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Continuity of Care and Provider Rights

by Andrew Selesnick and Stacey Zill
Becker's Hospital Review
July 22, 2015

Andrew Selesnick and Stacey Zill's article, "Continuity of Care and Provider Rights," was published in Becker's Hospital Review on July 22, 2015.

From the article...

"When a health care service plan ("Plan") or an Independent Practice Association ("IPA") terminates its contract with a provider, enrollees have certain continuity of care rights which permit them to continue care and treatment with the terminated provider.1 Providers want to keep seeing the enrollees, enrollees often want to keep seeing the providers, and Plans and IPAs want the exact opposite.

Plans and IPAs are concerned about the additional costs associated with continuity of care, and as significantly, the concern that the enrollee will become so attached to the provider that he will switch to a competing Plan or IPA. To ensure that the enrollees' continuity of care rights are not compromised in the contract termination process, there are laws and regulations governing the process by which enrollees are notified of the termination. If a health care service plan does not comply with these regulations, the provider may wish to notify the Department of Managed Health Care ("DMHC"), send out its own communication to the enrollee that is compliant with the applicable rules and regulations, and/or pursue legal action and seek, among other things, injunctive relief to prevent any further interference with the doctor-patient relationship."

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