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The No Surprises Act: Continuity of Care Requirements

The No Surprises Act requires health plans or issuers to notify certain enrollees in a timely manner when a provider or facility is terminated from the network due to contract expiration or non-renewal. Claritev examines what this means.

January 24, 2022 |
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The No Surprises Act requires health plans or issuers to notify certain enrollees in a timely manner when a provider or facility is terminated from the network due to contract expiration or non-renewal. The 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.

 

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.

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