summary
Introduced
02/07/2025
02/07/2025
In Committee
05/07/2025
05/07/2025
Crossed Over
04/11/2025
04/11/2025
Passed
08/15/2025
08/15/2025
Dead
Signed/Enacted/Adopted
08/15/2025
08/15/2025
Introduced Session
104th General Assembly
Bill Summary
Amends the Network Adequacy and Transparency Act. In provisions concerning continuity of care for beneficiaries, provides that the network plan shall permit the beneficiary to continue an ongoing course of treatment with that provider during a transitional period for 90 days from the date of the notice to the beneficiary of the provider's disaffiliation from the network plan if the beneficiary has a confirmed appointment and the provider attests that the appointment was scheduled prior to the date of notification. Requires a network plan to provide for continuity of care for new beneficiaries during a transition period of 90 days from the effective date of enrollment if the beneficiary has a confirmed appointment and the current provider attests that the appointment was scheduled prior to the effective date of enrollment. Limits the applicability of continuity of care requirements if the provider or beneficiary reschedules an appointment or schedules any follow up appointments after 90 days from the effective date of enrollment. Effective January 1, 2027.
AI Summary
This bill amends the Network Adequacy and Transparency Act to enhance patient protections when healthcare providers leave or are no longer part of a network plan. The bill specifically modifies continuity of care provisions to allow patients to continue receiving treatment from a provider who has left the network or is not in a new patient's network. For existing patients, if a provider leaves the network, patients can continue treatment with that provider for 90 days from the notification date, specifically if they have a confirmed appointment that was scheduled before the provider's network departure. Similarly, for new beneficiaries enrolling in a network plan, patients can continue seeing their current provider for 90 days from the enrollment date if they have a pre-scheduled confirmed appointment. The bill limits these continuity of care requirements if either the provider or patient reschedules appointments beyond the 90-day transition period. The provisions do not apply if the care is not medically necessary, the patient has already transitioned to another in-network provider, or the patient has exceeded their plan's benefit limitations. The bill will take effect on January 1, 2027, and aims to provide patients with more flexibility and stability in maintaining their healthcare relationships during network changes.
Committee Categories
Business and Industry
Sponsors (2)
Last Action
Public Act . . . . . . . . . 104-0333 (on 08/15/2025)
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