Rate Review
  
  • Guidance posted on May 24, 2011.
  • Petition to Participate due by June 8, 2011.
  • Award of Fees Application due by June 22, 2011.

Please note: approval of a Petition to Participate in a Proceeding Form will not guarantee the payment of the dollar amounts requested, or any amount whatsoever.

Within 30 days of receipt of a completed Petition to Participate in a Proceeding Form, the Director will rule on whether the Petition is granted. The petition may be denied if the Director elects not to award compensation to any participants in that proceeding, or if the petition does not meet the requirements.

An amended estimate must be submitted as soon as possible when the Applicant learns that the total amount requested substantially increases. The Director may approve or disapprove the amended amount.

Procedure for Applying for an Award of Fees:

An applicant who has been found eligible for an award of compensation may submit an Application for an Award of Advocacy and Witness Fees within 60 days after issuance of a regulation, Director's order or Director's opinion. An applicant who makes a substantial contribution may be eligible for compensation.

Within 30 days after submission of the request, which will be posted on the Department's web site, the Department or any other person participating in the proceeding may file an objection to the request, which must be submitted to the Department and sent to the claiming Applicant.

Below is a list of the Applications for an Award of Advocacy and Witness Fees:

• Health Rights Hotline (Block Transfer Filings) - November 16, 2005
• Health Rights Hotline (Block Transfer Filings) - January 23, 2006
• Health Access (Prescription Drug Benefits and Co-Payments) - September 22, 2006
• Legal Aid of San Mateo County (Access to Language Assistance) - April 9, 2007
• Health Rights Hotline (Access to Language Assistance) - April 9, 2007
• Latino Issues Forum (Access to Language Assistance) - April 9, 2007
• California Pan-Ethnic Health Network (Access to Language Assistance) - April 20, 2007
• Health Access (Access to Language Assistance) - April 20, 2007
• Health Rights Hotline (Unfair Billing Practices) – October 3, 2008
• Neighborhood Legal Services of Los Angeles County (Unfair Billing Patterns) – October 10, 2008
• Health Access of California (Unfair Billing Patterns) – December 12, 2008
• Western Center on Law and Poverty (Definition of Unfair Billing Patterns) - November 13, 2008
• Legal Services of Northern California (Timely Access to Health Care Services)- February 2, 2010
• California Pan-Ethnic Health Network (Timely Access to Health Care Services) - March 16, 2010
• Health Access of California (Timely Access to Health Care Services) - March 16, 2010
• The Western Center On Law And Poverty, Inc (Timely Access to Health Care Services) - March 18, 2010
• Consumers Union of United States, Inc. (Guidance on SB 1163) - June 22, 2011
• California Pan-Ethnic Health Network (Guidance on SB 1163) - June 22, 2011
• Health Access of California (Guidance on AB 2244) - June 30, 2011

Objections to the application can be submitted by email to cpp@dmhc.ca.gov.

Below is a list of Decisions for an Award of Advocacy and Witness Fees:

• Health Rights Hotline (Block Transfer Filings) - March 10, 2006
• Health Access (Prescription Drug Benefits and Co-Payments) - February 6, 2007
• Latino Issues Forum (Language Assistance Programs) - June 5, 2007
• Health Rights Hotline (Language Assistance Programs) - June 6, 2007
• California Pan-Ethnic Health Network (Language Assistance Programs) - June 29, 2007
• Health Access of California (Language Assistance Programs) - July 12, 2007
• Legal Aid Society of San Mateo County (Language Assistance Programs) - September 6, 2007
• Health Rights Hotline (Unfair Billing Patterns) - December 22, 2008
• Neighborhood Legal Services of Los Angeles County DBA Health Consumer Center of Los Angeles (Unfair Billing Patterns) – April 3, 2009
• The Western Center on Law and Poverty, Inc (Unfair Billing Patterns) – April 27, 2009
• Health Access of California, a California Corporation (Definition of Unfair Billing Patterns) - May 22, 2009
• Health Rights Hotline (Timely Access) – June 3, 2010
• Health Access of California (Timely Access) – June 22, 2010
• Western Center On Law And Poverty (Timely Access) – June 29, 2010
• California Pan-Ethnic Health Network (Timely Access) – June 29, 2010
• Health Access of California, a California Corporation (Implementation of AB 2244)- January 10, 2012
• Consumers Union of United States, Inc. (Implementation of SB 1163) – January 27, 2012
• California Pan-Ethnic Health Network (Implementation of SB 1163) - February 9, 2012

Objections to the decision can be submitted by email to cpp@dmhc.ca.gov.

If you have questions regarding the Consumer Participation Program please use the Frequently Asked Questions or send an email to cpp@dmhc.ca.gov.

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