ACEP/EDPMA Joint Task Force Model Out-of Network Legislation developed in 2017, along with a document of guiding principles, providing explanatory notes and strategic guidance.  

 

Connecticut Out-of-Network Payment Act 
State law requires reimbursement at greatest of the in-network rate, the usual and customary rate or Medicare. The usual and customary rate is defined as the 80th percentile of provider charges as reported by an independent, nonprofit organization. (See Section 9 on page 11 in the pdf.)

 

AMA Model Bill Revised - Health Plans Patient Protections

Physicians for Fair Coverage Model Legislation - Jan 2018

In January 2018, the American Medical Association adopted model legislation addressing balance billing and out of network reimbursement in response to a House of Delegates resolution adopted the previous summer. Physicians for Fair Coverage created a new model making use of the AMA Model while eliminating sections on other issues. Depending on the political situation, either of these models may be useful to states where these issues are under consideration.

 

Physicians for Fair Coverage Model Legislation 
A comprehensive legislative approach incorporating the key elements supported by ACEP and allied organizations.