Continuity of care
(a) Except as provided under subsection (b), if an insurer or MA or CHIP managed care plan initiates termination of its contract with a participating health care provider, a covered person or enrollee may continue an ongoing course of treatment with that health care provider at the covered person’s or enrollee’s option for a transitional period of up to sixty (60) days from the date the covered person or enrollee was notified by the insurer or MA or CHIP managed care plan of the termination or pending termination. The insurer or MA or CHIP managed care plan, in consultation with the covered person or enrollee and the health care provider, may extend the transitional period if determined to be clinically appropriate. In the case of a covered person or enrollee in the second or third trimester of pregnancy at the time of notice of the termination or pending termination, the transitional period shall extend through postpartum care related to the delivery. Any health care service provided under this section shall be covered by the insurer or MA or CHIP managed care plan under the same terms and conditions as applicable for participating health care providers.
(b) If an insurer or MA or CHIP managed care plan terminates the contract of a participating health care provider for cause, including breach of contract, fraud, criminal activity or posing a danger to a covered person or enrollee or the health, safety or welfare of the public as determined by the insurer or MA or CHIP managed care plan, the insurer or MA or CHIP managed care plan shall not be responsible for health care services provided to the covered person or enrollee following the date of termination.
(c) If an insurer or MA or CHIP managed care plan terminates the contract of a participating primary care provider, the insurer or MA or CHIP managed care plan shall notify every covered person or enrollee served by that provider of the insurer’s or MA or CHIP managed care plan’s termination of its contract and shall request that the covered person or enrollee select another primary care provider.
(d) A new covered person or enrollee may continue an ongoing course of treatment with a nonparticipating health care provider for a transitional period of up to sixty (60) days from the effective date of enrollment in a health insurance policy or MA or CHIP managed care plan. The insurer or MA or CHIP managed care plan, in consultation with the covered person or enrollee and the health care provider, may extend this transitional period if determined to be clinically appropriate. In the case of a new covered person or enrollee in the second or third trimester of pregnancy on the effective date of enrollment, the transitional period shall extend through postpartum care related to the delivery. Any health care service provided under this section shall be covered by the health insurance policy or MA or CHIP managed care plan under the same terms and conditions as applicable for participating health care providers.
(e) An insurer or MA or CHIP managed care plan may require a nonparticipating health care provider whose health care services are covered under this section to meet the same terms and conditions as a participating health care provider.
(f) Nothing in this section shall require an insurer or MA or CHIP managed care plan to provide health care services that are not otherwise covered under the terms and conditions of the covered person’s health insurance policy or an agreement with the Department of Human Services.