SB 444 — Relating to health insurance coverage for certain emergency services

(2) (3) (4)An Coverageinsurer ofthat has given prior authorization for emergency services shall becover subjectthe toservices coinsurance,and copaymentsshall andnot deductiblesretract applicablethe underauthorization after the services have been provided unless the authorization was based on a material misrepresentation about the covered person's health benefitcondition plan.made by the referring provider, the provider of the emergency services, or the covered person.

(3) (4) (5)Coverage Theof emergency departmentservices and the insurer shall makebe asubject good faith effort to communicatecoinsurance, withcopayments, eachand otherdeductibles inapplicable aunder timely fashion to expedite postevaluation or poststabilization services in order to avoid material deterioration of the coveredhealth person'sbenefit condition.plan.

CS for SB 444 (4) (5) The emergency department and the insurer shall make a good faith effort to communicate with each other in a timely fashion to expedite post evaluation or post stabilization services in order to avoid material deterioration of the covered person's condition.

(B) "Prudent layperson" means a person who is without medical training and who draws on his or her practical experience when making a decision regarding whether an emergency medical Intr SB444 2024R2636 condition exists for which emergency treatment should be sought;

(D) "Stabilize" means with respect to an emergency medical condition, to provide medical treatment of the condition necessary to assure, with reasonable medical probabilityprobability, that no medical deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility:

Provided, That this provision may not be construed to prohibit, limitlimit, or otherwise delay the transportation required for a higher level of care than that possible at the treating facility;

and (F) "Emergency medical condition" means a condition that manifests itself by acute symptoms of sufficient severityseverity, including severe painpain, such that the absence of immediate CS for SB 444 medical attention could reasonably be expected to result in serious jeopardy to the individual's healthhealth, oror, with respect to a pregnant womanwoman, the health of the unborn child, serious impairment to bodily functionsfunctions, or serious dysfunction of any bodily part or organ.

(a) Notwithstanding any provision of any policy, provision, contract, planplan, or agreement to which this article applies, any entity regulated by this article shall provide as benefits to all subscribers and members coverage for emergency services.

A policy, provision, contract, planplan, or Intr SB444 2024R2636 agreement may apply to emergency services the same deductibles, coinsurancecoinsurance, and other limitations as apply to other covered services:

(2) The coverage for prehospital screening and stabilization of an emergency medical condition shall include ambulance services provided under the provisions of §16-4-1,§16-4C-1 et seq.

of this code, excluding air ambulance services as defined in §16-4C-3(a) of this code.

(2)The (3)coverage Anunder insurerthis thatsection hasis givensubject priorto authorizationdeductibles foror emergencycopayment servicesrequirements shall cover the services and shall not retract the authorization after the services have been provided unless the authorization was based on a material misrepresentation about the covered person's health condition made by the referring provider, the provider of the emergencypolicy, servicescontract, or theplan. covered person.

CS for SB 444 (2) (3) (4)An Coverageinsurer ofthat has given prior authorization for emergency services shall becover subjectthe toservices coinsurance,and copaymentsshall andnot deductiblesretract applicablethe underauthorization after the services have been provided unless the authorization was based on a material misrepresentation about the covered person's health benefitcondition plan.made by the referring provider, the provider of the emergency services, or the covered person.

(3) (4) (5)Coverage Theof emergency departmentservices and the insurer shall makebe asubject good faith effort to communicatecoinsurance, withcopayments, eachand otherdeductibles inapplicable aunder timely fashion to expedite postevaluation or poststabilization services in order to avoid material deterioration of the coveredhealth person'sbenefit condition.plan.

Intr(4) SB444(5) 2024R2636The (5)emergency (6)department Asand usedthe insurer shall make a good faith effort to communicate with each other in thisa section:timely fashion to expedite post evaluation or post stabilization services in order to avoid material deterioration of the covered person's condition.

