Utah Administrative Code
Topic - Health
Title R414 - Integrated Healthcare
Rule R414-511 - Medicaid Accountable Care Organization Incentives to Appropriately Use Emergency Room Services
Section R414-511-2 - Definitions
Universal Citation: UT Admin Code R 414-511-2
Current through Bulletin 2024-06, March 15, 2024
(1) "Non-emergent medical condition" means a medical condition that does not meet the criteria of an emergency medical condition under 42 U.S.C. 1395dd (e) of the Emergency Medical Treatment and Active Labor Act.
(2) "Non-emergent medical care" means medical care provided in an emergency room for the treatment of a non-emergent medical condition.
(3) "Non-emergent medical care" does not mean:
(a) medically
necessary services to conduct a medical screening examination to determine
whether the Medicaid member has an emergent or non-emergent medical condition;
and
(b) medical care provided to a
Medicaid member who, using a prudent layperson standard, reasonably believes
they are experiencing an emergency medical condition as defined by
42 U.S.C.
1395dd(e) of the Emergency
Medical Treatment and Active Labor Act.
(4) "Medicaid member" means a person who enrolls in an ACO in accordance with the department's Choice of Health Care Delivery Program freedom-of-choice waiver under Subsection 1915(b) of the Social Security Act.
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