---
kind: "section"
citation: "42 U.S.C. § 300gg–113"
title: "42"
title_heading: "The Public Health and Welfare"
number: "300gg–113"
heading: "Continuity of care"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/300gg-113"
units:
  - "Chapter 6A — Public Health Service"
  - "Subchapter XXV — Requirements Relating to Health Insurance Coverage"
  - "Part D — Additional Coverage Provisions"
---

# §300gg–113. Continuity of care

- (a) **Ensuring continuity of care with respect 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](/usc/42/300bb–8.md?p=1) or group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) offered by a [health insurance issuer](/usc/42/300gg–91.md?p=b-2) and with respect to a [health care provider](/usc/42/300aa–33.md?p=1) or facility that has a contractual relationship with such plan or such issuer (as applicable) for furnishing items and [services](/usc/42/201.md?p=a) under such plan or such coverage, if, while such individual is a continuing care patient (as defined in [subsection (b)](#b)) with respect to such [provider](/usc/42/299b–21.md?p=8) or facility—
    - (A) such contractual relationship is terminated (as defined in [subsection (b)](#b));
    - (B) benefits provided under such plan or such [health insurance coverage](/usc/42/300gg–91.md?p=b-1) with respect to such [provider](/usc/42/299b–21.md?p=8) or facility are terminated because of a change in the terms of the participation of such [provider](/usc/42/299b–21.md?p=8) or facility in such plan or coverage; or
    - (C) a contract between such [group health plan](/usc/42/300bb–8.md?p=1) and a [health insurance issuer](/usc/42/300gg–91.md?p=b-2) offering [health insurance coverage](/usc/42/300gg–91.md?p=b-1) in connection with such plan is terminated, resulting in a loss of benefits provided under such plan with respect to such [provider](/usc/42/299b–21.md?p=8) or facility;

    the plan or issuer, respectively, shall meet the requirements of [paragraph (2)](#a-2) with respect to such individual.

  - (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](/usc/42/299b–21.md?p=8) or facility at the time of a termination described in [paragraph (1)](#a-1) affecting such [provider](/usc/42/299b–21.md?p=8) or facility on a timely basis of such termination and such individual’s right to elect continued transitional care from such [provider](/usc/42/299b–21.md?p=8) or facility under this section;
    - (B) provide such individual with an opportunity to notify the plan or issuer of the individual’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 conditions as would have applied and with respect to such items and [services](/usc/42/201.md?p=a) as would have been covered under such plan or coverage had such termination not occurred, with respect to the course of [treatment](/usc/42/11851.md?p=11) furnished by such [provider](/usc/42/299b–21.md?p=8) or facility relating to such individual’s status as a continuing care patient during the period beginning on the date on which the notice under [subparagraph (A)](#a-2-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](/usc/42/299b–21.md?p=8) or facility.
- (b) **Definitions—** In this section:
  - (1) **Continuing care patient—** The term “continuing care patient” means an individual who, with respect to a [provider](/usc/42/299b–21.md?p=8) or facility—
    - (A) is undergoing a course of [treatment](/usc/42/11851.md?p=11) for a serious and complex condition from the [provider](/usc/42/299b–21.md?p=8) or facility;
    - (B) is undergoing a course of institutional or inpatient care from the [provider](/usc/42/299b–21.md?p=8) or facility;
    - (C) is scheduled to undergo nonelective surgery from the [provider](/usc/42/299b–21.md?p=8), including receipt of postoperative care from such [provider](/usc/42/299b–21.md?p=8) or facility with respect to such a surgery;
    - (D) is pregnant and undergoing a course of [treatment](/usc/42/11851.md?p=11) for the pregnancy from the [provider](/usc/42/299b–21.md?p=8) or facility; or
    - (E) is or was determined to be terminally ill (as determined under [section 1395x(dd)(3)(A) of this title](/usc/42/1395x.md?p=dd-3-A)) and is receiving [treatment](/usc/42/11851.md?p=11) for such illness from such [provider](/usc/42/299b–21.md?p=8) or facility.
  - (2) **Serious and complex condition—** The term “serious and complex condition” means, with respect to a [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee under a [group health plan](/usc/42/300bb–8.md?p=1) or group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5)—
    - (A) in the case of an acute illness, a condition that is serious enough to require specialized medical [treatment](/usc/42/11851.md?p=11) to avoid the reasonable possibility of death or permanent harm; or
    - (B) in the case of a chronic illness or condition, a condition that is—[^1]
      - (i) is life-threatening, degenerative, potentially disabling, or congenital; and
      - (ii) requires specialized [medical care](/usc/42/300gg–91.md?p=a-2) over a prolonged period of time.
  - (3) **Terminated—** The term “terminated” includes, 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 applicable quality standards or for fraud.

## Footnotes

[^1]: So in original. Probably should be “a condition that—”.

## Source credit

(July 1, 1944, ch. 373, title XXVII, § 2799A–3, as added Pub. L. 116–260, div. BB, title I, § 113(a), Dec. 27, 2020, 134 Stat. 2868.)

## Notes

### Statutory Notes and Related Subsidiaries

### Effective Date

Section applicable with respect to plan years beginning on or after Jan. 1, 2022, see section 113(e) of div. BB of Pub. L. 116–260, set out as a note under section 9818 of Title 26, Internal Revenue Code.