,i  #aafth ,,congress  #b;d ,session    
,h4 ,r4 #ehaf  ,,in ,,the ,,house ,,of  
,,representatives  ,february #g1        
#bjbj,ms4 ,moore 7for herself and ,mr4  
,schweikert7 introduced the following   
bill2 which was referred to the         
,committee on ,energy and ,commerce1 and
 in addition to the ,committees on ,ways
 and ,means1 and ,education and ,labor1 
for a period to be subsequently         
determined by the ,speaker1 in each case
 for consideration of such provisions as
 fall within the jurisdiction of the    
committee concerned  ,a ,,bill  ,to     
amend title ,,xxvii of the ,public      
,health ,service ,act1 the ,internal    
,revenue ,code of #aihf1 the ,employee  
,retirement ,income ,security ,act of   
#aigd1 and title ,,xi of the ,social    
,security ,act to require group health  
plans and health insurance issuers to   
provide for certain coverage in the case
 of a change in a provider's network    
status1 and for other purposes4  #a4    
,short title ,this ,act may be cited as 

the ,continuing ,care for ,patients ,act
 of #bjbj4  #b4 ,requiring group health 
plans and health insurance issuers to   
provide for certain coverage in the case
 of a change in a provider's network    
status  7a7 ,group health plan and      
health insurance issuer requirements    
7#a7 ,public ,health ,service ,act  7,a7
 ,in general ,subpart ,,ii of part ,a of
 title ,,xxvii of the ,public ,health   
,service ,act 7#db ,u4,s4,c4 #cjj;gg-#aa
 et seq47 is amended by adding at the   
end the following new section3  #bgcj4  
,continuity of care  7a7 ,ensuring      
continuity of care with respect to      
terminations of certain contractual     
relationships resulting in changes in   
provider network status  7#a7 ,in       
general ,in the case of an individual   
with benefits under a group health plan 
or group or individual health insurance 
coverage offered by a health insurance  
issuer and with respect to a health care
 provider or facility that has a        
contractual relationship with such plan 

or such issuer 7as applicable7 for      
furnishing items and services under such
 plan or such coverage1 if1 while such  
individual is a continuing care patient 
7as defined in subsection 7b77 with     
respect to such provider or facility--  
7,a7 such contractual relationship is   
terminated 7as defined in subsection    
7b772  7,b7 benefits provided under such
 plan or such health insurance coverage 
with respect to such provider or        
facility are terminated because of a    
change in the terms of the participation
 of such provider or facility in such   
plan or coverage2 or  7,c7 a contract   
between such group health plan and a    
health insurance issuer offering health 
insurance coverage in connection with   
such plan is terminated1 resulting in a 
loss of benefits provided under such    
plan with respect to such provider or   
facility1  the plan or issuer1          
respectively1 shall meet the            
requirements of paragraph 7#b7 with     
respect to such individual4  7#b7       

,requirements ,the requirements of this 
paragraph are that the plan or issuer-- 
7,a7 notify each individual enrolled    
under such plan or coverage who is a    
continuing care patient with respect to 
a provider or facility at the time of a 
termination described in paragraph 7#a7 
affecting such provider or facility on a
 timely basis of such termination and   
such individual's right to elect        
continued transitional care from such   
provider or facility under this section2
  7,b7 provide such individual with an  
opportunity to notify the plan or issuer
 of the individual's need for           
transitional care2 and  7,c7 permit the 
patient to elect to continue to have    
benefits provided under such plan or    
such coverage1 under the same terms and 
conditions as would have applied and    
with respect to such items and services 
as would have been covered under such   
plan or coverage had such termination   
not occurred1 with respect to the course
 of treatment furnished by such provider

 or facility relating to such           
individual's status as a continuing care
 patient during the period beginning on 
the date on which the notice under      
subparagraph 7,a7 is provided and ending
 on the earlier of-- 7i7 the #ij-;day   
period beginning on such date2 or  7ii7 
the date on which such individual is no 
longer a continuing care patient with   
respect to such provider or facility4   
7b7 ,definitions ,in this section3 7#a7 
,continuing care patient ,for purposes  
of this section1 the term continuing    
care patient means an individual who1   
with respect to a provider or facility--
 7,a7 is undergoing a course of         
treatment for a serious and complex     
condition from the provider or facility2
  7,b7 is undergoing a course of        
institutional or inpatient care from the
 provider or facility2  7,c7 is         
scheduled to undergo nonelective surgery
 from the provider or facility1         
including receipt of postoperative care 
from such provider or facility with     

