Common use of Emergency Room Services Copayment Clause in Contracts

Emergency Room Services Copayment. A copayment will apply to non-emergency use of an emergency room by Hoosier Care Connect members. Other than Hoosier Care Connect members exempt from copayments as described in Section 12.3, all Hoosier Care Connect members will be subject to a copayment for all non-emergent use of hospital emergency department services. Providers will collect the copayment from members. The Contractor shall include copayment information on the member's ID card that directs the provider to call the MCE for specific copayment amount due. All members must receive an appropriate medical screening examination under section 1867 of the Emergency Medical Treatment and Active labor Act. The copayment must be waived or returned if the member is found to have an emergency condition, as defined in section 1867(e)(I)(A) of the Emergency Medical Treatment and Active labor Act, or if the person is admitted to the hospital within twenty-four (24) hours of the original visit. In addition, the member copayment must be waived for any member who contacts the Contractor's 24-hour Nurse Call line prior to utilizing a hospital emergency department to obtain advice on their medical conditions and the appropriate setting to receive care. The Contractor shall develop a process by which a member may contact the Contractor's 24-hour Nurse Call line to obtain a copayment waiver prior to utilizing a hospital emergency department. If a member contacts the Nurse Call line prior to seeking emergency care, the member will not be subject to the prudent layperson review to determine whether an emergency medical condition exists for purposes of applying the copayment. The Contractor must have processes in place to communicate emergency department copayment waivers on a prospective basis. In addition, the Contractor shall track and monitor whether members who contacted the 24-Hour Nurse Call line for purposes of copayment waiver were advised to seek emergency services. Assuming a member has an available and accessible alternate non-emergency services provider and a determination has been made that the individual does not have an emergency medical condition and did not receive a waiver from the Contractor's 24-hour Nurse Call line, in accordance with 42 C.F.R. § 447.54(d), the hospital must inform the member before providing non-emergency services that:  The hospital may require payment of the copayment before the service can be provided;  The hospital provides the name and location of an alternate non-emergency services provider that is actually available and accessible;  An alternate provider can provide the services without the imposition of the copayment; and  The hospital provides a referral to coordinate scheduling of this treatment. The Contractor shall instruct its provider network of the emergency room services copayment policy and procedure, such as the hospital's notification responsibilities (outlined above) and the circumstances under which the hospital must waive or return the copayment.

Emergency Room Services Copayment. A copayment will apply to non-emergency Emergency use of an emergency Emergency room by Hoosier Care Connect members. Other than Hoosier Care Connect members exempt from copayments as described in Section 12.3, all Hoosier Care Connect members will be subject to a copayment for all non-emergent use of hospital emergency Emergency department services. Providers will collect the copayment from members. The Contractor shall include copayment information on the member's ID card that directs the provider to call the MCE for specific copayment amount due. All members must receive an appropriate medical screening examination under section 1867 of the Emergency Medical Treatment and Active labor Labor Act. The copayment must be waived or returned if the member is found to have an emergency Emergency condition, as defined in section 1867(e)(I)(A) of the Emergency Medical Treatment and Active labor Labor Act, or if the person is admitted to the hospital within twenty-four (24) hours of the original visit. In addition, the member copayment must be waived for any member who contacts the Contractor's 24-hour Nurse Call line prior to utilizing a hospital emergency Emergency department to obtain advice on their medical conditions and the appropriate setting to receive carec are. The Contractor shall develop a process by which a member may contact the Contractor's 24-hour Nurse Call line to obtain a copayment waiver prior to utilizing a hospital emergency Emergency department. If a member contacts the Nurse Call line prior to seeking emergency Emergency care, the member will not be subject to the prudent layperson review to determine whether an emergency Emergency medical condition exists for purposes of applying the copayment. The Contractor must have processes in place to communicate emergency Emergency department copayment waivers on a prospective basis. In addition, the Contractor shall track and monitor whether members who contacted the 24-Hour Nurse Call line for purposes of copayment waiver were advised to seek emergency Emergency services. Assuming a member has an available and accessible alternate non-emergency Emergency services provider and a determination has been made that the individual does not have an emergency Emergency medical condition and did not receive a waiver from the Contractor's 24-24- hour Nurse Call line, in accordance with 42 C.F.R. § 447.54(d), the hospital must inform the member before providing non-emergency Emergency services that:  ▪ The hospital may require payment of the copayment before the service can be provided;  ▪ The hospital provides the name and location of an alternate non-emergency Emergency services provider that is actually available and accessibleaccessible at the time the call is made to the Nurse Line;  ▪ An alternate provider can provide the services without the imposition of the copayment; and  ▪ The hospital provides a referral to coordinate scheduling of this treatment. The Contractor shall instruct its provider network of the emergency Emergency room services copayment policy and procedure, such as the hospital's notification responsibilities (outlined above) and the circumstances under which the hospital must waive or return the copayment.

