Continuation of Care Requirement

Continuation of Care Requirement

Definition: The Continuation of Care Requirement is a statutory or contractual provision that is found in health insurance policies. It mandates healthcare providers to continue delivering medical care to enrollees for a specified period, even after the insolvency of their Health Plan Company. This requirement aims to protect patients from sudden discontinuation of necessary medical treatments during a vulnerable period.

Purpose: The primary goal of the Continuation of Care Requirement is to ensure that enrollees who are mid-treatment are not left without essential care or forced to face abrupt changes in their care providers due to the financial failure of the insurer.

Regulatory Framework:

• In the United States, this requirement is often mandated by state insurance regulations and can vary by state. Each state’s Department of Insurance can provide specifics on their regulations. This framework exists to hold healthcare systems accountable and reduce the direct impact on patient care from corporate financial issues.

Protection under Law: Specific laws that can be reviewed for detailed provisions related to continued care include:

• State-specificHPA laws.
• The Health Insurer Solvency laws enlisted and explained within state legislative websites.

Example Scenario: A good example of this requirement in action involves a Health Plan Company declaring bankruptcy mid-way through a beneficiary’s cancer treatment protocol. Under the Continuation of Care Requirement, the healthcare providers must continue the predefined treatment regime, regardless of the insolvency, until the patient can transition safely to another insurer or until the treatment is duly completed, depending on state laws and the specifics of the contractual obligation.

References:

• National Association of Insurance Commissioners (NAIC): for wider understanding within different states.
• Health Insurance Portability and Accountability Act (HIPAA): potentially relevant in the discussion regarding patient information security and treatment consistency.