respect to such a surgery2  7,d7 is     
pregnant and undergoing a course of     
treatment for the pregnancy from the    
provider or facility2 or  7,e7 is or was
 determined to be terminally ill 7as    
determined under section                
#ahfa7;dd77#c77;,a7 of the ,social      
,security ,act7 and is receiving        
treatment for such illness from such    
provider or facility4  7#b7 ,serious and
 complex condition ,the term serious and
 complex condition means1 with respect  
to a participant1 beneficiary1 or       
enrollee under a group health plan or   
health insurance coverage-- 7,a7 in the 
case of an acute illness1 a condition   
that is serious enough to require       
specialized medical treatment to avoid  
the reasonable possibility of death or  
permanent harm2 or  7,b7 in the case of 
a chronic illness or condition1 a       
condition that-- 7i7 is                 
life-threatening1 degenerative1         
potentially disabling1 or congenital2   
and  7ii7 requires specialized medical  

care over a prolonged period of time4   
7#c7 ,terminated ,the term terminated   
includes1 with respect to a contract1   
the expiration or nonrenewal of the     
contract1 but does not include a        
termination of the contract for failure 
to meet applicable quality standards or 
for fraud4  4  7,b7 ,effective date ,the
 amendments made by this paragraph shall
 apply with respect to plan years       
beginning on or after ,january #a1      
#bjbb4  7#b7 ,internal ,revenue ,code of
 #aihf  7,a7 ,in general ,subchapter ,b 
of chapter #ajj of the ,internal        
,revenue ,code of #aihf is amended by   
adding at the end the following new     
section3  #ihaf4 ,continuity of care    
7a7 ,ensuring continuity of care with   
respect to terminations of certain      
contractual relationships resulting in  
changes in provider network status  7#a7
 ,in general ,in the case of an         
individual with benefits under a group  
health plan and with respect to a health
 care provider or health care facility  

that has a contractual relationship with
 such plan for furnishing items and     
services under such plan1 if1 while such
 individual is a continuing care patient
 7as defined in subsection 7b77 with    
respect to such provider or facility--  
7,a7 such contractual relationship is   
terminated 7as defined in paragraph     
7b772  7,b7 benefits provided under such
 plan with respect to such provider or  
facility are terminated because of a    
change in the terms of the participation
 of the provider or facility in such    
plan2 or  7,c7 a contract between such  
group health plan and a health insurance
 issuer offering health insurance       
coverage in connection with such plan is
 terminated1 resulting in a loss of     
benefits provided under such plan with  
respect to such provider or facility1   
the plan shall meet the requirements of 
paragraph 7#b7 with respect to such     
individual4  7#b7 ,requirements ,the    
requirements of this paragraph are that 
the plan-- 7,a7 notify each individual  

enrolled under such plan who is a       
continuing care patient with respect to 
a provider or facility at the time of a 
termination described in paragraph 7#a7 
affecting such provider or facility on a
 timely basis of such termination and   
such individual's right to elect        
continued transitional care from such   
provider or facility under this section2
  7,b7 provide such individual with an  
opportunity to notify the plan of the   
individual's need for transitional care2
 and  7,c7 permit the patient to elect  
to continue to have benefits provided   
under such plan1 under the same terms   
and conditions as would have applied and
 with respect to such items and services
 as would have been covered under such  
plan had such termination not occurred1 
with respect to the course of treatment 
furnished by such provider or facility  
relating to such individual's status as 
a continuing care patient during the    
period beginning on the date on which   
the notice under subparagraph 7,a7 is   

provided and ending on the earlier of-- 
7i7 the #ij-;day period beginning on    
such date2 or  7ii7 the date on which   
such individual is no longer a          
continuing care patient with respect to 
such provider or facility4  7b7         
,definitions ,in this section3 7#a7     
,continuing care patient ,for purposes  
of this section1 the term continuing    
care patient means an individual who1   
with respect to a provider or facility--
 7,a7 is undergoing a course of         
treatment for a serious and complex     
condition from the provider or facility2
  7,b7 is undergoing a course of        
institutional or inpatient care from the
 provider or facility2  7,c7 is         
scheduled to undergo nonelective surgery
 from the provider or facility1         
including receipt of postoperative care 
from such provider or facility with     
respect to such a surgery2  7,d7 is     
pregnant and undergoing a course of     
treatment for the pregnancy from the    
provider or facility2 or  7,e7 is or was

