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CMT SPOTLIGHT on “Knox-Keene Health Care Service Plan Act of 1975”

“The Knox-Keene Act contains standards about how HMOs must manage their memberships. 24/7 claims start to look like some of these standards and thus draw an allegory between DPC and HMO thereby suggesting that regulation would be necessary.” ~A.U., Attorney, Hint Community; 2017

CALIFORNIA LAWS

Knox-Keene Health Care Service Plan Act of 1975 [1]

The Knox-Keene Health Care Service Plan Act of 1975, as amended, is the set of laws passed by the State Legislature and administered by the Department of Managed Healthcare (DMHC) to regulate HMOs within the state. The documents below are copies of the Knox-Keene Act and include amendments through January 2017.[1]

Knox-Keene Health Care Service Plan Act of 1975 [2]

These are the laws administered by the Department.

The Knox-Keene Health Care Service Plan Act of 1975, as amended, is the set of laws or statutes passed by the State Legislature to regulate health care service plans, including health maintenance organizations (HMOs)  within the State. The Knox-Keene Act is in the California Health & Safety Code, section 1340 et seq.

In addition to statutes, the DMHC develops regulations with the help of our stakeholders: consumers, health plans, and providers, pursuant to the Administrative Procedures Act.   These regulations are codified under title 28 of the California Code of Regulations. Regulations are used by the DMHC to implement, interpret, or make specific the laws enforced by the Department.

SOURCES:

  1. https://www.dmhc.ca.gov/AbouttheDMHC/LawsRegulations.aspx#knoxkeene
  2. http://www.capg.org/index.aspx?page=124

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