State Provider Contract Requirements.
Health carriers must file all provider contracts and provider compensation agreements with the Office of the Insurance Commissioner (OIC) 30 calendar days before use.  When a carrier and provider negotiate an agreement that deviates from a filed agreement, the specific contract must be filed 30 days prior to use.  Any provider contract or provider compensation agreements not affirmatively disapproved by the OIC are deemed approved, except the OIC may extend the approval date an additional 15 days with notice before the initial 30-day period expires.  Changes to the previously filed agreements that modify the compensation or related terms, must be filed and are deemed approved upon filing if no other changes are made to the previously approved agreement.  The OIC may not base a disapproval of the agreement on the amount of the compensation or other financial arrangements between the carrier and provider, unless the compensation amount causes the underlying health benefit plan to be in violation of state or federal law. 

The OIC rules require a health carrier and contracting health care provider or facility to provide at least 60 days' written notice to each other before terminating the contract without cause.  Whether the termination was for cause, or without cause, the carrier must make a good faith effort to ensure written notice of a termination is provided at least 30 days before the effective date of the termination, or immediately for a termination for cause that results in less than 30 days' notice, to all enrollees who are patients seen on a regular basis by a specialist, by a provider for whom they have a standing referral; or by a primary care provider.  The OIC must approve the notices sent by carriers to enrollees.

Federal No Surprises Act Continuity of Care Requirements.

Under the federal No Surprises Act, if a provider or facility ceases to be an in-network provider because of a contract termination, certain continuity of care protections applies to an individual who meets the definition of a continuing care patient.  For the continuing care patient whose provider’s or facility’s contract termination leads to a change in network status, the carrier must: 

• timely notify each continuing care patient of the termination and their right to elect continued transitional care from the provider or facility; 
• provide each continuing care patient an opportunity to notify the carrier of the need for transitional care; and 
• permit the continuing care patient to elect to continue to have the same benefits provided, under the same terms and conditions as would have applied under the plan or coverage had the termination not occurred, with respect to the course of treatment furnished by the provider or facility.

Continuing care patients are defined as individuals who, with respect to a provider or facility, are: 

• undergoing treatment from the provider or facility for a serious and complex condition; 
• undergoing a course of institutional or inpatient care from the provider or facility; 
• scheduled to undergo nonelective surgery from the provider or facility, including postoperative care from such provider or facility with respect to such a surgery; 
• pregnant and undergoing treatment for pregnancy from the provider or facility; or 
• terminally ill and receiving treatment for such illness from the provider or facility.

The continued care election may last until the earlier of 90 days or the date on which such individual is no longer a continuing care patient with the provider or facility.  A continuing care patient’s treating provider or health care facility must:  accept payment from the carrier and cost sharing from the individual for items and services as payment in full; and continue to adhere to all policies, procedures, and quality standards imposed by the carrier for an individual as if the termination had not occurred.

For a provider contract that is expiring by its own terms or for which one party has given notice to the other party of intended termination without cause according to the contract terms, the health care facility or provider and the health carrier may not make public statements, including communications with impacted enrollees or patients, regarding the expiration or termination of the contract until 45 days before the termination date, unless the disclosure is required by law or the expiration or termination has already been disclosed because of a legal obligation. 

Public statements and communications with enrollees or patients may not occur before the carrier, facility, or provider gives written notice of the termination to the other party, unless agreed upon by the parties. 

The Insurance Commissioner (Commissioner), in consultation with carriers, providers, facilities, and consumers, must develop standard template language for notices sent to health plan enrollees.  The templates must include:

• the facility or facilities that would be affected by the potential contract termination and whether the termination would apply to hospital-based providers;
• direction to enrollees related to appointments that are scheduled past the date of the potential contract termination date; and
• information about the enrollee's continuity of care rights under the No Surprises Act.

All notices must be reviewed and approved by the Commissioner before use.  The Commissioner may enforce the requirements that are applicable to or regulate the conduct of carriers for plans issued or renewed on or after January 1, 2026.  In addition to the Commissioner's existing enforcement authority, the Commissioner may impose a civil penalty up to $100 for each day for each individual failing to comply with these requirements.  If the Commissioner has cause to believe that any provider or facility has engaged in a pattern of unresolved violations, the Commissioner may submit information to the Department of Health (DOH) or the appropriate disciplining authority for action.  Prior to submitting information to DOH or a disciplining authority, the Commissioner may provide the facility or provider an opportunity to cure the alleged violation or explain why actions in question did not violate the prohibitions.  The DOH or appropriate disciplining authority may levy a fine or cost recovery upon a provider or facility that has engaged in a pattern of unresolved violations and must notify the Commissioner of the results of any review and enforcement actions taken against a provider or facility.