‘‘(C) is scheduled to undergo nonelective 
surgery from the provider or facility, including 
receipt of postoperative care from such provider 
or facility with respect to such a surgery; 
‘‘(D) is pregnant and undergoing a course 
of treatment for the pregnancy from the pro-
vider or facility; or 
‘‘(E) is or was determined to be terminally 
ill (as determined under section 1861(dd)(3)(A) 
of the Social Security Act) and is receiving 
treatment for such illness from such provider or 
facility. 
‘‘(2) SERIOUS AND COMPLEX CONDITION.—The 
term ‘serious and complex condition’ means, with re-
spect to a participant or beneficiary under a group 
health plan— 
‘‘(A) in the case of an acute illness, a con-
dition that is serious enough to require special-
ized medical treatment to avoid the reasonable 
possibility of death or permanent harm; or 
‘‘(B) in the case of a chronic illness or con-
dition, a condition that— 
‘‘(i) is life-threatening, degenerative, 
potentially disabling, or congenital; and 
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‘‘(ii) requires specialized medical care 
over a prolonged period of time. 
‘‘(3) TERMINATED.—The term ‘terminated’ in-
cludes, with respect to a contract, the expiration or 
nonrenewal of the contract, but does not include a 
termination of the contract for failure to meet appli-
cable quality standards or for fraud.’’. 
(B) CONFORMING
AMENDMENT.—Section 
9815(a) of the Internal Revenue Code of 1986 
is amended— 
(i) in paragraph (1), by striking ‘‘(as 
amended by the Patient Protection and Af-
fordable Care Act)’’ and inserting ‘‘(other 
than the provisions of section 2730 of such 
Act)’’; and 
(ii) in paragraph (2), by inserting 
‘‘(other than the provisions of section 2730 
of such Act)’’ after the first occurrence of 
‘‘such part A’’. 
(C) CLERICAL AMENDMENT.—The table of 
sections for such subchapter is amended by 
adding at the end the following new items: 
‘‘Sec. 9815. Additional market reforms. 
‘‘Sec. 9816. Continuity of care.’’. 
(D) EFFECTIVE DATE.—The amendments 
made by this paragraph shall apply with respect 
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to plan years beginning on or after January 1, 
2022. 
(3) EMPLOYEE RETIREMENT INCOME SECURITY 
ACT OF 1974.— 
(A) IN GENERAL.—Subpart B of part 7 of 
subtitle B of title I of the Employee Retirement 
Income Security Act of 1974 (29 U.S.C. 1185 
et seq.) is amended by adding at the end the 
following new section: 
‘‘SEC. 716. CONTINUITY OF CARE. 
‘‘(a) ENSURING CONTINUITY OF CARE WITH RE-
SPECT
TO TERMINATIONS
OF CERTAIN CONTRACTUAL 
RELATIONSHIPS RESULTING IN CHANGES IN PROVIDER 
NETWORK STATUS.— 
‘‘(1) IN GENERAL.—In the case of an individual 
with benefits under a group health plan or health in-
surance 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 (as applicable) for furnishing 
items and services under such plan or such coverage, 
if, while such individual is a continuing care patient 
(as defined in subsection (b)) with respect to such 
provider or facility— 
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‘‘(A) such contractual relationship is termi-
nated (as defined in subsection (b)); 
‘‘(B) 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 coverage; or 
‘‘(C) a contract between such group health 
plan and a health insurance issuer offering 
health insurance coverage in connection with 
such plan is terminated, resulting in a loss of 
benefits provided under such plan with respect 
to such provider or facility, 
the plan or issuer, respectively, shall meet the re-
quirements of paragraph (2) with respect to such in-
dividual. 
‘‘(2) REQUIREMENTS.—The requirements of 
this paragraph are that the plan or issuer— 
‘‘(A) 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 para-
graph (1) affecting such provider or facility on 
a timely basis of such termination and such in-
dividual’s right to elect continued transitional 
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care from such provider or facility under this 
section; 
‘‘(B) provide such individual with an op-
portunity to notify the plan or issuer of the in-
dividual’s need for transitional care; and 
‘‘(C) permit the patient to elect to continue 
to have benefits provided under such plan or 
such coverage, under the same terms and condi-
tions as would have applied and with respect to 
such items and services as would have been cov-
ered under such plan or coverage had such ter-
mination not occurred, 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 be-
ginning on the date on which the notice under 
subparagraph (A) is provided and ending on the 
earlier of— 
‘‘(i) the 90-day period beginning on 
such date; or 
‘‘(ii) the date on which such individual 
is no longer a continuing care patient with 
respect to such provider or facility. 
‘‘(b) DEFINITIONS.—In this section: 
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‘‘(1) CONTINUING
CARE
PATIENT.—For pur-
poses of this section, the term ‘continuing care pa-
tient’ means an individual who, with respect to a 
provider or facility— 
‘‘(A) is undergoing a course of treatment 
for a serious and complex condition from the 
provider or facility; 
‘‘(B) is undergoing a course of institu-
tional or inpatient care from the provider or fa-
cility; 
‘‘(C) is scheduled to undergo nonelective 
surgery from the provider or facility, including 
receipt of postoperative care from such provider 
or facility with respect to such a surgery; 
‘‘(D) is pregnant and undergoing a course 
of treatment for the pregnancy from the pro-
vider or facility; or 
‘‘(E) is or was determined to be terminally 
ill (as determined under section 1861(dd)(3)(A) 
of the Social Security Act) and is receiving 
treatment for such illness from such provider or 
facility. 
‘‘(2) SERIOUS AND COMPLEX CONDITION.—The 
term ‘serious and complex condition’ means, with re-
spect to a participant, beneficiary, or enrollee under 
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