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Precedent Decisions

The DMHC has designated certain administrative decisions as being "precedent decisions." These administrative decisions contain significant legal or policy findings that apply beyond the facts of the particular case.

As authorized by Government Code section 11425.60, the DMHC has designated one administrative decision as a precedent decision. Members of the public may receive a subscription to the Index of Precedent Decisions by calling (916) 322-6727 or by sending a written request to Department of Managed Health Care, 980 9th Street, Suite 500, Sacramento, CA 95814.

  1. Respondent(s):  THE CAPELLA GROUP, INC. dba CARE ENTREE
  • Dept. file number:  04-312

  • OAH file number:  N2005100840
  • Law(s) involved:  Health & Safety Code §§1345 and 1349
  • Date of Proposed Decision:  June 15, 2006
  • Date of Decision:  September 26, 2006
  • Designated in whole or in part:  In Part
  • Summary:  This decision confirms the DMHC's jurisdiction to regulate discount health plans. Discount health plans contract with health care service providers to offer discounted health care services to plan enrollees. However, an enrollee in a discount health plan must pay the entire amount of the discounted services.



Cal Gov Code § 11425.60 (2006)


§ 11425.60. Decisions relied on as precedents; Index of precedent decisions

  • (a) A decision may not be expressly relied on as precedent unless it is designated as a precedent decision by the agency.

  • (b) An agency may designate as a precedent decision a decision or part of a decision that contains a significant legal or policy determination of general application that is likely to recur. Designation of a decision or part of a decision as a precedent decision is not rulemaking and need not be done under Chapter 3.5 (commencing with Section 11340). An agency's designation of a decision or part of a decision, or failure to designate a decision or part of a decision, as a precedent decision is not subject to judicial review.

  • (c) An agency shall maintain an index of significant legal and policy determinations made in precedent decisions. The index shall be updated not less frequently than annually, unless no precedent decision has been designated since the last preceding update. The index shall be made available to the public by subscription, and its availability shall be publicized annually in the California Regulatory Notice Register.

  • (d) This section applies to decisions issued on or after July 1, 1997. Nothing in this section precludes an agency from designating and indexing as a precedent decision a decision issued before July 1, 1997.

 
 
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