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CHA Comments on Draft Department of Managed Health Care No Surprises Act All Plan Letter

For CEOs, CFOs, government relations executives, finance & reimbursement staff, legal counsel

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CHA has provided comments to the Department of Managed Health Care (DMHC) on its draft All Plan Letter (APL) on No Surprises Act (NSA) enforcement.  

In the letter, DMHC incorrectly asserts that the Knox-Keene Act prohibition on balance billing enrollees for out-of-network emergency services does not constitute a “specified state law” within the framework of the NSA. As of a result this analysis, the draft APL concludes that plans regulated under Knox-Keene are subject to the patient cost sharing, provider payment determination, and plan/provider dispute resolution process provisions of the NSA.

In our comments, CHA argues that Knox-Keene does comport with the NSA requirements of a “specified state law” and provides a clear process for determining patient cost sharing, provider payments, and resolving payment disputes between plans and providers for out-of-network patients.

CHA requests that DMHC pause its work on the Draft APL and hold stakeholder meetings to further consider the issues raised in this letter.