D.C. Mun. Regs. tit. 29, r. 29-8810
Current through Register 71, No. 45, November 7, 2024
Rule 29-8810 - EMERGENCY CARE8810.1The PACE organization must establish and maintain a written plan to handle emergency care in accordance with the following requirements:
(a) The plan must ensure that CMS, DHCF, and PACE participants are held harmless if the PACE organization does not pay for emergency services; and(b) The plan must provide for the following: (1) An on-call provider, available twenty-four (24) hours per day to address participant questions about emergency services and respond to requests for authorization of urgently needed out-ofnetwork services and post-stabilization care services following emergency services; and(2) Coverage of urgently needed out-of-network and post-stabilization care services when either: (i) The services are preapproved by the PACE organization; or(ii) The services are not preapproved by the PACE organization because the PACE organization did not respond to a request for approval within one (1) hour after being contacted or cannot be contacted for approval.8810.2Emergency care is appropriate when services are needed immediately because of an injury or sudden illness and the time required to reach the PACE organization or one of its contract providers would cause risk of permanent damage to the participant's health. Emergency services include inpatient and outpatient services that are:
(a) Furnished by a qualified emergency services provider, other than the PACE organization or one of its contract providers, either in or out of the PACE organization's service area; and(b) Necessary to evaluate or stabilize an emergency medical condition, as defined at 42 CFR § 460.100(c).8810.3The PACE organization must ensure that each participant, and his or her authorized representative, and caregiver, understand when and how to get access to emergency services and that no prior authorization is needed.
D.C. Mun. Regs. tit. 29, r. 29-8810
Final Rulemaking published at 69 DCR 6400 (6/3/2022)