Iowa Admin. Code r. 441-73.7

Current through Regsiter Vol. 46, No. 26, June 12, 2024

Rule 441-73.7 - Emergency services

(1) Emergency services shall be available 24 hours a day, seven days a week.

(2) In accordance with federal funding requirements, including 42 CFR 438.114 as amended to July 19, 2022, the MCP shall:

a. Cover emergency services without the need for prior authorization and shall not limit reimbursement to network providers.

b. Cover and pay for emergency services regardless of whether the provider that furnishes the services is enrolled with Iowa Medicaid or has a contract with the MCP.

c. Pay noncontracted providers for emergency services the amount that would have been paid if the service had been provided under the state's fee-for-service Medicaid program.

d. Cover the medical screening examination, as described by EMTALA, provided to a member who presents to an emergency department with an emergency medical condition. This requirement applies to managed care organizations only.

(3) The MCP shall not deny payment for:

a. Treatment obtained when an enrollee has an emergency medical condition.

b. Treatment obtained when a representative of the MCP instructs the enrollee to seek emergency medical services.

Iowa Admin. Code r. 441-73.7

Adopted by IAB January 6, 2016/Volume XXXVIII, Number 14, effective 1/1/2016

Amended by IAB April 5, 2023/Volume XLV, Number 20, effective 6/1/2023