42 USC 300gg-139 - Provider requirements to protect patients and improve the accuracy of provider directory information

U.S Code last checked for updates: Nov 22, 2024

§ 300gg–139.

Provider requirements to protect patients and improve the accuracy of provider directory information

(a)

Provider business processes

Beginning not later than January 1, 2022, each health care provider and each health care facility shall have in place business processes to ensure the timely provision of provider directory information to a group health plan or a health insurance issuer offering group or individual health insurance coverage to support compliance by such plans or issuers with section 300gg–115(a)(1) of this title, section 1185i(a)(1) of title 29, or section 9820(a)(1) of title 26, as applicable. Such providers shall submit provider directory information to a plan or issuers, at a minimum—

(1)

when the provider or facility begins a network agreement with a plan or with an issuer with respect to certain coverage;

(2)

when the provider or facility terminates a network agreement with a plan or with an issuer with respect to certain coverage;

(3)

when there are material changes to the content of provider directory information of the provider or facility described in section 300gg–115(a)(1) of this title, section 1185i(a)(1) of title 29, or section 9820(a)(1) of title 26, as applicable; and

(4)

at any other time (including upon the request of such issuer or plan) determined appropriate by the provider, facility, or the Secretary.

(b)

Refunds to enrollees

(c)

Limitation

Nothing in this section shall prohibit a provider from requiring in the terms of a contract, or contract termination, with a group health plan or health insurance issuer—

(1)

that the plan or issuer remove, at the time of termination of such contract, the provider from a directory of the plan or issuer described in section 300gg–115(a) of this title, section 1185i(a) of title 29, or section 9820(a) of title 26, as applicable; or

(2)

that the plan or issuer bear financial responsibility, including under section 300gg–115(b) of this title, section 1185i(b) of title 29, or section 9820(b) of title 26, as applicable, for providing inaccurate network status information to an enrollee.

(d)

Definition

(e)

Rule of construction

(July 1, 1944, ch. 373, title XXVII, § 2799B–9, as added Pub. L. 116–260, div. BB, title I, § 116(e), Dec. 27, 2020, 134 Stat. 2887.)

cite as: 42 USC 300gg-139