LD 1890
pg. 12
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LR 1804
Item 1

 
A.__Except as provided in paragraphs B to D, the
transitional period under this subsection extends for at
least 90 days from the date the enrollee receives the notice
of the provider's termination under in subsection 1.

 
B.__The transitional period for institutional or inpatient
care from a provider extends until the discharge or
termination of the period of institutionalization and
includes institutional care provided within a reasonable
time of the date of termination of the provider if the care
was scheduled before the date of announcement of the
termination under subsection 1 or if the enrollee on that
date was on an established waiting list or otherwise
scheduled to have such care.

 
C.__If an enrollee has entered the 2nd trimester of
pregnancy at the time of a provider's termination and the
provider was treating the pregnancy before the date of the
termination, the transitional period under this subsection
for the provider's treatment of the pregnancy extends
through the provision of postpartum care directly related to
the delivery.

 
D.__If an enrollee is terminally ill, as determined under
the federal Social Security Act, Section 1861(dd)(3)(A), at
the time of a provider's termination and the provider was
treating the terminal illness before the date of
termination, the transitional period under this subsection
extends for the remainder of the enrollee's life for care
directly related to the treatment of the terminal illness.

 
3.__Permissible terms and conditions.__A carrier may condition
coverage of continued treatment by a provider under subsection 1
upon the provider's agreeing to the following terms and
conditions.

 
A.__The provider agrees to accept reimbursement from the
carrier and the enrollee involved with respect to cost-
sharing at the rates applicable prior to the start of the
transitional period as payment in full or, in the case of a
plan sponsor's termination of a contract with a carrier, at
the rates applicable under the replacement carrier after the
date of the termination of the contract with the prior
carrier.__The provider agrees not to impose cost-sharing for
the enrollee in an amount that exceeds the cost-sharing that
could have been imposed if the contract referred to in
subsection 1 had not been terminated.

 
B.__The provider agrees to adhere to the quality assurance
standards of the carrier responsible for payment and to


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