 determined to be terminally ill 7as    
determined under section                
#ahfa7;dd77#c77;,a7 of the ,social      
,security ,act7 and is receiving        
treatment for such illness from such    
provider or facility4  7#b7 ,serious and
 complex condition ,the term serious and
 complex condition means1 with respect  
to a participant or beneficiary under a 
group health plan-- 7,a7 in the case of 
an acute illness1 a condition that is   
serious enough to require specialized   
medical treatment to avoid the          
reasonable possibility of death or      
permanent harm2 or  7,b7 in the case of 
a chronic illness or condition1 a       
condition that-- 7i7 is                 
life-threatening1 degenerative1         
potentially disabling1 or congenital2   
and  7ii7 requires specialized medical  
care over a prolonged period of time4   
7#c7 ,terminated ,the term terminated   
includes1 with respect to a contract1   
the expiration or nonrenewal of the     
contract1 but does not include a        

termination of the contract for failure 
to meet applicable quality standards or 
for fraud4  4  7,b7 ,conforming         
amendment ,section #ihae7;a7 of the     
,internal ,revenue ,code of #aihf is    
amended-- 7i7 in paragraph 7#a71 by     
striking 7as amended by the ,patient    
,protection and ,affordable ,care ,act7 
and inserting 7other than the provisions
 of section #bgcj of such ,act72 and    
7ii7 in paragraph 7#b71 by inserting    
7other than the provisions of section   
#bgcj of such ,act7 after the first     
occurrence of such part ,a4  7,c7       
,clerical amendment ,the table of       
sections for such subchapter is amended 
by adding at the end the following new  
items3  ,sec4 #ihae4 ,additional market 
reforms4 ,sec4 #ihaf4 ,continuity of    
care4  4  7,d7 ,effective date ,the     
amendments made by this paragraph shall 
apply with respect to plan years        
beginning on or after ,january #a1      
#bjbb4  7#c7 ,employee ,retirement      
,income ,security ,act of #aigd  7,a7   

,in general ,subpart ,b of part #g of   
subtitle ,b of title ,i of the ,employee
 ,retirement ,income ,security ,act of  
#aigd 7#bi ,u4,s4,c4 #aahe et seq47 is  
amended by adding at the end the        
following new section3  #gaf4           
,continuity of care  7a7 ,ensuring      
continuity of care with respect to      
terminations of certain contractual     
relationships resulting in changes in   
provider network status  7#a7 ,in       
general ,in the case of an individual   
with benefits under a group health plan 
or health insurance coverage offered by 
a health insurance issuer in connection 
with such group health plan and with    
respect to a health care provider or    
health care facility that has a         
contractual relationship with such plan 
or such issuer 7as applicable7 for      
furnishing items and services under such
 plan or such coverage1 if1 while such  
individual is a continuing care patient 
7as defined in subsection 7b77 with     
respect to such provider or facility--  

7,a7 such contractual relationship is   
terminated 7as defined in subsection    
7b772  7,b7 benefits provided under such
 plan or such health insurance coverage 
with respect to such provider are       
terminated because of a change in the   
terms of the participation of such      
provider or facility in such plan or    
coverage2 or  7,c7 a contract between   
such group health plan and a health     
insurance issuer offering health        
insurance coverage in connection with   
such plan is terminated1 resulting in a 
loss of benefits provided under such    
plan with respect to such provider or   
facility1  the plan or issuer1          
respectively1 shall meet the            
requirements of paragraph 7#b7 with     
respect to such individual4  7#b7       
,requirements ,the requirements of this 
paragraph are that the plan or issuer-- 
7,a7 notify each individual enrolled    
under such plan or coverage who is a    
continuing care patient with respect to 
a provider or facility at the time of a 

termination described in paragraph 7#a7 
affecting such provider or facility on a
 timely basis of such termination and   
such individual's right to elect        
continued transitional care from such   
provider or facility under this section2
  7,b7 provide such individual with an  
opportunity to notify the plan or issuer
 of the individual's need for           
transitional care2 and  7,c7 permit the 
patient to elect to continue to have    
benefits provided under such plan or    
such coverage1 under the same terms and 
conditions as would have applied and    
with respect to such items and services 
as would have been covered under such   
plan or coverage had such termination   
not occurred1 with respect to the course
 of treatment furnished by such provider
 or facility relating to such           
individual's status as a continuing care
 patient during the period beginning on 
the date on which the notice under      
subparagraph 7,a7 is provided and ending
 on the earlier of-- 7i7 the #ij-;day   

period beginning on such date2 or  7ii7 
the date on which such individual is no 
longer a continuing care patient with   
respect to such provider or facility4   
7b7 ,definitions ,in this section3 7#a7 
,continuing care patient ,for purposes  
of this section1 the term continuing    
care patient means an individual who1   
with respect to a provider or facility--
 7,a7 is undergoing a course of         
treatment for a serious and complex     
condition from the provider or facility2
  7,b7 is undergoing a course of        
institutional or inpatient care from the
 provider or facility2  7,c7 is         
scheduled to undergo nonelective surgery
 from the provider or facility1         
including receipt of postoperative care 
from such provider or facility with     
respect to such a surgery2  7,d7 is     
pregnant and undergoing a course of     
treatment for the pregnancy from the    
provider or facility2 or  7,e7 is or was
 determined to be terminally ill 7as    
determined under section                

