State Law

Missouri Statutes-Title XXIII-Chapter 354. Health Services Corps/HMOs/Prepaid Dental Plans–Community-Based HMOs

08/09/2023 Missouri Section 354.612

Continuation of care after provider termination, when

Continuity of Care Post-Contract

1. Contracts between health plans and providers shall include a provision for the continuation of care to enrollees for a period of up to ninety days by a provider who terminates or is terminated from a network where the continuation of care is medically necessary and in accordance with the dictates of medical prudence, including circumstances such as disability, pregnancy, or life-threatening illness.

2. Such provision for the continuation of care shall guarantee that the enrollee shall not be liable to the provider for any amounts owed for medical care other than deductibles or co-payment amounts specified in the certificate of coverage or other contract between the enrollee and the health plan.

3. In the event the terminated provider is authorized to continue treating the enrollee pursuant to this section, the health plan shall have an obligation to pay the terminated provider at the previously contracted rate for services provided to the enrollee.