Emergency Room Services Copayment. A copayment will apply to non-emergency Emergency use of an emergency Emergency room by Hoosier Care Connect members. Other than Hoosier Care Connect members exempt from copayments as described in Section 12.3, all Hoosier Care Connect members will be subject to a copayment for all non-emergent use of hospital emergency Emergency department services. Providers will collect the copayment from members. The Contractor shall include copayment information on the member's ID card that directs the provider to call the MCE for specific copayment amount due. All members must receive an appropriate medical screening examination under section 1867 of the Emergency Medical Treatment and Active labor Labor Act. The copayment must be waived or returned if the member is found to have an emergency Emergency condition, as defined in section 1867(e)(I)(A) of the Emergency Medical Treatment and Active labor Labor Act, or if the person is admitted to the hospital within twenty-four (24) hours of the original visit. In addition, the member copayment must be waived for any member who contacts the Contractor's 24-hour Nurse Call line prior to utilizing a hospital emergency Emergency department to obtain advice on their medical conditions and the appropriate setting to receive care. The Contractor shall develop a process by which a member may contact the Contractor's 24-hour Nurse Call line to obtain a copayment waiver prior to utilizing a hospital emergency Emergency department. If a member contacts the Nurse Call line prior to seeking emergency Emergency care, the member will not be subject to the prudent layperson review to determine whether an emergency Emergency medical condition exists for purposes of applying the copayment. The Contractor must have processes in place to communicate emergency Emergency department copayment waivers on a prospective basis. In addition, the Contractor shall track and monitor whether members who contacted the 24-Hour Nurse Call line for purposes of copayment waiver were advised to seek emergency Emergency services. Assuming a member has an available and accessible alternate non-emergency Emergency services provider and a determination has been made that the individual does not have an emergency Emergency medical condition and did not receive a waiver from the Contractor's 24-hour Nurse Call line, in accordance with 42 C.F.R. § 447.54(d), the hospital must inform the member before providing non-emergency Emergency services that:  • The hospital may require payment of the copayment before the service can be provided;  • The hospital provides the name and location of an alternate non-emergency non- Emergency services provider that is actually available and accessibleaccessible at the time the call is made to the Nurse Line;  • An alternate provider can provide the services without the imposition of the copayment; and  • The hospital provides a referral to coordinate scheduling of this treatment. The Contractor shall instruct its provider network of the emergency Emergency room services copayment policy and procedure, such as the hospital's notification responsibilities (outlined above) and the circumstances under which the hospital must waive or return the copayment.

Emergency Room Services Copayment. A copayment will apply to non-emergency Emergency use of an emergency Emergency room by Hoosier Care Connect members. Other than Hoosier Care Connect members exempt from copayments as described in Section 12.3, all Hoosier Care Connect members will be subject to a copayment for all non-emergent use of hospital emergency Emergency department services. Providers will collect the copayment from members. The Contractor shall include copayment information on the member's ID card that directs the provider to call the MCE for specific copayment amount due. All members must receive an appropriate medical screening examination under section 1867 of the Emergency Medical Treatment and Active labor Labor Act. The copayment must be waived or returned if the member is found to have an emergency Emergency condition, as defined in section 1867(e)(I)(A) of the Emergency Medical Medical A. SCOPE OF WORK Treatment and Active labor Labor Act, or if the person is admitted to the hospital within twenty-four (24) hours of the original visit. In addition, the member copayment must be waived for any member who contacts the Contractor's 24-hour Nurse Call line prior to utilizing a hospital emergency Emergency department to obtain advice on their medical conditions and the appropriate setting to receive care. The Contractor shall develop a process by which a member may contact the Contractor's 24-hour Nurse Call line to obtain a copayment waiver prior to utilizing a hospital emergency Emergency department. If a member contacts the Nurse Call line prior to seeking emergency Emergency care, the member will not be subject to the prudent layperson review to determine whether an emergency Emergency medical condition exists for purposes of applying the copayment. The Contractor must have processes in place to communicate emergency Emergency department copayment waivers on a prospective basis. In addition, the Contractor shall track and monitor whether members who contacted the 24-Hour Nurse Call line for purposes of copayment waiver were advised to seek emergency Emergency services. Assuming a member has an available and accessible alternate non-emergency Emergency services provider and a determination has been made that the individual does not have an emergency Emergency medical condition and did not receive a waiver from the Contractor's 24-hour Nurse Call line, in accordance with 42 C.F.R. § 447.54(d), the hospital must inform the member before providing non-emergency Emergency services that:  • The hospital may require payment of the copayment before the service can be provided;  • The hospital provides the name and location of an alternate non-emergency Emergency services provider that is actually available and accessibleaccessible at the time the call is made to the Nurse Line;  • An alternate provider can provide the services without the imposition of the copayment; and  • The hospital provides a referral to coordinate scheduling of this treatment. The Contractor shall instruct its provider network of the emergency Emergency room services copayment policy and procedure, such as the hospital's notification responsibilities (outlined above) and the circumstances under which the hospital must waive or return the copayment.

