R382-3-2 - Definitions

R382-3-2. Definitions

(1) "CHIP Beneficiary" means a child under the age of 19 who is eligible for the Children's Health Insurance Program under Title XXI of the Social Security Act as adopted in the state under Title 26, Chapter 40.

(2) "Non-emergent medical condition" means a medical condition that does not meet the criteria of an emergency medical condition under 42 U.S.C. 1395 dd(e) of the Emergency Medical Treatment and Active Labor Act.

(3) "Non-emergent medical care" means:

(a) Medical care provided in an emergency room for the treatment of a non-emergent medical condition.

(4) "Non-emergent medical care" does not mean:

(a) Medical services necessary to conduct a medical screening examination to determine if the CHIP beneficiary has an emergent or non-emergent medical condition; and

(b) Medical care provided to a CHIP beneficiary who, using a prudent layperson standard, reasonably believes he is experiencing an "emergency medical condition" as defined by 42 U.S.C. 1395 dd(e) of the Emergency Medical Treatment and Active Labor Act.

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