Common use of Non-Emergency Room Services Clause in Contracts

Non-Emergency Room Services. Emergency room care includes care given for a medical emergency when a member believes that their health is in serious danger and every second counts (see also: 42 CFR 405.440). 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 provides the name and location of an alternate non- Emergency services provider that is available and accessible at the time the call is made to the Nurse Line; and ▪ The hospital provides a referral to coordinate scheduling of this treatment.

Non-Emergency Room Services. Emergency room care includes care given for a medical emergency when a member believes that their health is in serious danger and every second counts (see also: 42 CFR 405.440). Assuming a member has an available and accessible alternate non-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 provides the name and location of an alternate non- Emergency services provider that is available and accessible at the time the call is made to the Nurse Line; and ▪ • The hospital provides a referral to coordinate scheduling of this treatment.