Ama Policy

Amendments to Managed Care Contracts H-285.952

03/13/2019
Amendments, Continuity of Care Post-Contract

1. It is policy of the AMA that:

(A) participating physicians be allowed a minimum of 60 days to review amendments to managed care contracts;

(B) patients should have the opportunity for continued transitional care from physicians and hospitals whose contracts with health plans have terminated for reasons other than loss of/restrictions on their license/certification or fraud. Patients eligible for transitional care should specifically include, but not be limited to those who are: undergoing a course of treatment for a serious or complex condition, undergoing a course of institutional or inpatient care, undergoing non-elective surgery, pregnant, or are terminally ill at the time that they receive notice of the termination. Transitional care should be provided at the physicians’ and hospitals’ discretion, and should continue for an appropriate length of time. Physicians and hospitals also should continue to receive payment for the services provided during this transitional period;

(C) when a participating physician leaves a managed care plan, patients of the physician be informed, in a timely manner, of the departure by the physician and/or the managed care plan, and, if applicable, of their right to elect continued transitional care from that physician;

(D) when a participating physician voluntarily leaves a managed care plan, patients of the physician be informed of the departure by the physician and/or the managed care plan;

(E) the AMA opposes managed care plan mandating that physician to notify all his/her patients;

(F) the AMA opposes the preapproval of physician-developed notification letters by managed care plans required if a participating physician who is voluntarily leaving the plan chooses to inform his/her patient of the departure;  and

(G) managed care contracts not hold participating physicians financially liable for medical services delivered to a patient who electively chooses or mistakenly receives medical services from a “non-plan” physician.

 

2. Our AMA supports patients in an active course of treatment who switch to a new health plan having the opportunity to receive continued transitional care from their treating out-of-network physicians and hospitals at in-network cost-sharing levels. Transitional care should be provided at the physicians’ and hospitals’ discretion.

3. Our AMA will continue to provide assistance upon request to state medical associations in support of state legislative and regulatory efforts, and disseminate relevant model state legislation, to ensure continuity of care protections for patients in an active course of treatment.

 

Policy Timeline

Sub. Res. 708, I-96 Appended and Modified: CMS Rep. 8, A-02 Reaffirmed: CMS Rep. 4, A-12 Appended: CMS Rep. 03, A-17