Md. Code Regs. 10.09.44.22

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.44.22 - Payment for Emergency Services

A. The PACE provider shall be responsible for prompt payment for all emergency services received by participants.

B. If a claim is submitted to the PACE provider within 9 months of the date of service, the PACE provider shall reimburse a hospital emergency facility and provider, without requiring prior authorization or approval for payment from the PACE provider, for:

(1) Emergency services;

(2) Medical screening services rendered at an emergency facility to meet the requirements of the federal Emergency Medical Treatment and Active Labor Act; and

(3) Medically necessary and appropriate services if:

(a) The PACE provider authorized, referred, or otherwise allowed the participant to use the emergency facility; and

(b) The services are related to the condition for which the participant was allowed to use the emergency facility.

Md. Code Regs. 10.09.44.22

Regulations .22 adopted as an emergency provision effective November 1, 2002 (29:25 Md. R. 1979); adopted permanently effective April 28, 2003 (30:8 Md. R. 540)