16 Del. Admin. Code § 14000-14370
Current through Register Vol. 28, No. 7, January 1, 2025
Section 14000-14370 - Coverage of Emergency Services and Labor and Delivery OnlyEmergency services must be rendered in an acute care hospital emergency room or in an acute care inpatient hospital. Labor and delivery only services must be rendered in an acute care hospital emergency room, an acute care inpatient hospital, or a birthing center. The DMAP defines an emergency as:
| · | a sudden serious medical situation that is life threatening; or |
| · | a severe acute illness or accidental injury that demands immediate medical attention or surgical attention; and |
| · | without the treatment a person's life could be threatened or he or she could suffer serious long lasting disability. |
Medically necessary physician (surgeon, pathologist, anesthesiologist, emergency room physician, internist, etc.) or midwife services rendered during an emergency service that meets the above criteria are covered. Ancillary services (lab, x-ray, pharmacy, etc.) rendered during an emergency service that meets the above criteria are also covered. Emergency ambulance services to transport these individuals to and from the services defined above are also covered.
Services not covered for aliens who are determined to be eligible for emergency services and labor and delivery only include but are not limited to:
| · | any service delivered in a setting other than an acute care hospital emergency room or an acute care inpatient hospital. Exception: labor and delivery services may be rendered in a birthing center. |
| · | any service (such as pharmacy, transportation, office visit, lab or x-ray, home health) that precedes or is subsequent to a covered emergency service. Exception: ambulance transportation that is directly related to the emergency is covered. |
| · | long term care or rehabilitation care |
| · | routine prenatal and post partum care |
16 Del. Admin. Code § 14000-14370
13 DE Reg. 1540 (06/01/10)
15 DE Reg. 1023 (01/01/12)