Emergency Room Services Copayment. A copayment will apply to non-emergency Emergency use of an emergency Emergency room by Hoosier Care Connect members. Other than Hoosier Care Connect members exempt from copayments as described in Section 12.3, all Hoosier Care Connect members will be subject to a copayment for all non-emergent use of hospital emergency Emergency department services. Providers will collect the copayment from members. The Contractor shall include copayment information on the member's ID card that directs the provider to call the MCE for specific copayment amount due. All members must receive an appropriate medical screening examination under section 1867 of the Emergency Medical Treatment and Active labor Labor Act. The copayment must be waived or returned if the member is found to have an emergency Emergency condition, as defined in section 1867(e)(I)(A) of the Emergency Medical Treatment and Active labor Labor Act, or if the person is admitted to the hospital within twenty-four (24) hours of the original visit. EXHIBIT 1 SCOPE OF WORK In addition, the member copayment must be waived for any member who contacts the Contractor's 24-hour Nurse Call line prior to utilizing a hospital emergency Emergency department to obtain advice on their medical conditions and the appropriate setting to receive care. The Contractor shall develop a process by which a member may contact the Contractor's 24-hour Nurse Call line to obtain a copayment waiver prior to utilizing a hospital emergency Emergency department. If a member contacts the Nurse Call line prior to seeking emergency Emergency care, the member will not be subject to the prudent layperson review to determine whether an emergency Emergency medical condition exists for purposes of applying the copayment. The Contractor must have processes in place to communicate emergency Emergency department copayment waivers on a prospective basis. In addition, the Contractor shall track and monitor whether members who contacted the 24-Hour Nurse Call line for purposes of copayment waiver were advised to seek emergency Emergency services. Assuming a member has an available and accessible alternate non-emergency Emergency services provider and a determination has been made that the individual does not have an emergency Emergency medical condition and did not receive a waiver from the Contractor's 24-hour Nurse Call line, in accordance with 42 C.F.R. § 447.54(d), the hospital must inform the member before providing non-emergency Emergency services that:  • The hospital may require payment of the copayment before the service can be provided;  • The hospital provides the name and location of an alternate non-emergency Emergency services provider that is actually available and accessibleaccessible at the time the call is made to the Nurse Line;  • An alternate provider can provide the services without the imposition of the copayment; and  • The hospital provides a referral to coordinate scheduling of this treatment. The Contractor shall instruct its provider network of the emergency Emergency room services copayment policy and procedure, such as the hospital's notification responsibilities (outlined above) and the circumstances under which the hospital must waive or return the copayment.

