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CHA Provides State-Specific Language for Model No Surprises Act Forms

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

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CHA has drafted language summarizing California’s surprise billing laws for the No Surprises Act  model disclosure notice for patient protections against surprise billing notice regarding patient protections against surprise billing. 

CHA based this language on existing Department of Managed Health Care (DMHC) educational materials related to the state surprise billing law. In the instructions for the disclosure form, the U.S. Department of Health and Human Services affirms that, while facilities aren’t required to use its model notice to meet the disclosure requirements, those that do are considered to have made a good faith effort at complying with the law. 

CHA has also provided state and federal contact information for use in the model notice and consent form. Providers are required to use the standard notice and consent document with minimal modification as identified in the form.