Spotlight Mandate: Continuity of Care

Female Patient And Nurse Have Consultation In Hospital Room

This regulation will provide a member receiving in-network care for a serious and complex medical condition, a chronic illness or condition, a nonelective surgery, or pregnancy with the ability to request to continue receiving care from a participating provider who changes to non-participating provider status with BCBSND during their treatment.

Who it applies to: Fully insured group health plans, self-funded group health plans and individual policies. Does not include grandfathered plans.

Effective date: Plan years beginning on or after Jan. 1, 2022.

Action required: Members will receive a notification letter and continuity of care form if they are seeing a provider who goes from participating to non-participating and must complete the form (which is available online) to initiate the process of continuity of care.