§ 23-99-408 — Continuity of care

(a) When healthcare insurers use participating providers, the healthcare insurers shall develop procedures to provide for the continuity of care of their covered persons. At a minimum, the procedures shall: (1) Ensure that when a new patient is enrolled in a health benefit plan and is being treated by a nonparticipating provider for a current episode of an acute condition, the patient may continue to receive treatment as an in-network benefit from that provider until the current episode of treatment ends or until the end of ninety (90) days, whichever occurs first; (2) Ensure that when a provider's participation is terminated, his or her patients under the health benefit plan may continue to receive care from that provider as an in-network benefit until a current episode of treatment for an acute condition is completed or until the end of ninety (90) days, whichever occurs first; and (3) Explain how the covered person may request to continue services under subdivisions (a)(1) and (2) of this section. (b) During the period covered by subdivisions (a)(1) and (2) of this section, the provider shall be deemed to be a participating provider for purposes of reimbursement, utilization management, and quality of care. (c) Nothing in this section shall require a healthcare insurer to provide benefits that are not otherwise covered under the terms and provisions of the health benefit plan.

Legislative History

Acts 1997, No. 1196, § 8.