US No Surprises Act (42 USC 300gg-111 to 300gg-139) and 45 CFR Part 149
Plan and issuer duties: patient protections, continuity, directories, gag clauses and reporting (45 CFR 149.310, 149.530, 149.710 to 149.740; 42 U.S.C. 300gg-113 to 300gg-120) – US No Surprises Act (42 USC 300gg-111 to 300gg-139) and 45 CFR Part 149

US No Surprises Act (42 USC 300gg-111 to 300gg-139) and 45 CFR Part 149 300gg-113: Notify continuing care patients when a provider's network status ends and let them elect up to 90 days of transitional in-network coverage

When a contract with a provider or facility is terminated (including expiry or nonrenewal, but not termination for quality failure or fraud), benefits for that provider end because of changed participation terms, or the plan's contract with its issuer ends, the plan or issuer must notify each enrollee who is a continuing care patient of the provider (undergoing treatment for a serious and complex condition, institutional or inpatient care, scheduled nonelective surgery with postoperative care, pregnancy care, or terminal illness treatment) on a timely basis of the termination and of the right to elect transitional care; must give an opportunity to notify the plan of the need for transitional care; and must allow the patient to continue benefits under the same terms for the course of treatment from that provider for 90 days from the notice or until the patient is no longer a continuing care patient, whichever is earlier.

Maintained by Gerard Blokdyk

Other controls in Plan and issuer duties: patient protections, continuity, directories, gag clauses and reporting (45 CFR 149.310, 149.530, 149.710 to 149.740; 42 U.S.C. 300gg-113 to 300gg-120) – US No Surprises Act (42 USC 300gg-111 to 300gg-139) and 45 CFR Part 149

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