Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.44 - Programs of All-Inclusive Care for the Elderly (PACE)
Section 10.09.44.22 - Payment for Emergency Services
Universal Citation: MD Code Reg 10.09.44.22
Current through Register Vol. 51, No. 19, September 20, 2024
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.
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