354.612. Continuation of care after provider termination, when. - Missouri Statutes

Continuation of care after provider termination, when.

354.612. 1. Contracts between health plans and providers shallinclude a provision for the continuation of care to enrollees for a periodof up to ninety days by a provider who terminates or is terminated from anetwork where the continuation of care is medically necessary and inaccordance with the dictates of medical prudence, including circumstancessuch as disability, pregnancy, or life-threatening illness.

2. Such provision for the continuation of care shall guarantee thatthe enrollee shall not be liable to the provider for any amounts owed formedical care other than deductibles or co-payment amounts specified in thecertificate of coverage or other contract between the enrollee and thehealth plan.

3. In the event the terminated provider is authorized to continuetreating the enrollee pursuant to this section, the health plan shall havean obligation to pay the terminated provider at the previously contractedrate for services provided to the enrollee.

(L. 1997 H.B. 335)