Common use of Emergency Services, Generally Clause in Contracts

Emergency Services, Generally. (A) The Contractor is responsible for coverage and payment of Emergency Services as described by this Contract and by law. (B) The Contractor shall cover and pay for Emergency Services regardless of whether the Provider that furnishes the services is a Network Provider or a Non-Network Provider. (C) The Contractor may not limit what constitutes an Emergency Medical Condition on the basis of lists of diagnoses or symptoms. (D) The Contractor may not refuse to cover Emergency Services based on the emergency room Provider, hospital, or fiscal agent not notifying the Enrollee’s Primary Care Provider or the Contractor of the Enrollee’s screening and treatment within 10 calendar days of presentation for Emergency Services. (E) The Contractor shall inform Enrollees that access to Emergency Services is not restricted and that if an Enrollee experiences a medical emergency, he or she may obtain services from a Non- Network Provider without penalty. (F) The Contractor shall pay Non-Network Providers for Emergency Services no more than the amount that would have been paid if the service had been provided under the Department’s FFS Medicaid program.

Emergency Services, Generally. (A) The Contractor is responsible for coverage and payment of Emergency Services as described by this Contract and by law. (B) The Contractor shall cover and pay for Emergency Services regardless of whether the Provider that furnishes the services is a Network Provider or a Non-Network Provider. (C) The Contractor may not limit what constitutes an Emergency Medical Condition on the basis of lists of diagnoses or symptoms. (D) The Contractor may not refuse to cover Emergency Services based on the emergency room Provider, hospital, or fiscal agent Fiscal Agent not notifying the Enrollee’s Primary Care Provider or the Contractor of the Enrollee’s screening and treatment within 10 calendar days of presentation for Emergency Services. (E) The Contractor shall inform Enrollees that access to Emergency Services is not restricted and that if an Enrollee experiences a medical emergency, he or she may obtain services from a Non- Network Provider without penalty. (F) The Contractor shall pay Non-Network Providers for Emergency Services no more than the amount that would have been paid if the service had been provided under the Department’s FFS Medicaid program.