CHA News

DMHC Issues All Plan Letter with No Surprises Act Guidance

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

This post has been archived and contains information that may be out of date.

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.