#ahfa7;dd77#c77;,a7 of the ,social      
,security ,act7 and is receiving        
treatment for such illness from such    
provider or facility4  7#b7 ,serious and
 complex condition ,the term serious and
 complex condition means1 with respect  
to a participant1 beneficiary1 or       
enrollee under a group health plan or   
health insurance coverage offered in    
connection with such plan-- 7,a7 in the 
case of an acute illness1 a condition   
that is serious enough to require       
specialized medical treatment to avoid  
the reasonable possibility of death or  
permanent harm2 or  7,b7 in the case of 
a chronic illness or condition1 a       
condition that-- 7i7 is                 
life-threatening1 degenerative1         
potentially disabling1 or congenital2   
and  7ii7 requires specialized medical  
care over a prolonged period of time4   
7#c7 ,terminated ,the term terminated   
includes1 with respect to a contract1   
the expiration or nonrenewal of the     
contract1 but does not include a        

termination of the contract for failure 
to meet applicable quality standards or 
for fraud4  4  7,b7 ,conforming         
amendment ,section #gae7;a7 of the      
,employee ,retirement ,income ,security 
,act of #aigd 7#bi ,u4,s4,c4 #aahe;d7a77
 is amended-- 7i7 in paragraph 7#a71 by 
striking 7as amended by the ,patient    
,protection and ,affordable ,care ,act7 
and inserting 7other than the provisions
 of section #bgcj of such ,act72 and    
7ii7 in paragraph 7#b71 by inserting    
7other than the provisions of section   
#bgcj of such ,act7 after the first     
occurrence of such part ,a4  7,c7       
,clerical amendment ,the table of       
contents in section #a of the ,employee 
,retirement ,income ,security ,act of   
#aigd is amended by inserting after the 
item relating to section #gad the       
following new items3  ,sec4 #gae4       
,additional market reforms4 ,sec4 #gaf4 
,continuity of care4  4  7,d7 ,effective
 date ,the amendments made by this      
paragraph shall apply with respect to   

plan years beginning on or after        
,january #a1 #bjbb4  7b7 ,health care   
providers ,part ,a of title ,,xi of the 
,social ,security ,act 7#db ,u4,s4,c4   
#acja et seq471 as amended by subsection
 7a71 is further amended by adding at   
the end the following new sections3     
#aaej;,c4 ,continuity of care  7a7 ,in  
general ,a health care provider or      
health care facility shall1 in the case 
of an individual furnished items and    
services by such provider or facility   
for which coverage is provided under a  
group health plan or group or individual
 health insurance coverage pursuant to  
section #bgcj of such ,act1 section     
#ihaf of the ,internal ,revenue ,code of
 #aihf1 or section #gaf of the ,employee
 ,retirement ,income ,security ,act of  
#aigd-- 7#a7 accept payment from such   
plan or such issuer 7as applicable7 7and
 cost-sharing from such individual1 if  
applicable1 in accordance with          
subsection 7a77#b77;,c7 of such section 
#bgcj1 #ihag1 or #gag7 for such items   

and services as payment in full for such
 items and services2 and  7#b7 continue 
to adhere to all policies1 procedures1  
and quality standards imposed by such   
plan or issuer with respect to such     
individual and such items and services  
in the same manner as if such           
termination had not occurred4  7b7      
,penalty  7#a7 ,in general ,each health 
care provider or health care facility   
that violates a provision of subsection 
7a7 shall be subject to a civil monetary
 penalty in an amount not to exceed     
#aj1jjj for each such violation4  7#b7  
,application of provisions ,the         
provisions of section #aabh;,a 7other   
than subsection 7a71 subsection 7b71 the
 first sentence of subsection 7c77#a71  
and subsection 7o77 shall apply with    
respect to a civil monetary penalty     
imposed under this subsection in the    
same manner as such provisions apply    
with respect to a penalty or proceeding 
under subsection 7a7 of such section4   
7c7 ,definitions ,in this section1 the  

terms health insurance issuer1 group    
health plan1 group health insurance     
coverage1 and individual health         
insurance coverage have the meaning     
given such terms1 respectively1 in      
section #bgia of the ,public ,health    
,service ,act4  4