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(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:
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(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;
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(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
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(3) Explain how the covered person may request to continue services under subdivisions (a)(1) and (2) of this section.
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(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.
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(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.