(5) (6) As used in this section:

(D) "Stabilize" means with respect to an emergency medical condition, to provide medical treatment of the condition necessary to assure, with reasonable medical probabilityprobability, that no medical deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility:

Provided, That this provision may not be construed to prohibit, limitlimit, or CS for SB 444 otherwise delay the transportation required for a higher level of care than that possible at the treating facility;

and (F) "Emergency medical condition" means a condition that manifests itself by acute symptoms of sufficient severityseverity, including severe painpain, such that the absence of immediate medical attention could reasonably be expected to result in serious jeopardy to the individual's healthhealth, oror, with respect to a pregnant womanwoman, the health of the unborn child, serious impairment to bodily functions or serious dysfunction of any bodily part or organ.

Intr SB444 2024R2636 ARTICLE 25A.

(a) Notwithstanding any provision of any policy, provision, contract, planplan, or agreement to which this article applies, any entity regulated by this article shall provide as benefits to all subscribers and members coverage for emergency services.

A policy, provision, contract, planplan, or agreement may apply to emergency services the same deductibles, coinsurancecoinsurance, and other limitations as apply to other covered services:

Prior authorization of coverage shall not be required for stabilization if an emergency medical CS for SB 444 condition exists.

(2) The coverage for prehospital screening and stabilization of an emergency medical condition shall include ambulance services provided under the provisions of §16-4-1,§16-4C-1 et seq.

of this code, excluding air ambulance services as defined in §16-4C-3(a) of this code.

(2)The (3)coverage Anunder insurerthis thatsection hasis givensubject priorto authorizationdeductibles foror emergencycopayment servicesrequirements shall cover the services and shall not retract the authorization after the services have been provided unless the authorization was based on a material misrepresentation about the covered person's health Intr SB444 2024R2636 condition made by the referring provider, the provider of the emergencypolicy, servicescontract, or theplan. covered person.

(2) (3) (4)An Coverageinsurer ofthat has given prior authorization for emergency services shall becover subjectthe toservices coinsurance,and copaymentsshall andnot deductiblesretract applicablethe underauthorization after the services have been provided unless the authorization was based on a material misrepresentation about the covered person's health benefitcondition plan.made by the referring provider, the provider of the emergency services, or the covered person.

(3) (4) (5)Coverage Theof emergency departmentservices and the insurer shall makebe asubject good faith effort to communicatecoinsurance, withcopayments, eachand otherdeductibles inapplicable aunder timely fashion to expedite postevaluation or poststabilization services in order to avoid material deterioration of the coveredhealth person'sbenefit condition.plan.

(4) (5) The emergency department and the insurer shall make a good faith effort to communicate with each other in a timely fashion to expedite post evaluation or post stabilization services in order to avoid material deterioration of the covered person's condition.

CS for SB 444 (C) "Emergency medical condition for the prudent layperson" means one that manifests itself by acute symptoms of sufficient severity, including severe pain, such that the person could reasonably expect the absence of immediate medical attention to result in serious jeopardy to the individual's health, or, with respect to a pregnant woman, the health of the unborn child;

(D) "Stabilize" means with respect to an emergency medical condition, to provide medical treatment of the condition necessary to assure, with reasonable medical probabilityprobability, that no medical deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility:

Provided, That this provision may not be construed to prohibit, limitlimit, or otherwise delay the transportation required for a higher level of care than that possible at the treating facility;

(E) "Medical screening examination" means an appropriate examination within the capability of the hospital's emergency department, including ancillary services routinely available Intr SB444 2024R2636 to the emergency department, to determine whether or not an emergency medical condition exists;

and (F) "Emergency medical condition" means a condition that manifests itself by acute symptoms of sufficient severityseverity, including severe painpain, such that the absence of immediate medical attention could reasonably be expected to result in serious jeopardy to the individual's health or with respect to a pregnant womanwoman, the health of the unborn child, serious impairment to bodily functions or serious dysfunction of any bodily part or organ.

CS for SB 444 (C) Any potential responsibility of the member for payment for nonemergency services rendered in an emergency facility;

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The purpose of this bill is to clarify that health insurance coverage for emergency services when a prudent layperson acting reasonably would have believed that an emergency medical condition existed includes prehospital screening and stabilization of emergency condition by ambulance service if the patient declines to be transported against medical advice.

Strike-throughs indicate language that would be stricken from a heading or the present law and underscoring indicates new language that would be added.

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