Responses to California Health Benefit Exchange Stakeholder Questions: Developing Options for the Exchange – Qualified Health Plans, Benefit Design, and Promoting Delivery System Reform
Prepared by the National Health Law Program for the California Coalition for Reproductive Freedom members.
Access Women?s Health Justice, American Civil Liberties Union of California, American
College of Obstetricians and Gynecologists Region IX, California Family Health Council,
California Latinas for Reproductive Justice, California Primary Care Association, Maternal
and Child Health Access, National Health Law Program, Planned Parenthood Affiliates of
California, Women?s Community Clinic
1. What minimum standards for qualified health plans in the Exchange would ensure a basic level of service, access, consumer protection and health care quality?
The state of California has developed extensive rules governing health plans through the Knox-Keene Act. At a minimum, the Exchange should allow only Knox-Keene licensed plans to participate in the Exchange as QHPs to ensure that all enrollees have access to the consumer protection provisions of the Knox-Keene Act. By requiring QHPs to be Knox-Keene licensed, the Exchange will ensure that QHP enrollees have access to the consumer remedies available through the Department of Managed Health Care in addition to exercising their grievance rights through the Exchange or the QHPs themselves. In the alternative, if the Exchange decides to permit plans that are not Knox-Keene-licensed to become certified as QHPs, the Exchange must require, through the contracting process, those plans to provide Knox-Keene protections to enrollees. While the Knox-Keene protections and accompanying regulations are neither specifically designed for nor adequate to address the needs of those who will enroll in QHPs through the Exchange, they offer a minimal baseline of enforceable protection for enrollees. Our additional recommendations follow:
- Minimum standards to ensure access to a sufficient level of service
Newly promulgated regulations at 45 C.F.R. §§ 156.230 and 155.1050 establish minimum standards to ensure that QHPs? networks provide adequate access to necessary services. We urge the Exchange to adopt additional, specific standards beyond this federal floor to assure that enrollees have full access to the range of services needed.
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