Emergency Room Services Copayment. A copayment will apply to non-emergency use of an emergency room by Hoosier Care Connect members. Other than Hoosier Care Connect members exempt from copayments as described in Section 12.3, all Hoosier Care Connect members will be subject to a copayment for all non-emergent use of hospital emergency department services. Providers will collect the copayment from members. The Contractor shall include copayment information on the member's ID card that directs the provider to call the MCE for specific copayment amount due. All members must receive an appropriate medical screening examination under section 1867 of the Emergency Medical Treatment and Active labor Act. The copayment must be waived or returned if the member is found to have an emergency condition, as defined in section 1867(e)(I)(A) of the Emergency Medical Treatment and Active labor Act, or if the person is admitted to the hospital within twenty-four (24) hours of the original visit. In addition, the member copayment must be waived for any member who contacts the Contractor's 24-hour Nurse Call line prior to utilizing a hospital emergency department to obtain advice on their medical conditions and the appropriate setting to receive care. The Contractor shall develop a process by which a member may EXHIBIT 1.M SCOPE OF WORK contact the Contractor's 24-hour Nurse Call line to obtain a copayment waiver prior to utilizing a hospital emergency department. If a member contacts the Nurse Call line prior to seeking emergency care, the member will not be subject to the prudent layperson review to determine whether an emergency medical condition exists for purposes of applying the copayment. The Contractor must have processes in place to communicate emergency department copayment waivers on a prospective basis. In addition, the Contractor shall track and monitor whether members who contacted the 24-Hour Nurse Call line for purposes of copayment waiver were advised to seek emergency services. Assuming a member has an available and accessible alternate non-emergency services provider and a determination has been made that the individual does not have an emergency medical condition and did not receive a waiver from the Contractor's 24-hour Nurse Call line, in accordance with 42 C.F.R. § 447.54(d), the hospital must inform the member before providing non-emergency services that:  The hospital may require payment of the copayment before the service can be provided;  The hospital provides the name and location of an alternate non-emergency services provider that is actually available and accessible;  An alternate provider can provide the services without the imposition of the copayment; and  The hospital provides a referral to coordinate scheduling of this treatment. The Contractor shall instruct its provider network of the emergency room services copayment policy and procedure, such as the hospital's notification responsibilities (outlined above) and the circumstances under which the hospital must waive or return the copayment.

Emergency Room Services Copayment. A copayment will apply to non-emergency Emergency use of an emergency Emergency room by Hoosier Care Connect members. Other than Hoosier Care Connect members exempt from copayments as described in Section 12.3, all Hoosier Care Connect members will be subject to a copayment for all non-emergent use of hospital emergency Emergency department services. Providers will collect the copayment from members. The Contractor shall include copayment information on the member's ID card that directs the provider to call the MCE for specific copayment amount due. All members must receive an appropriate medical screening examination under section 1867 of the Emergency Medical Treatment and Active labor Labor Act. The copayment must be waived or returned if the member is found to have an emergency Emergency condition, as defined in section 1867(e)(I)(A) of the Emergency Medical Treatment and Active labor Labor Act, or if the person is admitted to the hospital within twenty-four (24) hours of the original visit. EXHIBIT 1 SCOPE OF WORK In addition, the member copayment must be waived for any member who contacts the Contractor's 24-hour Nurse Call line prior to utilizing a hospital emergency Emergency department to obtain advice on their medical conditions and the appropriate setting to receive care. The Contractor shall develop a process by which a member may contact the Contractor's 24-hour Nurse Call line to obtain a copayment waiver prior to utilizing a hospital emergency Emergency department. If a member contacts the Nurse Call line prior to seeking emergency Emergency care, the member will not be subject to the prudent layperson review to determine whether an emergency Emergency medical condition exists for purposes of applying the copayment. The Contractor must have processes in place to communicate emergency Emergency department copayment waivers on a prospective basis. In addition, the Contractor shall track and monitor whether members who contacted the 24-Hour Nurse Call line for purposes of copayment waiver were advised to seek emergency Emergency services. Assuming a member has an available and accessible alternate non-emergency Emergency services provider and a determination has been made that the individual does not have an emergency Emergency medical condition and did not receive a waiver from the Contractor's 24-hour Nurse Call line, in accordance with 42 C.F.R. § 447.54(d), the hospital must inform the member before providing non-emergency Emergency services that:  The hospital may require payment of the copayment before the service can be provided;  The hospital provides the name and location of an alternate non-emergency Emergency services provider that is actually available and accessibleaccessible at the time the call is made to the Nurse Line;  An alternate provider can provide the services without the imposition of the copayment; and  The hospital provides a referral to coordinate scheduling of this treatment. The Contractor shall instruct its provider network of the emergency Emergency room services copayment policy and procedure, such as the hospital's notification responsibilities (outlined above) and the circumstances under which the hospital must waive or return the copayment.

