Continuity of Care Requirements – No Surprises Act

The No Surprises Act requires health plans to notify eligible members when a provider or facility is terminated from the network due to contract expiration or non-renewal. This notice informs the plan members of their right, as a “continuing care patient,” to elect to continue the course of treatment for a period of time from the terminating provider or facility under the same coverage and terms and conditions that would have applied without the termination.

Eligibility
Health plan members are continuing care patients if they meet one or more of the following conditions with respect to a terminated provider or facility: 

  • Undergoing a course of treatment for a serious and complex condition
  • Undergoing a course of institutional or inpatient care
  • Are scheduled for a non-elective surgery, including receipt of postoperative care
  • Are pregnant and undergoing a course of treatment for the pregnancy
  • Are receiving treatment for a terminal illness (see section 1861(dd)(3)(A) of the Social Security Act)&

Duration
The election may last until the earlier of 90 days (starting on the date their plan or issuer notifies them of the change in network status) or the date when the member is no longer a continuing care patient with the provider or facility.

Final Rulemaking
Rulemaking is expected later this year and should include a prospective applicability date that will give plans, providers, and facilities a reasonable amount of time to comply with new requirements. Plans, providers and facilities are expected to implement the requirements using a good faith, reasonable interpretation of the statute prior to issuance of rulemaking.

6 Degrees

These authors are a combination of multiple resources throughout the company

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