Health Administration Responsibility Project
Medicare + Choice Preempts Knox Keene Act
In an order dated 8/27/01, in Case 00-06803 RSWL (Mcx) in the U.S. District
Court in Los Angeles, Judge Lew determined that most sections of the Knox Keene Act
are preempted in the case of Medicare+Choice HMOs by 42 USC § 1395w-26(b)(3),
which says:
(3) Relation to State laws
(A) In general
The standards established under this subsection shall supersede any State law or regulation
(including standards described in subparagraph (B)) with respect to Medicare+Choice plans which
are offered by Medicare+Choice organizations under this part to the extent such law or regulation
is inconsistent with such standards.
(B) Standards specifically superseded
State standards relating to the following are superseded under this paragraph:
(i) Benefit requirements.
(ii) Requirements relating to inclusion or treatment of providers.
(iii) Coverage determinations (including related appeals and grievance processes)
(iv)Marketing Materials and summaries and schedules of benefits.(This isn't listed yet on the Cornell USC site, but the Judge refers to it)
Sections specifically preempted as relating to Benefit Standards are:
HSC §§
- 1345(b)(1)-(7)
- 1363.01
- 1367(h)-(j)
- 1367.05
- 1367.09
- 1367.2
- 1367.3
- 1367.51
- 1367.54
- 1367.61
- 1367.62
- 1367.63
- 1367.635
- 1367.64
- 1367.65
- 1367.66
- 1367.665
- 1367.67
- 1367.68
- 1367.71
- 1367.8
- 1367.9
- 1367.11
- 1367.20
- 1367.21
- 1367.215
- 1367.22
- 1367.24
- 1367.25
- 1368.5
- 1371.4
- 1371.5
- 1373(b)(c)(f)(h)(j)
- 1373.4
- 1373.14
- 1373.96
- 1374.5
- 1374.56
- 1374.7(a)(second sentence only)
- 1374.11
- 1374.12
- 1374.16
- 1374.72
- 1383.15
and 28 CCR §§
- 1300.67
- 1300.67.1
- 1300.67.2
- 1300.67.2.1
- 1300.71.4
Sections specifically preempted as relating to inclusion or treatment of providers are:
HSC §§
- 1366.4(b)(d)
- 1367.02
- 1367.10
- 1367.69
- 1367.695
- 1371
- 1371.2
- 1371.35
- 1373(h)
- 1373.3
- 1373.65
- 1373.7
- 1373.8
- 1373.9
- 1373.11
- 1373.12
- 1373.13
- 1373.18
- 1395.5
- 1395.6
and 28 CCR §
- 1300.80(b)(6)
Sections specifically preempted as relating to coverage determinations including appeals and grievances are:
HSC §§
- 1363.5
- 1367.01
- 1368
- 1368.01
- 1368.02(b)
- 1368.03
- 1368.04
- 1368.1
- 1370.2
- 1370.4
- 1371.36
- 1371.37
- 1371.8
- 1373(i)
- 1373.19
- 1373.20
- 1373.21
- 1374.30
- 1374.31
- 1374.32
- 1374.33
- 1374.34
- 1374.35
- 1399.55
and 28 CCR §§
- 1300.68
- 1300.68.01
- 1300.80(b)(6)(c)
Sections specifically preempted as relating to marketing materials and summaries and schedules of benefits are:
HSC §§
- 1360
- 1361
- 1362
- 1363(but not (e)(f)(g))
- 1363.05
- 1363.1
- 1364
- 1367.05(b)
- 1372
- 1373
- 1383.1(a)(second sentence only)
- 1395(a)(g)(h)
- 1395.5
- 1395.6
and 28 CCR §§
- 1300.61
- 1300.61.3
- 1300.63.1
- 1300.63.2
- 1300.65
- 1300.65.1
Please send comments, suggestions and relevant citations to
Webmaster: hsfrey@harp.org