California Health and Safety Code

§ 1371.31

HSC § 1371.31 Effective Jan 1, 2022Div. 2 · Ch. 2.2 · Art. 5

Statute text

(a)(1) For services rendered subject to Section 1371.9, effective July 1, 2017, unless otherwise agreed to by the noncontracting individual health professional and the plan, the plan shall reimburse the greater of the average contracted rate or 125 percent of the amount Medicare reimburses on a fee-for-service basis for the same or similar services in the general geographic region in which the services were rendered. For the purposes of this section, “average contracted rate” means the average of the contracted commercial rates paid by the health plan or delegated entity for the same or similar services in the geographic region. This subdivision does not apply to subdivision (c) of Section 1371.9 or subdivision (b) of this section.

(2)(A) By July 1, 2017, each health care service plan and its delegated entities shall provide to the department all of the following:

(i)Data listing its average contracted rates for the plan for services most frequently subject to Section 1371.9 in each geographic region in which the services are rendered for the calendar year 2015.

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Legislative history

Amended by Stats. 2021, Ch. 615, Sec. 225. (AB 474) Effective January 1, 2022. Operative January 1, 2023, pursuant to Sec. 463 of Stats. 2021, Ch. 615.