Utah Admin. Code R414-511-2 - Definitions
(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.
Notes
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