Section 376.1367

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS

Chapter 376

Effective - 28 Aug 1997, 2 histories, see footnote   (history) 

  376.1367.  Emergency services benefit determination, coverage required, when. — When conducting utilization review or making a benefit determination for emergency services:

  (1)  A health carrier shall cover emergency services necessary to screen and stabilize an enrollee and shall not require prior authorization of such services;

  (2)  Coverage of emergency services shall be subject to applicable co-payments, coinsurance and deductibles;

  (3)  When an enrollee receives an emergency service that requires immediate post evaluation or post stabilization services, a health carrier shall provide an authorization decision within sixty minutes of receiving a request; if the authorization decision is not made within thirty minutes, such services shall be deemed approved.

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(L. 1997 H.B. 335)