I 
116TH CONGRESS 
2D SESSION 
H. R. 5816 
To amend title XXVII of the Public Health Service Act, the Internal Revenue 
Code of 1986, the Employee Retirement Income Security Act of 1974, 
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 status, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 7, 2020 
Ms. MOORE (for herself and Mr. SCHWEIKERT) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committees on Ways and Means, and Education and 
Labor, for a period to be subsequently determined by the Speaker, in 
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned 
A BILL 
To amend title XXVII of the Public Health Service Act, 
the Internal Revenue Code of 1986, the Employee Retire-
ment Income Security Act of 1974, 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 status, 
and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
VerDate Sep 11 2014 
20:16 Feb 19, 2020
Jkt 099200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H5816.IH
H5816
pamtmann on DSKBC07HB2PROD with BILLS
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Continuing Care for 
Patients Act of 2020’’. 
SEC. 2. REQUIRING GROUP HEALTH PLANS AND HEALTH 
INSURANCE ISSUERS TO PROVIDE FOR CER-
TAIN COVERAGE IN THE CASE OF A CHANGE 
IN A PROVIDER’S NETWORK STATUS. 
(a) GROUP HEALTH PLAN AND HEALTH INSURANCE 
ISSUER REQUIREMENTS.— 
(1) PUBLIC HEALTH SERVICE ACT.— 
(A) IN GENERAL.—Subpart II of part A of 
title XXVII of the Public Health Service Act 
(42 U.S.C. 300gg–11 et seq.) is amended by 
adding at the end the following new section: 
‘‘SEC. 2730. 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 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 rela-
tionship with such plan or such issuer (as applica-
ble) for furnishing items and services under such 
VerDate Sep 11 2014 
20:16 Feb 19, 2020
Jkt 099200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H5816.IH
H5816
pamtmann on DSKBC07HB2PROD with BILLS
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— 
‘‘(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 or facility are terminated because 
of a change in the terms of the participation of 
such provider or facility in such plan or cov-
erage; 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 
VerDate Sep 11 2014 
20:16 Feb 19, 2020
Jkt 099200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H5816.IH
H5816
pamtmann on DSKBC07HB2PROD with BILLS
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 
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 
VerDate Sep 11 2014 
20:16 Feb 19, 2020
Jkt 099200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H5816.IH
H5816
pamtmann on DSKBC07HB2PROD with BILLS
‘‘(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: 
‘‘(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 
VerDate Sep 11 2014 
20:16 Feb 19, 2020
Jkt 099200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H5816.IH
H5816
pamtmann on DSKBC07HB2PROD with BILLS
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 
a group health plan or health insurance coverage— 
‘‘(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 
‘‘(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) EFFECTIVE DATE.—The amendments 
made by this paragraph shall apply with respect 
to plan years beginning on or after January 1, 
2022. 
VerDate Sep 11 2014 
20:16 Feb 19, 2020
Jkt 099200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H5816.IH
H5816
pamtmann on DSKBC07HB2PROD with BILLS
(2) INTERNAL REVENUE CODE OF 1986.— 
(A) IN GENERAL.—Subchapter B of chap-
ter 100 of the Internal Revenue Code of 1986 
is amended by adding at the end the following 
new section: 
‘‘SEC. 9816. 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 and with re-
spect to a health care provider or health care facility 
that has a contractual relationship with such plan 
for furnishing items and services under such plan, if, 
while such individual is a continuing care patient (as 
defined in subsection (b)) with respect to such pro-
vider or facility— 
‘‘(A) such contractual relationship is termi-
nated (as defined in paragraph (b)); 
‘‘(B) benefits provided under such plan 
with respect to such provider or facility are ter-
minated because of a change in the terms of the 
participation of the provider or facility in such 
plan; or 
VerDate Sep 11 2014 
20:16 Feb 19, 2020
Jkt 099200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H5816.IH
H5816
pamtmann on DSKBC07HB2PROD with BILLS
‘‘(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 shall meet the requirements of paragraph 
(2) with respect to such individual. 
‘‘(2) REQUIREMENTS.—The requirements of 
this paragraph are that the plan— 
‘‘(A) 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 (1) affect-
ing 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 section; 
‘‘(B) provide such individual with an op-
portunity to notify the plan of the individual’s 
need for transitional care; and 
‘‘(C) permit the patient to elect to continue 
to have benefits provided under such plan, 
under the same terms and conditions as would 
have applied and with respect to such items and 
VerDate Sep 11 2014 
20:16 Feb 19, 2020
Jkt 099200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H5816.IH
H5816
pamtmann on DSKBC07HB2PROD with BILLS
services as would have been covered under such 
plan had such termination not occurred, with 
respect to the course of treatment furnished by 
such provider or facility relating to such indi-
vidual’s status as a continuing care patient dur-
ing the period beginning 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: 
‘‘(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; 
VerDate Sep 11 2014 
20:16 Feb 19, 2020
Jkt 099200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H5816.IH
H5816
pamtmann on DSKBC07HB2PROD with BILLS