01. When a health care provider leaves a plan. If a contract between an insurer and a health care provider is terminated by either party for any reason other than termination for failure to meet applicable quality standards of care or fraud, and a member is undergoing a course of treatment from the physician at the time of the termination, the insurer shall notify the member on a timely basis of the termination. When medically necessary, persons with serious illness undergoing a course of treatment or who are in the second trimester of a pregnancy shall be permitted to continue to receive medically necessary covered services, with respect to the cause of treatment, by the physician, certified nurse-midwife, or certified midwife during a transitional period of at least 90 days from the date of the notice under the same terms and conditions as specified under the provider contract. (Apr. 27, 1999, D.C. Law 12-274, § 301, 46 DCR 1294; Dec. 29, 2021, D.C. Law 24-46, § 4(c), 68 DCR 011642.) Prior Codifications 1981 Ed., § 32-573.1.
District of Columbia Legal Code