CHA News

DMHC Issues All Plan Letter with No Surprises Act Guidance

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

On March 21, the Department of Managed Health Care (DMHC) issued an All-Plan Letter (APL) providing guidance related to state enforcement of certain provisions of the No Surprises Act (NSA).  

The letter notes that California’s anti-balance billing law — Assembly Bill (AB) 72 — is a “specified state law” under the NSA. As such, the framework under AB 72 for patient cost-sharing and resolving out-of-network disputes for non-emergency, out-of-network services provided at an in-network facility will continue to apply for state-regulated insurance products.  

In a change from the draft APL that CHA advocated for, the final APL  identifies California case law and the Knox-Keene Act as also meeting the requirements of a “specified state law.” Therefore, for out-of-network emergency services, DMHC-licensed health plans must continue to comply with California law for enrollee cost-sharing, provider reimbursement, and the resolution of disputes between plans and providers/facilities for out-of-network emergency services.