AB 72 Summary

• Requires health care service plans and health insurers to limit patient cost-sharing to in-network levels when receiving covered services from noncontracting providers at contracting health facilities, effective July 1, 2017.

• Establishes independent dispute resolution processes by September 1, 2017 for both the Department of Managed Health Care and Insurance Commissioner to resolve reimbursement disputes between plans/insurers and noncontracting providers.

• Sets reimbursement rates for noncontracting providers at the greater of the average contracted rate or 125 percent of Medicare fee-for-service rates for the geographic region where services are rendered.

• Requires noncontracting providers to refund any overpayments within 30 days or accrue 15 percent annual interest, and prohibits wage garnishments and liens on primary residences for collection.

• Exempts Medi-Cal managed plans, emergency services, and out-of-network benefits when patients provide written informed consent with advance notice and cost estimates.