State Laws

Search state statutes and regulations in all 50 states and the District of Columbia to find out what rights you have in your state and what other states are doing to empower physicians and patients in the face of health insurer market power.

State Law

Texas Admin. Code-Title 28-Part 1-Chapter 3-Subchapter X-Division 1. General Requirements

05/12/2025 Texas Section 3.3708

Payment of Certain Out-of-Network Claims

OON-Payment Issues
State Law

California Code of Regulations-Title 10-Chapter 5-Subchapter 2-Policy Forms and Other Documents-Article 5.5. Average Contracted Rate Methodology

05/08/2025 California Sections 2238.10, 2238.11 and 2238.12

Definitions; Methodology for Calculation of Average Contracted Rate; Reporting

OON-Payment Issues
State Law

California Code of Regulations Title 28-Managed Health Care Division 1-The Department of Managed Health Care Chapter 2-Health Care Service Plans Article 8. Self-Policing Procedures

05/08/2025 California Section 1300.71.38

Fast, Fair and Cost-Effective Dispute Resolution Mechanism

OON-Payment Issues
State Law

California Code of Regulations Title 28-Managed Health Care Division 1-The Department of Managed Health Care Chapter 2-Health Care Service Plans Article 8. Self-Policing Procedures

05/08/2025 California Section 1300.71.31

Methodology for Determining Average Contracted Rate; Default Reimbursement Rate

OON-Payment Issues
State Law

California Code of Regulations Title 28-Managed Health Care Division 1-The Department of Managed Health Care Chapter 2-Health Care Service Plans Article 8. Self-Policing Procedures

05/08/2025 California Section 1300.71

Claims Settlement Practices

Amendments, Fee Schedules, OON-Payment Issues, Overpayments / Recoupments, Payment Edits, Payment Rules, Prompt Payment Deadlines, Retroactive Denial
State Law

New Hampshire Revised Statutes Title XXXI – Chapter 358-T. Prohibition on Balance Billing Covered Persons for Health Care Services

04/20/2025 New Hampshire Sections 358-T:1, 358-T:2, 358-T:3, and 358-T:4

Definitions; Balance Billing in Cases of Emergency Services; Balance Billing in Cases of Non-emergency Services Performed by Nonparticipating Providers at Certain Participating Health Care Facilities; Dispute Resolution Regarding the Fair Value of Health Care Items or Services

OON-Payment Issues
State Law

Revised Code of Washington-Title 48-Chapter 48.49-Balance Billing Protection Act

12/19/2024 Washington Sections 48.49.003, 48.49.005, 48.49.010, 48.49.040, 48.49.070, 48.49.080, 48.49.090, 48.49.130, 48.49.135, 48.49.160, and 48.49.170,

Findings—Intent—2019 c 427; Short title; Definitions; Dispute resolution process—Determination of commercially reasonable payment amount; Requirement to provide certain information on website or upon consumer request—Requirement to provide carriers with nonemployed provider lists; Health care provider—Requirement to provide certain information on website or upon consumer request—Requirement to submit network status information to carriers; Carrier—Requirement to update website and provider directory—Requirement to provide enrollee with certain information; Application of chapter to self-funded group health plans that elect to participate in balance billing protection provisions—Annual notice to commissioner; Determining the adequacy of provider networks—Required considerations; Allowed amounts paid to nonparticipating providers; Application of state and federal requirements—Applicability information access—Waivers prohibited

Directories, Network Adequacy, OON-Payment Issues
State Law

Division of Insurance-Code of Colorado Regs-3 CCR 702-4 Series 4-2

07/31/2023 Colorado Regulation 4-2-88

Concerning Gag Clauses in Individual and Group Health Benefit Plans

Anti-gag clause, OON-Payment Issues
State Law

Colorado Rev. Statutes-Title 25-Public Health And Environment-Article 3. Hospitals

07/31/2023 Colorado Section 25-3-121

Health-care facilities – emergency and nonemergency services – required disclosures – balance billing – rules – definitions.

OON-Payment Issues
State Law

Colorado Rev. Statutes-Title 12-Article 30-Part 1. Miscellaneous Provisions Applicable to Health Care Professions and Occupations

07/30/2023 Colorado Section 12-30-112

Health-care providers – required disclosures – balance billing – rules – definitions

OON-Payment Issues