Emergency Room Services Copayment. A copayment will apply to non-emergency use of an emergency room by Hoosier Care Connect members. Other than Hoosier Care Connect members exempt from copayments as described in Section 12.3, all Hoosier Care Connect members will be subject to a copayment for all non-emergent use of hospital emergency department services. Providers will collect the copayment from members. The Contractor shall include copayment information on the member's ID card that directs the provider to call the MCE for specific copayment amount due. All members must receive an appropriate medical screening examination under section 1867 of the Emergency Medical Treatment and Active labor Act. The copayment must be waived or returned if the member is found to have an emergency condition, as defined in section 1867(e)(I)(A) of the Emergency Medical Treatment and Active labor Act, or if the person is admitted to the hospital within twenty-four (24) hours of the original visit. In addition, the member copayment must be waived for any member who contacts the Contractor's 24-hour Nurse Call line prior to utilizing a hospital emergency department to obtain advice on their medical conditions and the appropriate setting EXHIBIT 1.M SCOPE OF WORK to receive care. The Contractor shall develop a process by which a member may contact the Contractor's 24-hour Nurse Call line to obtain a copayment waiver prior to utilizing a hospital emergency department. If a member contacts the Nurse Call line prior to seeking emergency care, the member will not be subject to the prudent layperson review to determine whether an emergency medical condition exists for purposes of applying the copayment. The Contractor must have processes in place to communicate emergency department copayment waivers on a prospective basis. In addition, the Contractor shall track and monitor whether members who contacted the 24-Hour Nurse Call line for purposes of copayment waiver were advised to seek emergency services. Assuming a member has an available and accessible alternate non-emergency services provider and a determination has been made that the individual does not have an emergency medical condition and did not receive a waiver from the Contractor's 24-hour Nurse Call line, in accordance with 42 C.F.R. § 447.54(d), the hospital must inform the member before providing non-emergency services that:  The hospital may require payment of the copayment before the service can be provided;  The hospital provides the name and location of an alternate non-emergency services provider that is actually available and accessible;  An alternate provider can provide the services without the imposition of the copayment; and  The hospital provides a referral to coordinate scheduling of this treatment. The Contractor shall instruct its provider network of the emergency room services copayment policy and procedure, such as the hospital's notification responsibilities (outlined above) and the circumstances under which the hospital must waive or return the copayment.

Emergency Room Services Copayment. A copayment will apply to non-emergency Emergency use of an emergency Emergency room by Hoosier Care Connect members. Other than Hoosier Care Connect members exempt from copayments as described in Section 12.3, all Hoosier Care Connect members will be subject to a copayment for all non-emergent use of hospital emergency Emergency department services. Providers will collect the copayment from members. The Contractor shall include copayment information on the member's ID card c ard that directs the provider to call the MCE for specific copayment amount due. All members must receive an appropriate medical screening examination under section 1867 of the Emergency Medical Treatment and Active labor Labor Act. The copayment must be waived or returned if the member is found to have an emergency Emergency condition, as defined in section 1867(e)(I)(A) of the Emergency Medical EXHIBIT 1 SCOPE OF WORK Treatment and Active labor Labor Act, or if the person is admitted to the hospital within twenty-four (24) hours of the original visit. In addition, the member copayment must be waived for any member who contacts the Contractor's 24-hour Nurse Call line prior to utilizing a hospital emergency Emergency department to obtain advice on their medical conditions and the appropriate setting to receive care. The Contractor shall develop a process by which a member may contact the Contractor's 24-hour Nurse Call line to obtain a copayment waiver prior to utilizing a hospital emergency Emergency department. If a member contacts the Nurse Call line prior to seeking emergency Emergency care, the member will not be subject to the prudent layperson review to determine whether an emergency Emergency medical condition exists for purposes of applying the copayment. The Contractor must have processes in place to communicate emergency Emergency department copayment waivers on a prospective basis. In addition, the Contractor shall track and monitor whether members who contacted the 24-Hour Nurse Call line for purposes of copayment waiver were advised to seek emergency Emergency services. Assuming a member has an available and accessible alternate non-emergency Emergency services provider and a determination has been made that the individual does not have an emergency Emergency medical condition and did not receive a waiver from the Contractor's 24-hour Nurse Call line, in accordance with 42 C.F.R. § 447.54(d), the hospital must inform the member before providing non-emergency Emergency services that:  • The hospital may require payment of the copayment before the service can be provided;  • The hospital provides the name and location of an alternate non-emergency Emergency services provider that is actually available and accessibleaccessible at the time the call is made to the Nurse Line;  • An alternate provider can provide the services without the imposition of the copayment; and  • The hospital provides a referral to coordinate scheduling of this treatment. The Contractor shall instruct its provider network of the emergency Emergency room services copayment policy and procedure, such as the hospital's notification responsibilities (outlined above) and the circumstances under which the hospital must waive or return the copayment.