Kudos to the folks in California for coming together on this effective legislation designed to protect patients and providers from surprise underpayments by insurers…

Very similar to the recently enacted Texas legislation that requires insurers to pay billed charges, as long as the local government has published their rates.

Another example of state legislation that the GAPBAC should consider to national replication… 

Salient language below…

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https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB716

SEC. 2. Section 1371.56 is added to the Health and Safety Code, to read:

1371.56. (a) (1) Unless otherwise required by this chapter, a health care service plan contract issued, amended, or renewed on or after January 1, 2024, shall require an enrollee who receives covered services from a noncontracting ground ambulance provider to pay no more than the same cost-sharing amount that the enrollee would pay for the same covered services received from a contracting ground ambulance provider. This amount shall be referred to as the “in-network cost-sharing amount.”

(d) (1) Unless otherwise agreed to by the noncontracting ground ambulance provider and the health care service plan, the plan shall directly reimburse a noncontracting ground ambulance provider for ground ambulance services the difference between the in-network cost-sharing amount and an amount described, as follows:

(A) If there is a rate established or approved by a local government, at the rate established or approved by the governing body of the local government having jurisdiction for that area or subarea, including an exclusive operating area pursuant to Section 1797.85.

(B) If the local government having jurisdiction where the service was provided does not have an established or approved rate for that service, the amount established by Section 1300.71 (a)(3)(B) of Title 28 of the California Code of Regulations.