CommercialReimbursementMedium impact
24-1284 Average Contract Rate Must Include Inflation Adjustment (Assembly Bill 72)
Health Net·CA·Reimbursement
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
California Health Net now requires participating physician groups (PPGs) to include inflation adjustments when calculating average contracted rates (ACR) for non-contracted providers in contracted facilities. The reimbursement must be the greater of the inflation-adjusted ACR or 125% of Medicare rates for non-emergency services.
Action Required
Immediately: PPGs with delegated risk must review and update their ACR calculations to incorporate inflation adjustments per DMHC APL 24-001. Contact Health Net Provider Services Center for clarification on calculation methodology. Update billing systems to ensure non-contracted provider reimbursements meet the greater of inflation-adjusted ACR or 125% Medicare rate requirements.