The No Surprises Act: Continuity of Care Requirements

Continuing care patient defined

Health plan members are continuing care patients if they meet one or more of these conditions with respect to a terminated provider or facility. They are:

• 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)

Continuity of care 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 gives plans, issuers, providers, and facilities a reasonable amount of time to comply with new requirements.  Plans, issuers, providers and facilities are expected to implement the requirements using a good faith, reasonable interpretation of the statute prior to issuance of rulemaking.

Learn how Claritev’s Surprise Billing Service can help you comply with requirements of the No Surprises Act.

The information provided on this website does not, and is not intended to, constitute legal advice; instead, all information, content, and materials available on this site are for general informational purposes only. If you have questions about how the No Surprises Act applies to your organization, please consult your legal counsel.