Termination of participating providers – Procedures and conditions
A. Every managed care plan shall establish procedures governing termination of a participating provider who is terminated for reasons other than cause. The procedures shall include assurance of continued coverage of services, at the contract terms and price by a terminated provider for up to ninety (90) calendar days from the date of notice to the covered person, for a covered person who:
1. Has a degenerative and disabling condition or disease;
2. Has entered the third trimester of pregnancy. Additional coverage of services by the terminated provider shall continue through at least six (6) weeks of postpartum evaluation; or
3. Is terminally ill.
B.1. If a participating provider voluntarily chooses to discontinue participation as a network provider in a managed care plan, the managed care plan shall permit a covered person to continue an ongoing course of treatment with the disaffiliated provider during a transitional period:
a. of up to ninety (90) days from the date of notice to the managed care plan of the provider’s disaffiliation from the managed care plan” network, or
b. that includes delivery and postpartum care if the covered person has entered the third trimester of pregnancy at the time of the provider’s disaffiliation.
2. If a provider voluntarily chooses to discontinue participation as a network provider participating in a managedcare plan, such provider shall give at least a ninety-day notice of the disaffiliation to the managed care plan. The managed care plan shall immediately notify the disaffiliated provider’s patients of that fact.
3. Notwithstanding the provisions of paragraph 1 of this subsection, continuing care shall be authorized by the managed care plan during the transitional period only if the disaffiliated provider agrees to:
a. continue to accept reimbursement from the managed care plan at the rates applicable prior to the start of the transitional period as payment in full,
b. adhere to the managed care plan’s quality assurance requirements and to provide to the managed care plan necessary medical information related to such care, and
c. otherwise adhere to the managed care plan’s policies and procedures, including, but not limited to, policies and procedures regarding referrals, and obtaining preauthorization and treatment plan approval from the managed care plan.